Illinois Administrative Code
Title 29 - EMERGENCY SERVICES, DISASTERS, AND CIVIL DEFENSE
Part 301 - POLITICAL SUBDIVISION EMERGENCY SERVICES AND DISASTER AGENCIES
Subpart F - WORKERS' COMPENSATION ACT AND WORKERS' OCCUPATIONAL DISEASES ACT COVERAGE FOR VOLUNTEERS
Section 301.630 - Procedures for Filing A Claim
Universal Citation: 29 IL Admin Code ยง 301.630
Current through Register Vol. 48, No. 38, September 20, 2024
a) To file a claim for a volunteer under the Workers' Compensation Act or the Workers' Occupational Diseases Act, the accredited ESDA that appointed and enrolled the volunteer shall submit to IEMA, in a timely manner, all of the following:
1) Evidence that the notification
or pre-approval requirements of Section
301.620(e)
have been satisfied for the disaster response, disaster exercise, training, or
search-and-rescue team response;
2)
Information provided by the volunteer including:
A) Evidence of immediate notification to the
volunteer's supervisor of the disease or injury;
B) Evidence that the volunteer, or a
supervisor in the event the volunteer is seriously injured or incapacitated,
contacted the early intervention partner prescribed by the Illinois Department
of Central Management Services (CMS) at 800-773-3221 immediately after
suffering the disease or injury;
C)
Completed documentation on the forms prescribed by CMS (available at
http://www2.illinois.gov/cms/Employees/benefits /rm/Pages
/WorkersCompensation.aspx), including, but not limited to:
i) The Employee's Notice of Injury;
ii) The Initial Workers' Compensation Medical
Report;
iii) An Information Release
Authorization; and
iv) The Demands
of the Job;
3)
A Workers Compensation Coverage Request, on a form prescribed by IEMA,
submitted by the ESDA coordinator;
4) A copy of the sworn oath taken by the
volunteer in accordance with Section 20 of the Act, signed and dated by the
volunteer;
5) A Supervisor's Report
of Injury or Illness, on a form prescribed by CMS that may be found on the CMS
website; and
6) The Workers'
Compensation Witness Report, on a form prescribed by CMS that may be found on
the CMS website.
b) Completed claims shall be forwarded to CMS for compensation determinations in accordance with requirements of the Workers' Compensation Act and the Workers' Occupational Diseases Act.
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