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Tuesday, January 21, 2020

Appeals court rules Peoria not required to pay disabled ex-cop's higher health insurance premium


By John Breslin | Dec 5, 2019

Third district appellate ottawa illinois
Illinois Third District Appellate Courthouse, Ottawa | IvoShandor [CC BY-SA 3.0 (]

OTTAWA -  A state appeals panel says Illinois law doesn't require the city of Peoria to pay the full premium for a more expensive health insurance policy for a disabled police officer.

In an opinion filed Nov. 20, a three-justice panel of the Illinois Third District Appellate Court in downstate Ottawa found Peoria properly argued that its full payment of a high-deductible policy covered the requirements of the state's Public Safety Employee Benefits Act.

Former Peoria Police officer Terry Esser, who is disabled after suffering back injuries at work in 2013, had appealed a decision handed down by a Peoria County judge, who ruled the city did not have to pay the full amount of the more expensive low-deductible policy. Esser was awarded health insurance benefits under the Act, but the city initially objected to granting them.

Esser received a letter in February 2016 notifying him of two different insurance plans, one with a low deductible and one high-deductible plan, and was told he must pay the difference between the more and less expensive premium. He opted for the more expensive, low-deductible plan. 

Esser filed a complaint arguing that the city was required to pay the full amount of the premium of the more expensive plan. The complaint stated that, at the time of the injury, the city was paying the entire premium for all plans.

The trial court disagreed and found that the city did not run afoul of the Act's requirement to offer and pay for basic insurance. 

In a judgment authored by Justice Robert Carter, with Justices Mary O’Brien and Vicki Wright concurring, the appeals panel agreed with the city's position that the "plain language of the act mandates only that the city pay the entire premium amount for the 'basic' group health insurance plan, which the city contends is the high-deductible plan."

Carter added that courts have decided that municipalities can enact administrative ways to determine claims for benefits as long as they are consistent with the language of the act.

"We find that the city was not required by the Act to pay the entire premium amount for Esser to have the city’s more expensive, low-deductible group health insurance plan," the appeals panel concluded.

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City of PeoriaIllinois' Third District Appellate CourtIllinois' 10th Judicial Circuit

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