§ 16-241. Claims procedures before the board decision.  

Latest version.
  • (a) Claims of affected persons.

    (1) The board shall grant an initial hearing upon receipt of a written request ("claim"), on matters which affect the substantial rights of any person ("claimant"), including members, retirees, beneficiaries, or any person affected by a decision of the board.

    (2) The board shall review the claim at an initial hearing and enter an order within ninety (90) days from the date of receipt of the claim. The board may extend the time for entering the order at an initial hearing for an additional ninety (90) days if it determines such time is necessary for full discovery and adequate review. the chairman of the board or general counsel and the claimant may stipulate to further extensions of time.

    (3) The claimant shall have the right to be represented by counsel at any or all times throughout the claims procedure.

    (b) Initial hearing.

    (1) At the initial hearing, the only evidence to be considered by the board shall be documentary evidence contained in his employment and pension file, including but not limited to, correspondence, medical records and reports of treating physicians and/or examining physicians, and evidence received pursuant to paragraph (2) below.

    (2) Other than questions from the trustees, there will be no taking of additional evidence at the initial hearing, except that the claimant will be afforded five (5) minutes to make a presentation, which shall be limited to comments and/or arguments as to the evidence or information already contained in the pension file, including the report of the examining physician.

    (3) Upon completion of the review of the claim at the initial hearing, the board shall enter an order setting forth its findings and conclusions on the claim. The written order shall be provided to the claimant. The order shall include:

    a. The specific findings and conclusions of the board, including specific references to pertinent provisions of the plan on which such conclusions are based;

    b. A description of any additional material or information that the board may deem necessary for the claimant to perfect his or her claim, together with the reasons why such material or information is necessary; and

    c. An explanation of the right to a full hearing on the claim and the time limit in which a full hearing must be requested in writing.

    (4) The decision of the board at the initial hearing shall not be final until after the time has expired to request a full hearing or, if a full hearing is requested, until the board makes a decision at the conclusion of the full hearing.

    (c) Full hearing.

    (1) Any claimant may request a full hearing on the issues presented to the board at an initial hearing and upon which the board has entered an order as provided in subsection (b)(3) above.

    (2) A full hearing must be requested by the claimant within ninety (90) days of the receipt of the board's order. The order will be deemed received three (3) days following the date it is mailed to claimant at the address provided to the board by claimant.

    (3) Upon receipt of the request for a full hearing and considering the amount of discovery which might be conducted, the board shall establish a date for full hearing and cause notice to be given to the claimant. The full hearing shall be held within ninety (90) days from the receipt of the request from the claimant. The full hearing may be postponed, if necessary and with the consent of the claimant, to permit full discovery of the facts.

    (4) Copies of all documents to be offered into evidence at the full hearing, including depositions, and a complete witness list with names and addresses of witnesses expected to be called, shall be furnished to the board and the general counsel by the claimant at least twenty (20) days prior to the full hearing. Documents not furnished to the board within the prescribed time limit may be excluded from evidence at the full hearing if a reasonable explanation is not provided for the delay in providing the documents.

    (5) The claimant shall be responsible for the appearance of any witnesses which he or she wishes to have testify at the hearing.

    (6) Testimony at the full hearing may be submitted in the form of a deposition. Depositions timely submitted will be part of the record before the board at the full hearing and will not be read in totality at the full hearing; provided however, that this does not preclude the claimant or the general counsel from reading parts of depositions in an opening or closing statement.

    (7) Irrelevant and unduly repetitious evidence shall be excluded.

    (8) Any person who knowingly gives false testimony is guilty of a misdemeanor of the first degree, punishable as provided in F.S. § 775.082 or 775.083.

    (9) The file maintained by the board is part of the record before the board at the full hearing.

    (10) All proceedings of the board shall be conducted in public.

    (11) In cases concerning an application for pension benefits, the burden of proof, except as otherwise provided by law, shall be on the claimant seeking to show entitlement to such benefits.

    (12) In cases concerning termination of pension benefits, the burden of proof shall be on the board.

