[Adopted 1-14-2019 by Ord. No. 2019-01]
A. 
Purpose.
(1) 
The purpose of this article is to provide a fair and efficient method of determining the eligibility of an employee for the continuation of health insurance coverage as provided under the Public Safety Employee Benefits Act[1] ("PSEBA" or the "Act") through an administrative process, including if necessary, an administrative or evidentiary hearing.
[1]
Editor's Note: See 820 ILCS 320/1 et seq.
(2) 
All benefits provided to employees pursuant to PSEBA will be consistent with PSEBA, including the requirement that PSEBA benefits are only available when the applicant has existing coverage under a Village health insurance plan at the time of the applicant's PSEBA application, as well as at the time that the applicant is found to be eligible for PSEBA benefits. Additionally, PSEBA benefits shall be limited to paying the entire premium for the Village's basic health insurance plan. For purposes of this article, the term "basic health insurance plan" means the health insurance plan available to Village public safety employees with the lowest monthly premium. Any description in this article of the benefits available under PSEBA shall be limited to paying the premium for the Village's basic health insurance plan.
B. 
Application procedure.
(1) 
In order to seek benefits under PSEBA, public safety employees or family members of an injured or deceased public safety officer in the event the employee is not capable of taking this action ("applicant") must file with the Village Manager a full and complete written PSEBA application as further described in this section within 30 calendar days of filing a disability pension claim, or within 30 calendar days of the date of the adoption of this article in the event that an applicant has filed for a disability pension claim prior to the date of the adoption of this article, whichever is later. Failure to timely file the full and complete application with the Village Manager shall result in a forfeiture of the benefits under PSEBA. Upon request, the village shall furnish a Public Safety Employee Benefit Act application (the "application form") to the applicant.
(2) 
Any applicant seeking benefits under the Act shall complete the application form provided by the Village, and shall, pursuant to the Act, include the applicant's or family member's firsthand knowledge explaining how the disability injury/death directly resulted from the public safety employee's:
(a) 
Response to fresh pursuit;
(b) 
Response to what was reasonably believed to be an emergency;
(c) 
Response to an unlawful act perpetrated by another; or
(d) 
Participation during the investigation of a criminal act.
(3) 
The application form must be sworn and notarized to certify the truthfulness of the content of the information contained in the application form and the additional information required for a completed application, including without limitation a signed PSEBA medical authorization release, and a signed PSEBA general information release. Both the PSEBA medical and PSEBA general information releases authorize the collection of information related to the incident, including without limitation the disability pension proceedings, worker's compensation records, and medical records. A review of the application will not occur until all elements of the application are complete, including the medical releases.
(4) 
The complete application must include the name of the public safety employee, date of hire, detailed information regarding the incident, (including date, time, place, nature of injury, any other factual circumstances surrounding said incident giving rise to said claim), witnesses to the incident, witnesses the applicant intends to call at any PSEBA hearing, information and supporting pension documentation filed in connection with a disability pension request and any determination or ruling on such request, information supporting the PSEBA eligibility requirements, including a statement that the applicant has existing coverage under the Village's health insurance plan at the time of the applicant's PSEBA application, a signed PSEBA medical authorization release, a PSEBA general information release authorizing the collection of information as set forth in § 67-18B(3) above, and if applicable, other sources of health insurance benefits currently enrolled in or received by the employee and/or family members if the employee is deceased.
(5) 
The PSEBA medical information release must specify name and address information for pertinent health care provider(s) and hospital(s), along with the employee's and/or his/her authorized representative's signature and witness signature.
(6) 
The PSEBA general information release must specify name and signature of the employee or his/her authorized representative, along with legal proof of said representation along with name and signature of witness authorizing the collection of information pertinent to the incident review process.
(7) 
On the date that the Village receives a complete application, which will include a completed application form, PSEBA medical release, PSEBA general information release, and all other supplemental information supporting the application, the Village shall issue the applicant a receipt, and the application shall then be submitted to the Village Manager, as the preliminary administrative record; a copy of the same shall be date stamped and provided to the applicant.
(8) 
Upon receipt of a complete application for PSEBA benefits timely filed, the Village Manager shall review the application and supporting documents to make a determination (subject to final approval of the Board of Trustees) as follows:
(a) 
Grant or deny benefits based upon the facts on the application as it stands;
(b) 
Set matter for a final administrative hearing before a hearing officer to make a determination based on the result of an administrative hearing;
(c) 
Set matter for an evidentiary hearing before a hearing officer to make a recommendation to the Board of Trustees based on the result of an evidentiary hearing. Following receipt of the recommendation of the hearing officer, the board of trustees shall render a determination rewarding the applicant's eligibility for benefits under PSEBA;
(d) 
Enter such other finding as is consistent with the evidence or by agreement of the applicant and the Village.
(9) 
If the Board of Trustees grants the benefit based on the preliminary record as it stands, the applicant will be contacted by the Village within 30 days of the decision. The applicant will be required to contact the finance director for benefit explanation and processing.
(10) 
If the Board of Trustees determines the matter requires a final administrative or evidentiary hearing, the applicant will be given written notice of such decision along with a date for the scheduled hearing.
