CHICAGO — A state appeals panel upheld a ruling establishing the city of Chicago can stop providing free health insurance to injured firefighters who become eligible for Medicare coverage.
Nineteen Chicago Fire Department employees whose careers ended after on-duty injuries sued the city in Cook County Circuit Court, alleging a state law guarantees them lifetime, premium-free coverage in the city’s group health policy. They further sought to press claims on behalf of their eligible dependents, saying their spouses and children younger than 26 years old were also affected by the city's decision to give them the boot.
A 20th plaintiff alleged, when he turned 65, the city gave him and his wife premium-free coverage under a retiree health plan instead of the plan for active-duty employees.
Bertina E. Lampkin
| illinoiscourts.gov
Cook County Judge Raymond Mitchell had dismissed the complaint, determining Illinois' Public Safety Employee Benefits Act allows a reduction in city-paid benefits when a person qualifies for benefits from any other source. The retirees appealed that ruling to the Illinois First District Appellate Court.
Justice Bertina Lampkin wrote the panel’s opinion, issued Dec. 23. Justices Jesse Reyes and Mary Rochford concurred.
On appeal, the plaintiffs contended Judge Mitchell’s ruling was flawed because it relied on a 2012 Illinois Fifth District Appellate Court ruling in Pyle v. City of Granite City, arguing that decision wrongly relied on the Illinois Insurance Code. They also said Mitchell treated the city’s group plan as a Medicare supplemental policy.
In Pyle, the Fifth District overturned a circuit court ruling that a municipality had to pay a retiree’s premium for Medicare gap coverage. The First District read Pyle to support Chicago’s position and said Pyle didn’t rely on the Insurance Code to determine the Public Safety Employee Benefits Act’s framework.
“Once the plaintiff’s primary plan became Medicare, the city’s payment of premiums would have been for a ‘plan that supplemented Medicare,’ and ‘the plain language of the statute’ did not require it ‘to pay premiums for these supplemental benefits,’ ” Lampkin wrote. She added that former firefighters who reach 65 — injured or otherwise — can pay premiums to remain in a group policy to supplement Medicare.
The plaintiffs’ argument, Lampkin wrote, “seeks to add words to the Act that the legislature did not use and fails to construe the entire statute coherently. Although the Act does guarantee that injured firefighters will always have some type of health insurance coverage, whether from their former employer or another source like Medicare, the Act never states that premium-free coverage under the employer’s group plan must last a lifetime.”
The panel further rejected the argument the Public Safety Employee Benefits Act section is intended to address coordination of benefits, noting it doesn’t contain that phrase or do the work of such a clause usually found in insurance policies. There is no reference to primary or secondary payers or stipulations for paying particular claims.
The challenged section, Lampkin wrote, “simply relieves public employees of the Act’s obligation to pay insurance premiums when beneficiaries have insurance from any other source.”
According to the panel, the city allowed the plaintiffs to join a Medicare supplement retiree plan, which was discontinued in December 2016. Since then, the same group could participate in a union plan or buy other Medicare supplemental plans at their own expense.
“The Act guarantees injured firefighters basic insurance coverage,” Lampkin wrote. “When Medicare provides that coverage, the Act does not require the City to supplement it.”
The panel also rejected the plaintiffs’ standing argument. While acknowledging spouses and children of injured firefighters are entitled to premium-free health insurance under the law, “a close family relationship does not entitle someone to assert another person’s claims,” Lampkin wrote, adding the “plaintiffs do not even attempt to explain why their wives and adult children are unable to assert their own rights. And the record does not suggest that they lack the capacity to do so.”
Plaintiffs were represented in the action by attorney Stephen B. Horwitz, of Hogan Marren Babbo & Rose, of Chicago.
The city was represented by corporation counsel from the Chicago Department of Law.