Current through Register Vol. 48, No. 38, September 20, 2024
a)
Administrative Determination
The Board of Trustees hereby delegates to the SURS
administrative staff the responsibility for the daily claims-processing
function of SURS, including making initial determinations as to all
applications for annuities and benefits, service credit, or any other claims
against or relating to SURS, consistent with the provisions of the Illinois
Pension Code.
b) Review by
Senior Claims Management
Any participant, annuitant or beneficiary adversely affected
by the disposition of a claim by the administrative staff may file a written
request for review by a member of the SURS senior claims management or such
other person as may be designated by the Executive Director. A request for
review by the member of senior claims management must be received within 35
days from the date of the decision from which review is sought. The review will
be based upon all materials contained in the file, as well as any additional
materials the claimant attaches to the written request for review. All filings
or submissions, whether optional or required under this Section, shall be
considered timely if date stamped by SURS within the time prescribed. The
decision reached by senior claims management or the Executive Director's
designee shall be served on the participant, annuitant or beneficiary by
delivery to a third-party commercial carrier or by registered or certified
mail, return receipt requested.
c) Review by the Claims Panel
1) A Claims Panel shall hear all
administrative contested matters. The Panel shall meet periodically as
determined by the Executive Director.
2) Request for Review. Any participant,
annuitant or beneficiary (hereinafter "claimant") adversely affected by the
disposition of a claim by the member of senior claims management or the
Executive Director's designee may request, in writing, a review by the Claims
Panel and, at the same time, a copy of all relevant documents from the
claimant's file. A request for review must be received by the General Counsel
of SURS, or the General Counsel's designee, within 35 days from the date of the
decision from which review is sought.
3) Notice of Hearing. Upon receipt of a
claimant's Request for Review, SURS shall assign the claim a docket number;
schedule the claim for the first available meeting of the Claims Panel; and
notify the claimant, by a Notice of Hearing, that the claimant is required to
file a single Statement of Claim. The Notice of Hearing may be accompanied by
any relevant documentation from the claimant's file.
4) Statement of Claim. The Statement of Claim
must be received by the SURS General Counsel, or the General Counsel's
designee, no later than 35 days from the date of the mailing of the Notice of
Hearing. The Statement of Claim shall include: a formal Appearance, containing
the claimant's name, SURS identification number and address; the name and
address of the claimant's authorized representative, if any; a statement of the
facts forming the basis for the appeal; any documents or other materials the
claimant wishes to be considered in conjunction with the appeal, in addition to
those already contained in the claimant's file; whether the claimant desires a
hearing or whether the claimant desires to waive a hearing and allow the Claims
Panel to reach a decision based upon the Statement of Claim and the relevant
documents in the claimant's file; a list of witnesses, if any, the claimant
intends to present at a hearing; and an explanation of the relief sought. The
Statement of Claim shall not exceed 15 pages in length, unless an exception is
granted by the Claims Panel Hearing Officer. The Hearing Officer may grant a
motion to Strike/Dismiss all or part of the Statement of Claim.
5) Response to Statement of Claim. SURS staff
may submit a Response to the Statement of Claim, which shall also not exceed 15
pages in length, unless an exception is granted by the Claims Panel Hearing
Officer.
6) Notification. The
Notice of Hearing shall also provide a claimant with written notice of:
the date, time and place of the hearing; the subject matter of the
hearing; and relevant procedural and substantive statutory and
regulatory provisions [5 ILCS 100/10-25] . The Notice
shall inform the claimant of an opportunity to provide a statement of the
claimant's position, present oral evidence, and conduct examination and
cross-examination of witnesses as necessary for full and true disclosure of the
facts. Notice shall also be given to the claimant that the claimant is required
to provide written confirmation, at least 14 days prior to the scheduled date
of the hearing, of the claimant's intent to appear at the hearing, whether in
person or by telephone conference call. The claimant is not required to
physically appear at the hearing. The claimant may appear at the hearing by
telephone conference call. The claimant may also choose to affirmatively waive
personal appearance at the hearing. In the absence of the claimant, the Claims
Panel will consider the claimant's Statement of Claim and any documentary
evidence, testimony evidence, argument and any other information properly
presented to the Claims Panel by SURS staff during the scheduled
hearing.
7) Pre-hearing Conference.
Upon request of the General Counsel, the claimant, or upon the decision of the
Hearing Officer, a pre-hearing conference shall be held for the purpose of
simplification or definition of issues or procedures at the hearing.
8) Legal Representation and Other Assistance.
The claimant and SURS may be represented by legal counsel and/or assisted by a
designated family member or spokesperson at the hearing.