(11) 
If the applicant, upon receiving written notice of the date for a final administrative hearing or an evidentiary hearing, cannot attend said date as indicated in the notice of such hearing, the applicant must contact the hearing officer within seven days after being served with notice of the hearing, communicating alternative hearing date(s) which are within close proximity of the original date indicated by the hearing officer. Failure to appear may result in denial of benefits.
(12) 
If the Board of Trustees denies the benefit based on the preliminary record as it stands, the applicant will receive written notice of such denial.
(a) 
The applicant shall have the right to request an evidentiary hearing, which must be served in writing to the Village Manager not later than 30 calendar days after being served with written notice of the denial. Upon receipt of a timely notice from the applicant, the Village Manager shall schedule the evidentiary hearing and serve the applicant with notice of such hearing.
(b) 
If the applicant, upon receiving written notice of denial, chooses not to request an evidentiary hearing, the applicant will be required to contact the finance director to discuss other options in which the applicant may be eligible to participate.
C. 
Administrative composition. A final administrative hearing or an evidentiary hearing under this § 67-18 shall be scheduled, which hearing shall be conducted by a hearing officer whose power and authority and limitations are as follows:
(1) 
Power of the hearing officer. The hearing officer shall have all of the powers granted to him or her under common law relative to the conduct of a final administrative hearing or an evidentiary hearing, including the power to:
(a) 
Preside over all Village hearings involving PSEBA;
(b) 
Administer oaths;
(c) 
Hear testimony and accept evidence that is relevant to the issue of eligibility under PSEBA;
(d) 
Issue subpoenas to secure attendance of witnesses and the production of relevant papers or documents upon the request of the parties or their representatives;
(e) 
Rule upon objections in the admissibility of evidence;
(f) 
Preserve and authenticate the record of the hearing and all exhibits in evidence introduced at the hearing;
(g) 
Issue a determination (in the case of a final administrative hearing) or a recommendation (in the event of an evidentiary hearing) based on the evidence presented at the hearing, which determination or recommendation shall be in writing and shall include either a written finding of fact, decision and order or a recommended finding of fact, decision and order.
(2) 
Hearing officer. The Village President with the consent of the Board of Trustees is hereby authorized to appoint a person to hold the position of a hearing officer for each and every individual hearing that shall come before this Village. In making said selection, the Village President shall consider all pertinent information including, at a minimum:
(a) 
The candidate's ability to comply with the job description as set forth herein;
(b) 
Background and performance data made available to the Village President on file with the Village or otherwise obtained by the Village;
(c) 
The candidate must be an attorney licensed to practice law in the State of Illinois for at least three years and have knowledge of and experience in employment and labor law, general civil procedure, the rules of evidence, and administrative practice.
D. 
Procedure. An administrative or evidentiary hearing shall be initiated either by the Board of Trustees or by an applicant as described in more detail in § 67-18B, but only after the submission of a full and complete PSEBA application.
E. 
Administrative and evidentiary hearings. A final administrative hearing shall be held to adjudicate and determine whether the applicant is eligible for benefits under PSEBA. An evidentiary hearing shall be held to ascertain facts and formulate a recommendation to the Board of Trustees whether the applicant is eligible for benefits under PSEBA. If the applicant is ultimately found eligible, the benefits shall be consistent with the Act.
(1) 
Time and date. Hearings shall be held on the date, time and place as established by the Village with appropriate notice served upon the applicant.
(2) 
Record. The applicant, at applicant's expense, shall ensure that all hearings shall be attended by a certified court reporter and a transcript of all proceedings shall be made by said certified court reporter and a copy be provided to the Village at applicant's expense within 14 days of the date of the hearing.
(3) 
Procedures. The Village and the applicant shall be entitled to representation by counsel at said hearing and may present witnesses, may present testimony and documents, may cross-examine opposing witnesses, and may request the issuance of subpoenas to compel the appearance of relevant witnesses or the production of relevant documents. Each party shall bear the costs of its own counsel and witnesses.
(4) 
Evidence. The rules of evidence as set forth in the Illinois Code of Evidence shall apply.
(5) 
Final determination; recommendation.
(a) 
For each final administrative hearing, the determination by the hearing officer of whether the petitioning applicant is eligible for the benefits under the Public Safety Employee Benefits Act (820 ILCS 320/1 et seq.) shall constitute a final administrative determination for the purpose of judicial review under the common law writ of certiorari.
(b) 
For each evidentiary hearing, the determination of the Board of Trustees (after receiving the recommendation of the hearing officer) of whether the petitioning applicant is eligible for the benefits under the Public Safety Employee Benefits Act (820 ILCS 320/1 et seq.) shall constitute a final administrative determination for the purpose of judicial review under the common law writ of certiorari.
(6) 
Burden of proof. At any hearing under this § 67-18, the applicant shall have the obligation and burden of proof to establish that the applicant is qualified to receive the benefits.
(7) 
Administrative records. All records pertaining to the administrative process will be held in a separate file in the employee's name within the management services department of the Village.