Firefighter Family Health Care Benefits go the Supreme Court

Tuesday, June 8, 2010 | 0

By John P. Campbell Jr.
Keefe, Campbell & Associates

In two separate but very similar cases, two divisions of the Illinois 1st District Appellate Court disagree as to the factual elements needed for firefighters to qualify for family lifetime health coverage. Accordingly, we look for the Illinois Supreme Court to settle the score.

These rulings may be critical for municipal risk managers to follow. We are certain it is a lot more expensive to provide lifetime family healthcare insurance for injured firefighters than individual coverage. In Gaffney v. Bd. of Trustees of the Orland Fire Department; and Lemmons v. Orland Fire Protection Dist., our Appellate Court tried to answer the question as to whether plaintiffs-firefighters, who were catastrophically injured during live training exercises, were entitled to payment of lifetime family health coverage benefits under Section 10 of Public Safety Employee Benefits Act. In doing so, the Court struggled with what constitutes a reasonable belief by the firefighters they were responding to an emergency, thereby affording lifetime health benefits under the Act.
 
Section 10 of the Public Safety Employee Benefits Act provides, in relevant part:
 
(a) An employer who employs a full-time law enforcement, correctional or correctional probation officer, or firefighter, who, on or after the effective date of this Act suffers a catastrophic injury or is killed in the line of duty shall pay the entire premium of the employer's health insurance plan for the injured employee, the injured employee's spouse, and for each dependent child of the injured employee until the child reaches the age of majority or until the end of the calendar year in which the child reaches the age of 25 if the child continues to be dependent for support or the child is a full-time or part-time student and is dependent for support.
 
(b) In order for the law enforcement, correctional or correctional probation officer, firefighter, spouse, or dependent children to be eligible for insurance coverage under this Act, the injury or death must have occurred as the result of the officer's response to fresh pursuit, the officer or firefighter's response to what is reasonably believed to be an emergency, an unlawful act perpetrated by another, or during the investigation of a criminal act.
 
Nothing in this Section shall be construed to limit health insurance coverage or pension benefits for which the officer, firefighter, spouse, or dependent children may otherwise be eligible.”  820 ILCS 320/10 (West 2006).
 
Plaintiff/firefighter Gaffney was injured during a “live” training exercise where the building used in the drill actually was on fire, however the rescue involved only a dummy. While the “rescue” of the dummy was successful, Gaffney was injured lifting a sofa to free a fire hose which was snagged during the drill. His shoulder injury was serious enough to prevent his return to firefighting. Therefore, there was no dispute the injury was “catastrophic” as defined by the Act. However, the Court found this fact pattern insufficient to afford Gaffney family healthcare benefits under Section 10, as Gaffney could not reasonably believe he was in a true emergency situation.
 
In so ruling, the Court reasoned the drill was “controlled” at all times and there was no rescue of a live person, but only a dummy. In fact, Plaintiff’s testimony in his disability hearing established he did not believe he was responding to an emergency. Plaintiff knew this training exercise was not an actual emergency and that it was a live-fire training exercise only. Accordingly, the Court affirmed the circuit court’s denial of benefits, concluding Plaintiff did not have a reasonable belief that he was responding to an emergency.
 
However, a separate division of the 1stt District Appellate Court in Lemmons reached an opposite conclusion, finding a firefighter who injured his knee in a training drill was responding to an emergency situation and further, had the reasonable belief he was responding to an emergency, simply because he was told to assume the training exercise was a real emergency.
 
Remarkably however, in Lemmons, the building where the exercise was being held was not even burning, unlike in Gaffney, where the training was in a live fire. Also, there was unlimited oxygen supply for the firefighters in the Lemmons drill, making this drill far less “real” than the drill conducted by Gaffney. Nevertheless, Gaffney was left without benefits and Lemmons was afforded lifetime family healthcare benefits by a different faction of the same Appellate Court.
 
Due to the obvious inconsistency in these two cases, the Supreme Court certified the issue for appeal. Since the statute does not expressly offer life-time family healthcare benefits in the event of any work-related injury for police and firefighters, it is clear the intention of Section 10 was to provide additional health benefits for public safety workers who were truly responding to an emergency situation. The critical question is whether a simulation of an emergency (in the form of a practice drill) is sufficient to trigger the additional health benefits.
 
One could easily argue any form of practice or simulation is not a real “emergency” as would be understood in the classic sense. Then again, most of us outside of the public safety services industry cannot appreciate how dangerous it is to run into a burning building, three stories up, even if it is “simulated” or “practice”. Either way you cut it, there is certainly a heightened level of danger to be appreciated.
 
While reading these two decisions, we couldn’t help but feel our appellate court stopped short of a full discussion on this issue. For example, neither decision entertained a discussion of whether a real “emergency” could occur during training and therefore, compel entitlement to lifetime health benefits. For example, in Gaffney, it is entirely possible Plaintiff Gaffney felt as though the snagged fire hose was a life threatening situation to his comrades on the third floor of a burning building and therefore, when lifting a sofa to dislodge the hose, it would be entirely reasonable for Gaffney to believe he was in an emergency situation.

Such an analysis may have compelled the Court to rule differently and award benefits. Then again, it is always difficult, after the fact, to measure how serious/threatened/dangerous a firefighter perceives the situation. The Gaffney court finds the true measure of an emergency is just that–whether there is an emergency, either perceived or real. Conversely, the Lemmons court finds the heightened level of danger created by a simulated emergency sufficient to qualify for the additional lifetime health benefits in the event of an injury.
 
As we stated earlier, we should look for the Illinois Supreme Court to take up this issue and provide guidance for municipalities and their police and fire boards. As it stands now, these contradictory opinions leave it uncertain just how to measure the entitlement to lifetime family healthcare benefits under the Public Safety Employee Benefits Act.

<i>John P. Campbell is a founding member of Keefe, Campbell & Associates, a Chicago workers' compensation defense firm. This column was reprinted from the firm's client newsletter.</i>