9) Burden of Proof. It shall be the burden of
the claimant to establish a right to the benefit claimed, or the right to the
continuation of the benefit claimed in cases of revocation of the benefit by
SURS, by establishing that right by a preponderance of the
evidence.
d) Discovery.
All discovery is at the discretion of the Hearing Officer. Requests to take
discovery must be made in writing to the Hearing Officer with notice to the
other party. Discovery may be taken with the prior permission of the Hearing
Officer only upon good cause shown, that is, if the evidence sought is material
and cannot be obtained in any other way. Failure to comply with orders of the
Hearing Officer may be sanctioned by the Hearing Officer, by means including,
but not limited to, dismissal of a claim.
e) Depositions
1) The Hearing Officer may order the taking
of evidence depositions of a person, specifying the subject matter to be
covered, under oral examination or written questions, for use as evidence at
the hearing, provided:
A) The Hearing Officer
has determined upon request that there is a need to preserve a person's
testimony. The need to preserve a person's testimony shall be determined using
criteria similar to that set forth under Illinois Supreme Court Rule
212(b);
B) The request is made on
motion by a party who gives notice of the motion to the other party;
C) The Hearing Officer has determined that an
evidence deposition containing oral testimony will be necessary to the Claims
Panel in determining the merits of the claim; and
D) The Hearing Officer shall not grant any
request to take the evidence deposition of any SURS trustee, employee, or
consultant working on behalf of SURS. Requests for oral testimony at the
hearing from these individuals must be filed with the Hearing Officer for
determination.
2) The
taking of depositions shall be in accordance with the provisions for taking
depositions in civil cases, and the order for the taking of a deposition may
provide that any deposition exhibits, designated books, papers, documents or
tangible objects that are not privileged shall be produced by the party
requesting the deposition at least 7 days in advance of the scheduled
deposition.
3) Any party to the
hearing shall, during any deposition process, have the right to confront and
cross-examine any witness whose deposition testimony is to be presented to the
Claims Panel.
4) Depositions shall
be taken in the county of residence or employment of the witness, unless the
witness waives that right in writing.
5) Depositions shall be taken at the cost of
the party requesting the deposition. All deposition-related expenses shall be
paid by the party requesting the deposition. The party requesting the
deposition shall pay for and submit an original sealed transcript of the
evidence deposition to SURS in advance of the Claims Panel hearing. The
non-requesting party may order and pay for its own copy of the
transcript.
f) Subpoenas
1) The Hearing Officer may request the
Secretary of the Board to issue a subpoena to compel the attendance of a
witness at an evidence deposition or the production of documents when the
witness has, or the documents contain, relevant evidence. A party may also
request the Hearing Officer to request the Secretary of the Board to issue a
subpoena to compel the attendance of a witness at an evidence deposition or the
production of documents. The request shall either be in writing or on the
record and shall:
A) Identify the witness or
document sought; and
B) State the
facts that will be proven by each witness or document
sought.
2) The Hearing
Officer shall grant or deny the request, either in writing or on the record. If
the request for subpoena is granted, the Hearing Officer shall, if necessary,
reschedule the hearing to a specific date. The request for subpoena shall be
denied if the Hearing Officer finds that the evidence sought is immaterial,
irrelevant or cumulative. If the request for subpoena is denied, the specific
reasons for denial of the request shall be made part of the record on
appeal.
3) If a witness fails to
obey a subpoena, the party seeking enforcement of the subpoena shall prepare an
application to the circuit court of the county in which the subpoenaed witness
resides requesting enforcement of the subpoena, and shall present the
application to the Hearing Officer, at the same time serving a copy of the
application upon the other party. If satisfied that the subpoena was properly
served and that the application is in proper form, the Hearing Officer shall
sign a subpoena to be submitted with the application and the party seeking the
subpoena may then file and prosecute the application in the circuit court, in
the name of the Board. The petitioner in the application shall be styled as
"Name of Petitioner ex rel. Board of Trustees of the State Universities
Retirement System" unless the petitioner is SURS, in which case the petition
shall be brought in the name of the Board. In the event of an application being
filed with the circuit court, the matter shall be continued pending the outcome
of the application to enforce the subpoena.
4) The fees of witnesses for attendance and
travel shall be the same as fees of witnesses before the circuit courts of this
State and shall be paid by the party seeking the subpoena.
g) Conduct of the Hearing
1) Hearing Officer. The hearing shall be
conducted by the Hearing Officer. The Hearing Officer shall be an attorney
licensed to practice law in the State of Illinois and approved by the Board.
Other members of the Claims Panel may, but are not required to, attend the
hearing. Members may attend hearings either in-person or by video or
teleconference.
