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Officer Receiving Line of Duty Disability Not Entitled to PSEBA Benefits

April 6th, 2016

Vaughn  v. City of Carbondale, 2016 IL 119181

            This case was originally reported in our October 2015 newsletter, following the Fifth District Appellate Court’s ruling.  As you may recall, Officer Jeffery Vaughn suffered a head injury while reaching into his squad car for his police radio to respond to a request from dispatch.  Based on this injury, Vaughn applied for line of duty disability pension benefits.  The pension board denied Vaughn’s application and he appealed.  In an unrelated appeal, the Appellate Court affirmed the reversal of the pension board’s denial and ordered Vaughn be granted a line of duty disability pension.  Based on his receipt of a line of duty disability pension, Vaughn requested the City of Carbondale (“City”) provide him with benefits under PSEBA.  The City provided Vaughn and his wife with health insurance, without objection.   In 2012, the pension board directed Vaughn to submit to an annual examination to determine continuing eligibility for his line of duty disability pension benefits.  The examining doctor determined Vaughn was no longer disabled and the pension board issued a decision terminating Vaughn’s disability pension benefits.  The Appellate Court reversed the pension board decision because Vaughn had not been given due notice and an opportunity to be heard.

            The Appellate Court determined, based on its decision to reinstate his line of duty disability pension benefits, Vaughn had suffered a “catastrophic injury” as required under PSEBA and continued to be eligible for health insurance coverage under PSEBA.  The Appellate Court found Vaughn’s work-related injury “occurred as a result of his response to what he reasonably believed was an emergency.”  2015 IL App (5th) 140122, ¶12.  The Appellate Court included extensive discussion of the definition and application of the requirement of the injury occurring in response to an “emergency.”  The Appellate Court found the undisputed facts demonstrated Vaughn had met the requirements for “catastrophic injury” occurred in responding to an “emergency.”  The City filed a Petition for Leave to Appeal to the Illinois Supreme Court, which was granted.

             The Illinois Supreme Court reversed the Appellate Court and held, “the facts of this case do not fit within the emergency situation set forth in section 10(b).”  2016 IL 119181, ¶42.  The Supreme Court specifically found responding to a call from dispatch does not equate to an event “reasonably believed to be an emergency.”  See 820 ILCS 320/10.  The Supreme Court noted, “That a call from dispatch could evolve into an emergency situation for purposes of Section 10(b) of the Act does not mean that every call from dispatch is an emergency situation until proven otherwise.  Answering a call from dispatch is not an unforeseen circumstance.”  Id.  The Court found telling the lack of facts to established any imminent danger to person or property which required an urgent response to the call from dispatch.

In finding Vaughn was not entitled to a permanent injunction, which would have enjoined the City from terminating his benefits under PSEBA, the Court noted Vaughn “was not eligible for insurance benefits under section 10 of the Act in the first place.”  2016 IL 119181, ¶47.  Therefore, the City was not prohibited from terminating benefits it was never statutorily obligated to provide.

 Finally, the Supreme Court found that equitable estoppel did not prevent the City from terminating Vaughn’s benefits under PSEBA.  The Court noted Vaughn had options available for continuing health insurance under either COBRA or the Affordable Care Act, and therefore was not detrimentally affected by the Court’s ruling.  “The fact that plaintiff now will have to pay some or all of his health insurance premiums does not constitute a detrimental change in position for purposes of equitable estoppel, let alone rise to the level of fraud or injustice.”  2016 IL 119181, ¶50.  The end result is Vaughn’s benefits under PSEBA can be terminated, because his injury was not found to meet the requirements of Section 10 of the statute.