Section 301.630  Procedures for Filing A Claim

a)         To request coverage 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 the IEMA Workers' Compensation Coordinator, in a timely manner, all of the following:

1)         Evidence that the notification or pre-approval requirements of Section 301.620(e) of this Part 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 of:

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, signed by the ESDA coordinator;

4)         A written 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; and

6)         The Workers' Compensation Witness Report, on a form prescribed by CMS.

b)         Completed claims shall be forwarded from IEMA to the Illinois Department of Central Management Services for compensation determinations in accordance with requirements of the Workers' Compensation Act and the Workers' Occupational Diseases Act.