Court Finds Firefighter Eligible for Health Benefits and Entitled to Reimbursement for Healthcare Expenses
In this case, a firefighter worked for the Village between 1997 and
2012. During that time, he injured his back numerous times in both emergency and
non-emergency situations, which ultimately required him to undergo multiple spinal
fusions and resulted in the firefighter filing an application for a disability pension. Once he was approved for an on-duty disability pension, the Village informed the
firefighter it would no longer cover his health insurance premiums under the
Village health insurance plan. In April 2014, the firefighter joined his wife’s
private insurance and filed an application for the Village to cover the private
insurance premiums.
In 2017, having been paying those premiums since April 2014,
the firefighter filed a lawsuit demanding reimbursement for those
premiums pursuant to PSEBA. The court
ordered the Village to hold a hearing regarding his PSEBA application. At that
hearing, the hearing officer determined the firefighter was eligible for PSEBA benefits,
but the Village had no obligation to reimburse his private insurance premiums. The
hearing officer’s rulings were reviewed by the trial court which upheld both decisions.
Both parties then appealed.
On appeal, the Appellate Court heard two issues:
1) The Village appealed the decision that the firefighter
qualified for PSEBA benefits; and
2) The firefighter appealed the decision that the Village
was not required to reimburse his private insurance premiums when the Village
stopped paying premiums on the Village health insurance plan.
On the first issue, the Appellate Court noted that eligibility
for PSEBA benefits required first responders to have been catastrophically
injured in what was reasonably believed to be an emergency, an unlawful act by
another, or while investigating a criminal act. The issue here was whether the firefighter’s various back injuries that occurred during non-emergency situations disqualified him from receiving
PSEBA benefits. The Appellate Court held it did not, and what was relevant in this case was
how the back injuries he suffered while responding to emergencies contributed to his ultimate disability.
On the second issue, the Appellate Court stated that the right to PSEBA benefits attaches when a first responder is determined to have been catastrophically injured. The Appellate Court reasoned it went against public policy to deny a first responder reimbursement for premiums while waiting for that determination. As a result, the Appellate Court held that the hearing officer’s ruling that the Village was not obligated to pay the premiums for private insurance was in error.
Post Authored by Daniel Lev, Ancel Glink
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