A) The Hearing Officer shall
have full power to conduct the hearing and the presence of any other members of
the Claims Panel is not required. The Hearing Officer shall be one of the
members of the Claims Panel and shall be chosen by SURS to serve in that
capacity.
B) The Claims Panel shall
consist of:
i) the Executive Director of
SURS;
ii) the Hearing Officer;
and
iii) one other person, selected
by the Chairperson of the Board of Trustees of SURS, who shall be a member of
the Board.
C) Each member
of the Panel shall be reimbursed for travel or other related expenses incurred
in connection with duties as a member of the Panel. The Hearing Officer shall
receive reasonable compensation and reimbursement for travel or other related
expenses incurred per the terms of the contract with SURS.
D) At a minimum, the members of the Claims
Panel shall have a general familiarity with the provisions of the Illinois
Pension Code, this Part and the internal operating procedures of
SURS.
2) Procedures
A) The Hearing Officer shall conduct a full
and fair hearing, receive testimony of the claimant and admit exhibits into
evidence, avoid delay, maintain order and make a sufficient record for a full
and true disclosure of the facts and issues.
B) To accomplish these ends, the Hearing
Officer shall make all procedural and evidentiary rulings necessary for the
conduct of the hearing.
C) All
testimony shall be taken under oath before an officer authorized to administer
oaths by the laws of this State or of the United States or of the place where
the testimony is to be given.
D) As
a general matter, the rules of evidence as applied in civil cases in
the circuit courts of the State of Illinois shall be followed; however,
evidence inadmissible under those rules may be admitted (except where precluded
by statute) if it is of a type commonly relied upon by reasonably prudent
persons in the conduct of their affairs. Any part of the evidence may be
received in written form, provided that the interests of the parties will not
be prejudiced. Notice may be taken of generally recognized technical facts
within SURS' specialized knowledge and SURS'
experience, technical competence and specialized knowledge may be used
in evaluation of the evidence. [5 ILCS
100/10-40]
E) The Hearing Officer, and any member of the
Claims Panel attending the hearing, may ask questions necessary for better
understanding of the facts or law.
F) The Hearing Officer shall have the
authority to impose reasonable time limits for each party to present its case
and shall, in general, have the power to manage and control the hearing
process.
G) The hearing shall be
open to the public and conducted pursuant to the Open Meetings Act [5 ILCS 120
].
3) Record of
Proceedings. The record of proceedings shall be kept in the form of either a
stenographic transcription or an audio recording. The claimant may directly
obtain a stenographic transcription of the hearing from the stenographer or
request a copy of the audio recording of the hearing from SURS by making a
request after the close of the hearing and paying the actual cost charged by
the stenographer for the transcription.
4) Disqualification; Ex Parte Communications
A) Disqualification
i)
A Hearing Officer or
other member of the Claims Panel may be disqualified on grounds of bias
or conflict of interest. A motion to disqualify a Hearing Officer or
other member of the Claims Panel for bias or conflict of interest shall be made
to the Hearing Officer by any party to the hearing within 14 days after the
issuance of the notice of the hearing, with a copy of the motion to be
simultaneously submitted to the SURS General Counsel. The motion shall be
heard, considered and ruled upon by the Hearing Officer at or prior to the
commencement of the hearing. The movant shall have the burden of proof with
respect to the motion to disqualify. An adverse ruling,
familiarity with the facts of the case, non-dispositive involvement in the
staff decision underlying the case, or the fact that a Hearing Officer or other
member of the Claims Panel is a SURS trustee, an employee of SURS or has a
contract with SURS, standing alone, shall not constitute bias or
conflict of interest. [5 ILCS 100/10-30]
ii) The Executive Director may not be called
as a witness unless it is demonstrated that the Executive Director has relevant
noncumulative personal knowledge of facts bearing upon the claim. The Executive
Director may not be disqualified as a member of the Claims Panel on the basis
that the Executive Director is responsible for the overall administration of
SURS.
iii) In the event that any
member of the Claims Panel is disqualified or is otherwise unable to serve, the
Board Chairperson may appoint another qualified person to the Claims Panel. The
Board Chairperson shall appoint another person if the Claims Panel is reduced
to fewer than two members. If the Hearing Officer is disqualified or is
otherwise unable to serve, SURS may retain another duly licensed attorney who
may serve as the Hearing Officer.
