Non-Disability Appeal Procedures (including non-medical disability claims)

I. Administrative Staff Determination

1. Staff Determination The IMRF administrative staff is responsible for the daily claims-processing function of the Fund, including processing of all claims for benefits or service credit or any other claims against or relating to the Fund.
   
   
2. Benefit Oversight Committee The purpose of the Committee is to review all requests for hearing on non-disability claims before the Benefit Review Committee or the Administrative Hearing Officer. The Committee shall determine whether such hearing requests are appropriate and ready for a hearing before the Benefit Review Committee or the Administrative Hearing Officer. The Committee shall be composed of the Executive Director, the Customer Service Director, the General Counsel, the Disability Manager, and the Benefits Manager.

II. Hearing

1. Petition Any person or employer adversely affected by an administrative staff determination not involving a disability claim (medical) may petition for a hearing. The petition must be in writing but may be in any format and need merely inform the Fund of the petitioner’s desire for a hearing. The petition should be directed to the Associate General Counsel in the IMRF Oak Brook office and must be received by IMRF no later than sixty-three (63) days after the date of the administrative staff determination letter. Failure to timely file an appeal petition shall result in the administrative staff determination becoming a final administrative decision, for purposes of the Administrative Review Law, on the sixty-fourth (64th) day after the date of the staff determination letter.
2. Acknowledgment of Petition; Statement of Claim Upon the filing of a petition for a hearing, the Associate General Counsel shall send an acknowledgment of the petition informing the claimant that he/she is required to file a Statement of Claim within ninety-one (91) days of the date of the appeal acknowledgement letter. On any acknowledgement of a petition by an appealing party, the Associate General Counsel shall copy any other interested party who may be impacted by the appeal. The Statement of Claim shall include:
• the petitioner’s name, MID or employer number, and address
• the name and address of the petitioner’s authorized representative, if any
• a statement of the facts forming the basis for the appeal, which may include any new or additional evidence
• any documents or other materials the petitioner wishes to be considered in conjunction with the appeal
• an explanation of the relief sought

The Statement of Claim shall be limited to 20 pages, excluding exhibits. The Statement of Claim and any exhibits shall be filed electronically with the Associate General Counsel. If the claimant is unable to submit an electronic copy of the materials, hard copies may be mailed to IMRF’s Oak Brook office, to the attention of the Associate General Counsel. The Statement of Claim shall be signed, physically or electronically, by the claimant or the claimant’s attorney. Statement of Claims which are submitted electronically through the claimant’s own Member or Employer Portal shall be considered to have met the signature requirement.

In the event that a petitioner fails to submit a Statement of Claim, for matters heard by the Administrative Hearing Officer, consideration of the appeal will be based solely upon the written materials that are already in the IMRF file on the due date for the Statement of Claim, and will be decided without hearing. For matters heard by the Benefit Review Committee, the appeal will be considered at the first available hearing date occurring after the expiration of ninety-one (91) days from the date of the appeal acknowledgement letter.

If an interested party who is impacted by the staff determination wishes to file their own Statement of Claim following the acknowledgement of appeal, the interested party’s Statement of Claim is subject to the same requirements as a Statement of Claim filed by the petitioner, including that it must be filed with the Associate General Counsel within ninety-one (91) days of the date of the appeal acknowledgement letter, unless the petitioner’s Statement of Claim has been received and the Associate General Counsel schedules the appeal for hearing.

3. Presiding Authority An Administrative Hearing Officer will hear appeals of staff decisions except for those decisions which are heard by the Board of Trustees Benefit Review Committee as described in this section below. The hearing officer will be an independent attorney licensed to practice law in Illinois, designated by the Board of Trustees.
   
   The Board of Trustees Benefit Review Committee will hear appeals of staff decisions regarding the following:
   
   • Benefit calculation errors and resulting benefit recoupment
   • Annuitant return to work issues (non-ERI related)
     
     
4. Scheduling of Hearing Upon receipt of the petitioner’s Statement of Claim, the claim shall be assigned to a hearing date within a reasonable time as determined by the Associate General Counsel. However, if the Statement of Claim reveals that the appeal only concerns legal, as opposed to factual issues, or if no Statement of Claim is filed and it appears from the staff determination that the appeal only concerns legal, as opposed to factual issues, a formal hearing will not be held, and the Benefit Review Committee or Administrative Hearing Officer, as appropriate, will decide the appeal based solely upon the written record.
5. Notification Upon scheduling of a hearing, a petitioner shall be provided with written notice of the date and place of the hearing and the subject matter of the hearing. The petitioner or his/her representative will be provided with all documentation and other materials to be presented at the hearing by the administrative staff. Whenever practicable, the notice and the documentation will be provided to the petitioner electronically. An interested party, who was provided notice of the appeal, will also be notified of the date and place of the hearing and its subject matter.
6. Continuances and Extensions of Time Continuances of the hearing date and other extensions of time may be granted to the petitioner upon request, if received more than 14 days before the scheduled hearing date.
   An appeal will normally be considered at the first available hearing date after the receipt of the petitioner's Statement of Claim, however the Associate General Counsel may reasonably postpone the scheduling of a hearing at his or her discretion.
   Absent extraordinary circumstances, no more than one continuance or extension shall be granted.
7. Late Submissions Any documents or other materials that are submitted in addition to a Statement of Claim must be received by IMRF no later than twenty (20) days prior to the scheduled hearing date. In the event that the Associate General Counsel schedules a hearing prior to the ninety-one (91) day deadline for any interested party to submit a Statement of Claim, the interested party must submit any documents it wishes to be considered no later than twenty (20) days prior to the scheduled hearing date. Any additional materials received less than twenty (20) days before the hearing date will be considered a late submission. Whenever a petitioner makes a late submission, the petitioner will be offered the following alternatives:
   
