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.
(Source: Amended at 42 Ill. Reg. 15933, effective July 31, 2018)