In the recent case of Mertes v. Village of Mt. Prospect (2024 IL App (1st) 221787), the Appellate Court considered a dispute over whether a Village firefighter, Eric Mertes, was properly determined to have suffered line-of-duty injuries that were “catastrophic” pursuant to the Public Safety Employee Benefits Act, also known as PSEBA, and if the Village was required to pay for Mertes’ health insurance coverage.

Between 1999 and 2012, Mertes suffered a series of back injuries while responding to emergency calls, and in several instances when he was not responding to emergencies. The Village’s Firefighters’ Pension Fund granted Mertes line-of-duty benefits in 2014, but Mertes was issued a letter from the Village informing him that his insurance coverage under the Village’s group plan was being terminated. As a result, Mertes obtained insurance through his wife’s employee benefits but contended the Village should be responsible for all premiums Mertes paid following the Village’s termination of his insurance.

With both parties unhappy, the Village agreed to provide Mertes with a new administrative hearing on his application for line-of-duty benefits. The hearing officer found that Mertes was entitled to line-of-duty benefits but denied that the Village had an obligation to pay Mertes’ premiums incurred after the Village terminated coverage. The Village then filed an administrative review complaint challenging the award of line-of-duty benefits, while Mertes filed his own action challenging the denial of insurance coverage.

Following its review of the case, the Appellate Court (1) upheld the hearing officer’s granting of line-of-duty benefits, finding that Mertes’ back injuries from the non-emergency situations did not disqualify him from line-of-duty benefits under PSEBA; and (2) overturned the hearing officer’s determination that the Village was not responsible for Mertes’ health insurance.

The Court determined that Mertes did not forfeit his right to benefits by finding alternative health insurance while his line-of-duty benefits were being decided, reasoning that Mertes’s actions to mitigate damages by obtaining other insurance was reasonable. Because Mertes was ultimately found eligible for line-of-duty benefits, the Court ordered the Village to reimburse Mertes for the premiums he paid for the alternative insurance plan, and that he be re-enrolled in the Village’s group plan moving forward.

This case underscores the importance of municipalities fully understanding their rights and responsibilities under the Public Safety Employee Benefits Act. Benefits awarded through PSEBA can impose a significant financial burden on municipalities, so it is important to work closely with legal counsel on all PSEBA matters.

For more information about this article, please contact Tressler attorney
Jim Hess at jhess@tresslerllp.com.