    (13) Except as to those records which are exempted from the provisions of F.S. ch. 119, Florida's Public Record Law, records maintained by the board are open for inspection and/or copying during normal business hours at a reasonable cost for copying.

    (14) Should a claimant requesting an initial or full hearing decide to appeal any decision made by the board, with respect to any matter considered at such hearing, the claimant requesting an initial or full hearing will need a record of the proceedings and may need to assure that a verbatim record of the proceeding is made. The claimant requesting an initial or full hearing will be responsible for obtaining a court reporter or otherwise making a record of the proceedings before the board.

    (15) The decisions of the board after the requested full hearing shall be final and binding.

    (16) Within fifteen (15) days after making a decision at the full hearing the board shall enter a final order setting forth its findings and conclusions and a copy of the order shall be provided to the claimant.

    (d) Conduct of the full hearing.

    (1) The chairman of the board shall preside over the hearing and shall rule on all evidentiary procedural, and other legal questions that arise during the hearing. The chairman's rulings shall stand unless overruled by a majority of the trustees present. The chairman shall open the full hearing by explaining the procedures to be followed.

    (2) The claimant shall have the right to be represented by counsel or be self-represented.

    (3) The claimant shall be allowed to make an opening statement not to exceed five (5) minutes.

    (4) Testimony of witnesses shall be under oath or affirmation. Depositions and affidavits shall be admissible.

    (5) The chairman, any trustee, the general counsel, the claimant or the claimant's counsel, upon recognition by the chairman, may direct questions to any witness during the proceedings.

    (6) Either the claimant or the general counsel shall have the right to present evidence relevant to the issues, to cross examine witnesses, to impeach witnesses and to respond to the evidence presented.

    (7) The claimant shall be permitted a closing argument not to exceed five (5) minutes.

    (8) The board shall deliberate and make a decision following closing argument and thereafter enter an order as provided herein.

    (e) Disability claims additional procedures.

    (1) All applications for disability pensions shall be in writing. Forms for such applications may be provided by the board.

    (2) Upon receipt of the application for disability, the general counsel will provide the claimant with a set of interrogatories or questions to be answered under oath and a medical release authorization. Both documents will be completed by the claimant and returned to the general counsel.

    (3) Upon receipt of the properly completed interrogatories and medical release authorization, the general counsel will request medical records from all relevant treating physicians; personnel records from the city, copies of relevant workers' compensation records, and copies of other records deemed to be relevant to the claim. The board shall pay, from the fund, the cost of any medical examinations required by the board and for copies of medical records.

    (4) The general counsel will, if authorized by the board, upon receipt of the medical records from the treating physicians, schedule an independent medical examination or examinations (IME) with an appropriate independent examining physician or physicians who will be asked to render an opinion about claimant's physical condition as it relates to the claimed disability.

    (5) Upon receipt of the IME report or reports from the examining physician or physicians, the general counsel will provide all records of treating physicians, relevant workman's compensation claims records, the independent medical evaluation, and all other relevant documents to the board for inclusion in the pension file and the board shall then schedule the initial hearing.

    (f) Evidence. Anyone required to give evidence under the terms of the plan may do so by certificate, affidavit, document or other information which the person to act in reliance may consider pertinent, reliable and genuine, and to have been signed, made or presented by the proper party or parties. Both the board and the trustee shall be fully protected in acting and relying upon any evidence described under the immediately preceding sentence.

    (g) Litigation against the trust. If any legal action filed against the plan administrator or the board, or against any member or members of the board, by or on behalf of any member or beneficiary, results adversely to the member or to the beneficiary, the trustee shall reimburse itself, or any member or members of the board all costs and fees expended by it or them by surcharging all costs and fees against the sums payable under the plan to the member or to the beneficiary, but only to the extent a court of competent jurisdiction specifically authorizes and directs any such surcharges and then only to the extent Code section 401(a)(13) does not prohibit any such surcharges.

(Ord. No. 98-19, § 2, 10-20-98)