Staff Determination. The IMRF administrative staff is responsible
for the daily claims-processing function of the Fund, including processing
of all claims for disability benefits.
II. Hearing.
Petition.
Any person adversely affected by the disposition of a disability claim
by the administrative staff may petition for a hearing before the Board
of Trustees Benefit Review Committee. The petition must be in writing
on a Form 5.70 "Request For A Hearing". A copy of this form
is sent to the member at the time staff denies or terminates disability
benefits. The completed 5.70 form should be returned to the Benefits
Manager in the IMRF Oak Brook office and must be received by IMRF no
later than sixty-three (63) days after the date of the staff disposition
letter.
Failure to timely file a 5.70 form shall result in the staff disposition
becoming a final administrative decision, for purposes of the Administrative
Review Law, on the sixty-fourth (64th) dayafter the date of
the staff disposition letter.
Acknowledgment
of Request for a Hearing. Upon the filing of the Request For A
Hearing, the Benefits Manager shall send an acknowledgment of the Request.
Scheduling
of Hearing. Upon receipt of the Request For Hearing, the Benefits
Manager will schedule the hearing as follows:
If the Hearing Request indicates that additional medical information
WILL NOT be submitted for consideration, the hearing will be scheduled
for the next available meeting of the Board of Trustees Benefit Review
Committee.
If the Hearing Request indicates that additional medical information
WILL be submitted for consideration, the hearing will be scheduled for
the next available meeting of the Board of Trustees Benefit Review Committee
following the review of the additional medical information.
Additionally, if the appeal only concerns a legal, as opposed to factual
issues, or if the "Statement of Claim" portion of the 5.70 form is
not completed and it appears from the staff determination that the
appeal only concerns legal, as opposed to factual issues, a formal
hearing before the Benefit Review Committee will not be held, and the
Board of Trustees will decide the appeal based solely upon the written
record. In that case, the Board of Trustees will decide the appeal
via Board Schedule H.
Notification.
Upon scheduling of a hearing before the Benefit Review Committee, a
petitioner shall be provided with written notice of the date, time and
place of the hearing. Due to the volume of medical records, the petitioner
will not routinely be provided with all of the documentation and other
materials to be presented to the Benefit Review Committee by the administrative
staff. However, copies of any or all of those materials will be provided
to the petitioner or his/her representative upon request.
Continuances
and Extensions of Time. Continuances of the hearing date and other
extensions of time may be granted to the petitioner upon request. The
Benefit Review Committee will normally consider an appeal at the first
available meeting after the receipt of the petitioner's medical information.
If the petitioner does not submit additional medical information within
ninety-one (91) days from the receipt by IMRF of the Request for a Hearing
Form 5.70, the Benefit Review Committee will consider the appeal at
the first available meeting after the expiration of the foregoing ninety-one
(91) day period.
Additional medical information or other materials must be received
by IMRF no later than ten (10) days prior to the scheduled hearing
date. Any additional materials received less than ten (10) days before
the hearing date will be considered a “late submission”.
Whenever a claimant makes a “late submission”, the Benefit
Review Committee will offer the member the following alternatives:
The member can proceed with the hearing as scheduled; however,
the Benefit Review Committee WILL NOT consider the “late submission”;
or
The member can request, and receive, a postponement of the hearing
until the earliest available future date in order to allow for consideration
of the “late submission”.
If a hearing is postponed in order to allow for consideration of
the “late submission”, any additional materials submitted
within ten (10) days of the re-scheduled hearing date WILL NOT be
considered by the Benefit Review Committee or by the full Board
of Trustees.
In the event that a petitioner fails to appear on the scheduled
hearing date, the Benefit Review Committee’s consideration
of the appeal will be based solely upon the written materials that
are already in the IMRF file and no hearing will be held.
Representation.
The petitioner may be represented by counsel or a designated spokesperson
at the hearing. The Benefits Manager or his/her designated representative
shall present the IMRF administrative staff position.
Conduct of
the Hearing.
Appearance.
The petitioner is not required to personally appear at the hearing
and may be represented solely by the medical records and related
documentation on file with IMRF. In the alternative, at the
petitioner’s
discretion, the petitioner or his representative may appear in
person, or the hearing may be conducted via telephone or video
conference.
