Updates on cases, laws, and other topics of interest to local governments

Subscribe by Email

Enter your Email:
Preview | Powered by FeedBlitz

Subscribe in a Reader

Follow Municipal Minute on Twitter


Blog comments do not reflect the views or opinions of the Author or Ancel Glink. Some of the content may be considered attorney advertising material under the applicable rules of certain states. Prior results do not guarantee a similar outcome. Please read our full disclaimer

Thursday, April 4, 2024

Court Finds Firefighter Eligible for Health Benefits and Entitled to Reimbursement for Healthcare Expenses

An Illinois Appellate Court recently held that a firefighter qualified for health insurance benefits under the Public Safety Employee Benefits Act (PSEBA) and reversed a hearing officer's ruling that the Village was not required to reimburse the firefighter for premiums paid to a private insurer. Mertes v. Village of Mt. Prospect

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


Post a Comment