Ill. Admin. Code tit. 29 § 301.630

Current through Register Vol. 48, No. 45, November 8, 2024

Section 301.630 - Procedures for Filing A Claim

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.

Ill. Admin. Code tit. 29, § 301.630

Amended at 42 Ill. Reg. 15933, effective 7/31/2018