Procedures. The Chairman of the Benefit
Review Committee shall conduct a full and fair hearing, maintain
order and make a sufficient record for a full and true disclosure
of the facts and issues. Three members of the Benefit Review Committee
shall constitute a quorum and a quorum is needed for all hearings.
The hearing shall be informal and the rules of evidence shall not
apply. Any part of the evidence may be received in written form.
The Committee shall be provided with a copy of the Statement of
Claim, a statement of the position of the administrative staff,
which shall include the administrative staff determination, and
such other documentation (medical records, etc.) as is available.
Members of the Benefit Review Committee may ask questions necessary
for better understanding of the facts or law.
The hearing shall be open to the public unless the chair, for good
cause shown, and pursuant to the applicable provisions of the
Open Meetings Act, shall determine otherwise. An IMRF employer
(participating municipality or participating instrumentality)
may provide written materials to IMRF staff for incorporation
into the packet submitted to the Benefit Review Committee and
the full Board of Trustees.
An employer may also attend hearings of the Benefit Review Committee
and meetings of the full Board of Trustees and can make audio
recordings of said hearings and meetings. An employer also has
standing to, in a separate proceeding, contest a rate increase
that might be assessed due to a decision of the Benefit Review
Committee and the full Board of Trustees. However, an employer
normally does not have standing to actively participate in an individual’s
appeal of an administrative staff determination.
Record of Proceedings. A record of proceedings
shall be kept which shall be in the form of a non-verbatim summary
report. The petitioner may obtain a verbatim record of the hearing
taken by a court reporter by making a timely request and paying
the actual cost entailed. The Benefits Manager shall be the custodian
of the documents and the record of proceedings.
Determination.
Upon conclusion of all evidence and arguments, the Benefit Review
Committee shall, in private deliberation, make its decision
as to the disposition of the claim. The vote of at least a majority
of a quorum shall be required for any decision of the Benefit
Review Committee. The Benefit Review Committee shall render
one of the following recommendations to the full
Board of Trustees:
affirmance of the administrative staff determination, reversal
of the administrative staff determination, remand of the proceedings
to the administrative staff for further investigation, or, in
the case of deadlock, continuation of the claim for consideration
by the full Board of Trustees. The decision shall be in the form
of a recommendation to the full Board of Trustees. Where an appeal
is to be decided via Schedule H, any one member of the Committee
can request that the matter be removed from said Schedule and
placed on a future Committee agenda for hearing and recommendation.
III. Final Administrative Decision.
Decision of Full Board of Trustees. The full Board of Trustees
will consider the recommendation of the Benefit Review Committee in
making the decision for the Fund as to the disposition of the appeal.
The Board will also decide appeals in which a formal hearing has not
been held before the Benefit Review Committee. At least five (5) affirmative
votes shall be required for any decision of the Board of Trustees.
The Board of Trustees shall render one of the following decisions: affirmance
of the administrative staff determination, reversal of the administrative
staff determination, or remand of the proceedings to the administrative
staff for further investigation. The Board of Trustees will normally
consider an appeal following receipt of the Benefit Review Committee's
recommendation, or if the appeal concerns legal, as opposed to factual
issues, after the expiration of the aforementioned ninety-one (91) day
period.
Final
Administrative Decision. A decision of the Board of Trustees either
affirming or reversing the determination of the administrative staff
shall be a final administrative decision for purposes of review under
the Illinois Administrative Review Act (735 ILCS 5/3-101 et seq.) Remand
of the proceedings to the administrative staff by the Board of Trustees
shall not be considered a final decision.
Remand
for Further Investigation. In the case of a remand of the proceedings
to the administrative staff for further investigation, the administrative
staff, upon completion of the directed investigation, shall present
its recommendation to the full Board of Trustees at the next regularly
scheduled meeting, and the Board of Trustees shall make a final administrative
decision either affirming or reversing that recommendation.
Notice
of Decision. The Benefits Manager shall send written notice of
the decision of the Board of Trustees to the petitioner and, if applicable,
the petitioner’s representative.
IMRF Online provides
a brief summary of IMRF benefits and the adminstration of those benefits.
IMRF members'
and employers' rights and obligations are governed by
Article
7
of the Illinois Pension Code.
Statements in these publications are general,
and the Illinois state law governing IMRF is complex and specific.
If a
conflict arises between information in these publications and the law, all
decisions are based on the law.