B) Ex Parte Communications Prohibited
i)
Except in the disposition of
matters that SURS is authorized by law to entertain or dispose of on an ex
parte basis, the members of the Claims Panel shall not, after receiving notice
of a hearing in a contested matter, communicate, directly or indirectly, in
connection with any issue of fact, with any party, or in connection with any
other issue with any party, or the representative of any party, except upon
notice and opportunity for all parties to participate. However, an employee of
SURS may communicate with other employees of SURS and an employee of SURS or
member of the Claims Panel may have the aid and advice of one or more
assistants. An ex parte communication received by any member of the Claims
Panel shall be made a part of the record of the pending matter, including all
written communications, all written responses to the communications, and a
memorandum stating the substance of all oral communications and all responses
made and the identity of each person from whom the ex parte communication was
received. Communications regarding matters of procedure and practice, such as
the format of pleadings, number of copies required, manner of service, and
status of proceedings, and questions concerning potential conflict of
interest and possible recusal are not considered ex parte
communications. [5 ILCS 100/10-60]
ii) Any documentary evidence, testimony
evidence, argument and any other information properly presented to the Claims
Panel by SURS staff during a scheduled hearing held in the absence of a
claimant who waived the right to participate in the hearing will not be deemed
to be ex parte communications.
5) Decisions of the Claims Panel and
Executive Committee
A) Claims Panel Decisions
i) The record of proceedings shall be
completed upon conclusion of the hearing by the Hearing Officer, unless the
Hearing Officer determines to re-open the proceedings. In compliance with the
Illinois Open Meetings Act, upon conclusion of all evidence and arguments, the
Claims Panel shall deliberate in closed session and make a Decision as to the
disposition of the claim based on the evidence of record when they return to
open session. The Claims Panel Decision shall be served on all parties and
their agents, if any, by delivery to a third-party commercial carrier or by
registered or certified mail, return receipt requested. If a Statement of
Exceptions to the Decision is not filed pursuant to this subsection (g)(5)(A),
the Decision is final for all purposes and not subject to administrative or
judicial review. However, if a Statement of Exceptions to the Decision is filed
or, if the members of the Panel are unable to agree on a Decision, then the
claim shall be presented to the Executive Committee for a final administrative
decision.
ii) If a Statement of
Exceptions is filed by either party, it must be received by SURS, along with a
brief in support, within 21 days after the date of mailing of the Claims Panel
Decision. SURS will pay to procure a copy of the verbatim transcript of the
Claims Panel proceedings. Any responsive brief filed by the opposing party
shall be received by SURS within 21 days after the filing of the Statement of
Exceptions. Any reply brief shall be received by SURS within 14 days after the
filing of the responsive brief. The filing of any responsive or reply brief is
optional. The Executive Director, or The Director's designee, shall provide the
Executive Committee with a copy of the decision of the Claims Panel. The
Executive Committee will make a final administrative decision based on the
Claims Panel Decision, any Statement of Exceptions, and/or briefs properly
filed. All filings shall be served upon the opposing party and shall contain a
certificate of service. Filing deadlines in this subsection (g)(5)(A)(ii) may
be continued to a date certain by the Chairperson of the Executive Committee
for good cause shown on written application filed with SURS prior to the
expiration of the deadline sought to be continued.
iii) If the claim is presented to the
Executive Committee because the members of the Claims Panel are unable to agree
on a Decision, the Executive Committee shall make a final administrative
decision based on the written record, the verbatim transcription of the
proceedings, and any briefs properly filed with the Claims Panel by the
parties. SURS will pay to procure a copy of the verbatim transcript of the
Claims Panel proceedings.
B) Executive Committee Decision
i) When necessary pursuant to subsection
(g)(5)(A), the Executive Committee of the Board shall make a decision on the
claim. No oral argument shall be permitted before the Executive
Committee.
ii) The Executive
Committee shall render one of the following decisions with respect to the
claim: affirmance of the administrative action, reversal of the administrative
action, or remand of the case to the administrative staff for further
investigation and/or consideration. Remand of the case to the administrative
staff shall not be considered a final decision of the Executive Committee. A
decision by the Executive Committee either reversing or affirming the decision
of the administrative staff shall constitute a final decision for the purpose
of review under the Administrative Review Law [735 ILCS 5/Art. III ]. A
final decision of the Executive Committee shall be in writing or stated in the
record.
iii) The Executive
Committee may adopt, as its own, the findings of fact and conclusions of law of
the Claims Panel. Findings of fact, if set forth in statutory language,
shall be accompanied by a concise and explicit statement of the underlying
facts supporting the findings.
iv)
All decisions of the Executive
Committee shall specify whether they are final and subject to the
Administrative Review Law. [5 ILCS
100/10-50]
v) Parties and their agents, if any, shall be
notified by sending the decision of the Executive Committee via a third-party
commercial carrier, or by registered or certified mail, return receipt
requested. The date of mailing of the decision shall constitute the date of
service for purposes of the Administrative Review Law or any other applicable
law.