Section 10 of the Public Safety Employee Benefits Act provides that under certain circumstances, police officers receiving a line-of-duty disability pension are entitled to receive fully paid health insurance coverage for themselves and their families. Section 10 has been a recurring interest of the Illinois Supreme Court over the past few years, see here and here. During its January term, the Court heard oral argument in Vaughn v. City of Carbondale, which poses yet another Section 10 question: was an officer reaching for his squad car radio to respond to a dispatcher call responding to what he reasonably believed was an emergency? Our detailed summary of the facts and underlying court decisions in Vaughn is here.
Vaughn arises from an incident in 2005. The plaintiff was talking to a motorist who had asked for directions when he heard a dispatcher calling on his radio. He walked back to his car, and when he reached inside to retrieve the radio, struck the top of his head, causing a sharp pain in his arm. Nearly two years later, the officer applied for a line-of-duty disability pension. The Pension Board rejected his application, but the Circuit Court reversed and the Appellate Court affirmed.
In 2012, the plaintiff requested the Section health insurance benefits. The City initially began paying the benefits, but later that year, instructed the officer to submit to a physical examination. Following that physical, the Board terminated his pension on the grounds that he was fit to return to work. While that decision was on appeal, the officer filed a complaint seeking a permanent injunction against the termination of his health insurance coverage. The Circuit Court declined to enter the injunction, but the Fifth District reversed.
Counsel for the defendant began the argument at the Supreme Court. He explained that the Section 10 benefit was narrowly defined and available only when the officer (1) has suffered catastrophic injury (2) in one of four situations (response to fresh pursuit, response to what he or she reasonably believed to be an emergency, as a result of an unlawful act of another, or during investigation of a criminal act). Justice Burke asked whether the Pension Board held a hearing, and counsel responded that proceedings were in progress – an initial hearing finding the officer fit had been overturned for lack of due notice. As a result, the plaintiff is still receiving his pension. Counsel told the Court that the facts are simple and stipulated. The defendant argued that when the officer walked back to his car to respond to the radio dispatcher, he was not responding to an emergency. But the Fifth District concluded that officers must treat all radio calls as emergencies until they know differently. Counsel argued that this is irreconcilable with the Supreme Court’s Gaffney decision, which defined an emergency as an unforeseen circumstance, putting persons or property at risk and requiring an urgent response. Justice Thomas asked whether the Fifth District had held the plaintiff was entitled to a permanent injunction. Counsel said yes. Justice Thomas asked whether the Court had remanded for entry of the injunction, or for an injunction hearing. Counsel responded that the Court expected that an injunction would be entered. Justice Thomas asked whether the defendant was arguing that the plaintiff was never entitled to Section 10 benefits, and even if he was, the benefits could be stopped once he was no longer disabled. Counsel answered that if the plaintiff is fit to return, he no longer satisfies the first prerequisite under Section 10 – a catastrophic injury. Counsel argued that given that the Fifth District found that it didn’t matter that the plaintiff’s call ultimately turned out not to be an emergency, the Court had effectively established a fifth grounds for Section 10 benefits – answering a dispatcher call. According to counsel, the Fifth District’s ruling meant that if an officer fell on a station staircase walking from the second to the first floor after being summoned by a captain, that would trigger the benefit.
Counsel for the plaintiff argued next, explaining the procedural history and noting that the Pension Board has once again demanded that the plaintiff submit to a physical. Justice Theis noted that the statute doesn’t distinguish between temporary and permanent disability, and asked whether it presupposed that an employer could seek reevaluation. Counsel said yes, and noted that the plaintiff had been provided with Section 10 benefits initially without objection by the City. Justice Thomas asked whether that was enough to trigger estoppel. Counsel said yes. There was no other reason to pay him unless the City was admitting that Section 10 was satisfied. Once Section 10 was triggered, the insurance premium benefits could be reduced, but barring fraud in the inception – not present here – the benefits could never be termination. Justice Thomas asked what plaintiff’s detrimental reliance was for establishing estoppel. Counsel answered that plaintiff had stopped his personal health insurance, and for a time had been uninsured. Justice Thomas asked how that was possible under federal law. Counsel said that it was his understanding that the plaintiff would have been entitled to coverage under federal law. Justice Theis asked if it was determined that the plaintiff was no longer disabled, would he still be entitled to health insurance benefits? Counsel said yes. Justice Theis pointed out that the pension itself could be stopped if the plaintiff were no longer disabled, and asked again whether plaintiff was arguing that health insurance benefits would nevertheless continue forever. Counsel said that was correct, and if there was something wrong with that conclusion, it was an argument for the legislature – the statute had no provision for stopping the payments. Chief Justice Garman asked whether there could ever be an injury fielding a dispatcher’s call which was not covered. Counsel said yes, if the officer knew when he reached for the radio that it wasn’t an emergency. The Chief Justice asked whether the Appellate Court’s finding of an emergency was one of fact or law. Counsel said it didn’t matter – every call was an emergency until the officer knew differently. Justice Thomas asked whether that mean nearly all calls qualified. Counsel agreed. Justice Thomas asked why, if that was right, the statute didn’t simply say an “officer’s response to any call”? Counsel answered that it was nevertheless true that all calls were treated as emergencies until the circumstances were known. Justice Thomas asked whether Section 10’s reference to an “officer’s response to what is reasonably believed to be an emergency” was an objective standard. Under the plaintiff’s position, why would “reasonable belief” matter? Counsel once again reiterated that all calls were an emergency until the officer knew differently.
In rebuttal, counsel for the defendant argued that the Fifth District’s holding – that all calls are an emergency until the officer knows differently – is just not what the statute says, or how the Supreme Court ruled in Gaffney. When the plaintiff is legally able to return to work, the employer is entitled to terminate health insurance benefits. According to counsel, plaintiff had no detriment sufficient for estoppel, given that he could get health insurance – he just didn’t want to pay a premium. Counsel concluded by arguing that the plaintiff’s affidavit amounted to an admission that he didn’t believe the call to be an emergency – if he had, he would have responded via the radio on his vest instead of returning to the car.
We expect Vaughn to be decided in three to four months.