   • The petitioner can proceed with the hearing as scheduled; however, the late submission will only be considered at the discretion of the Administrative Hearing Officer or the Benefit Review Committee.
   • The petitioner 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 twenty (20) days of the re-scheduled hearing date will only be considered at the discretion of the Administrative Hearing Officer or the Benefit Review Committee.
8. Failure to Appear In the event that a petitioner fails to appear on the scheduled hearing date, the consideration of the appeal will be based solely upon the written materials that are already in the IMRF file. At the request of the Administrative Hearing Officer or the Benefit Review Committee, the Associate General Counsel may present a case on behalf of the IMRF administrative staff position.
9. Representation The petitioner may be represented by counsel or a designated spokesperson at the hearing. The Associate General Counsel or his/her designated representative shall present the IMRF administrative staff position.
10. Conduct of the Hearing
    
    • Appearance The petitioner is not required to personally appear at the hearing and may be represented solely by the Statement of Claim on file. In the alternative, at the petitioner’s discretion, the petitioner or his/her representative may appear in person or the hearing may be conducted via telephone or video conference. An interested party, or their designated representative, may also appear at the hearing.
    • Procedures The Chairman of the Benefit Review Committee or the Administrative Hearing Officer 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. The hearing shall be informal and the rules of evidence shall not apply. The petitioner shall be limited to no more than 30 minutes to present their appeal. An interested party who has submitted a Statement of Claim may present their appeal subject to the 30 minute time limit only if the interested party has set forth a basis of appeal in its Statement of Claim that is different from that of the petitioner, as determined by the Administrative Hearing Officer or Benefit Review Committee.
      
      
11. Record of Proceedings A record of proceedings shall be kept which shall be in the form of a non-verbatim summary report. The petitioner or other interested party may obtain a verbatim record of the hearing by arranging for a court reporter. The petitioner or other interested party is responsible for paying the actual costs entailed. The Associate General Counsel shall be the custodian of the documents and the record of proceedings.
12. Determination (Benefit Review Committee) Upon conclusion of all evidence and arguments, the Benefit Review Committee shall deliberate and make its decision as to the disposition of the claim. The vote of at least a majority of the committee shall be required for any decision of the Benefit Review Committee.
13. Determination (Administrative Hearing Officer) Upon conclusion of all evidence and arguments, the Administrative Hearing Officer shall prepare written findings of fact and conclusions of law to support a recommendation to the Board of Trustees. That recommendation shall be:

III. Board of Trustees Benefit Review Committee

1. Recommendation of the Board of Trustees Benefit Review Committee When the Board of Trustees Benefit Review Committee does not act as hearing officer, the Committee will consider the recommendation of the Administrative Hearing Officer. The Benefit Review Committee shall review the recommendation of the Administrative Hearing Officer, and may, at the discretion of the Committee, question the Administrative Hearing Officer about his or her recommendation. The Benefit Review Committee shall then render one of the following recommendations to the full Board of Trustees:
• Affirmance of the administrative staff determination
• Reversal of the administrative staff determination
• Request the development of an alternative resolution.

Meetings of the Benefit Review Committee 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. A quorum of the Committee is needed in order to make a recommendation to the full Board of Trustees.

IV. Final Administrative Decision

1. Decision of the 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. 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
• Request the development of an alternative resolution.

The Board of Trustees will normally consider an appeal at the first available meeting following receipt of the recommendation or, if the appeal only concerns legal, as opposed to factual issues, after expiration of the aforementioned ninety-one (91) day period.

2. 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 Hearing Officer by the Board of Trustees shall not be considered a final decision, nor shall requesting the development of an alternative resolution be considered a final decision.
3. Remand In the case of a remand of the proceedings to the Administrative Hearing Officer or the Benefit Review Committee, the Administrative Hearing Officer or the Benefit Review Committee shall present the requested information to the full Board of Trustees at the next regularly scheduled meeting, and the Board of Trustees shall make its final administrative decision.
4. Notice of Decision IMRF Staff shall send written notice of the decision of the Board of Trustees to the petitioner and, if applicable, the petitioner’s representative. In any case where an interested party is impacted by the decision, IMRF Staff shall also send written notice of the decision of the Board of Trustees to that interested party and its representative.