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The Interplay Between Workers’ Compensation, PEDA, and PSEBA The Interplay Between Workers’ Compensation, PEDA, and PSEBA

The Interplay Between Workers’ Compensation, PEDA, and PSEBA - PowerPoint Presentation

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The Interplay Between Workers’ Compensation, PEDA, and PSEBA - PPT Presentation

The Interplay Between Workers Compensation PEDA and PSEBA in Illinois IML Municipal Attorneys Seminar Bloomington Illinois April 22 2016 Presented By Erin M Baker 1 2 Overview PEDA PSEBA ID: 773114

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The Interplay Between Workers’ Compensation, PEDA, and PSEBA in Illinois IML Municipal Attorney’s SeminarBloomington, IllinoisApril 22, 2016Presented By Erin M. Baker 1

2 Overview PEDA PSEBA Disability Pensions Workers’ Compensation ActEffect of Res Judicata/Collateral EstoppelBest Practices for Municipal Clients

3 PEDA PSEBA Workers’ Compensation Disability Pensions

4 4 PEDA PSEBA Workers’ Compensation Disability Pensions

Public Employee’s Disability Act (PEDA) 5 ILCS 345/0.015

What is PEDA?PEDA provides police offers and firefighters who suffer an injury in the line of duty with their full salary for 52 weeks/ one year after the injury. Employee must be paid on the same basis on which he or she was paid before the accident with no deduction for sick leave credits, compensatory time for overtime or vacation, or service credits. 6

One Year Requirement“One year” means a full year of incapacity. If an employee returns intermittently to work, he is still entitled to one full year of benefits related to that injury.If employer accommodates the employee with light duty work, the clock stops. Albee v. City of Bloomington, 365 Ill.App.3d 526 (2006).7

Who is eligible for PEDA benefits?Any full-time police officer or firefighter who is unable to perform his or her duties as a result of an injury suffered in the line of duty. While on PEDA, the employee may not be employed in any other manner. (5 ILCS 345/1(d). May be subject to physical or mental exams.8

In the line of duty...PEDA does not define Mabie v. Village of Schaumburg, 364 Ill. App. 3d 756, 301 Ill. Dec. 786, 847 N.E.2d 796 (1st Dist. 2006).Swanson v. Village of Lake in the Hills, 233 Ill. App. 3d 58, 174 Ill. Dec. 233, 598 N.E.2d 430 (2d Dist. 1992).9

PEDA and other benefits...Any salary benefits under workers’ compensation revert back to the employer while the employee is paid under PEDA. Employees receiving PEDA are not entitled to disability benefits under the Illinois Pension Code.10

Public Safety Employee Benefits Act(PSEBA)820 ILCS 320/1 11

What is PSEBA?PSEBA provides lifetime health insurance benefits to police officers and firefighters who suffer a “catastrophic injury” in the line of the duty. Extends to spouses, civil union partners, and dependent children. 12

Who is Eligible for PSEBA benefits?Employee must prove: Suffered a catastrophic injury or deathAs a result of:The officer’s response to fresh pursuit,The officer’s response to what is reasonably believed to be an emergency,An unlawful act perpetrated by another, ORDuring the investigation of a criminal act. 13

14Catastrophic Injury =An injury resulting ina line of duty disabilityKrohe v. City of Bloomington , 204 Ill.2d 392 (2003). Village of Vernon Hills v. Heelan, 2015 IL 118170, 39 N.E. 3d 937, (2015).

Reasonably believed to be an emergencyGaffney v. Board of Trustees of the Orland Fire Protection District, 2012 IL 110012, 360 Ill.Dec. 549 (2012).Emergency = an unforeseen circumstance involving imminent danger to a person or property requiring an urgent responseActions in a training exercise can sometimes be reasonably believed to be a response to an emergency under PSEBA.Vaughn v. City of Carbondale, 2016 IL 119181 (2016). 15

When do PSEBA benefits begin?Date of accident v. date permanently disabled? Nowak v. City of Country Club Hills, 2011 IL 111838, 958 N.E.2d 1021, 354 Ill.Dec. 825 (Dec. 1, 2011).Held the City should begin paying health insurance premiums on the date the officer was deemed permanently disabled by the Pension Board16

Pyle v. City of Granite City, IL App (5th) 110472, 978 N.E.2d 1086, 365 lll.Dec. 583 (5th Dist. 2012). PSEBA benefits may be reduced or cease completely as a result of Medicare eligibility. 17

Illinois Pension CodePolice: 40 ILCS 5/3-114.1, 114.2 Firefighters: 40 ILCS 5/4-110, 111 18

Illinois Pension CodeProvides disability pensions to police and firefights suffering from line-of-duty or not-on-duty disabilities or occupational diseases. 19

Illinois Pension CodeDisability pensions are available to members of the police pension fund at a rate of 65% of their salary at the time of suspension of duty or retirement for duty-related disabilities, and 50% of the salary at the time of suspension of duty or retirement for non duty-duty disabilities. Similar on-duty and off-duty disability pensions are also available to firefighters under the Code, provided that they have provided seven years of creditable service to be eligible for the non-duty disability pension. 20

Illinois Pension CodePolice Pension Code allows an Illinois pension board to grant a line-of-duty disability pension for “sickness, accident, or injury incurred in or resulting from the performance of an act of duty or from the cumulative effects of acts of duty.” 40 ILCS 5/4-110. 21

Illinois Pension CodeFor firefighters, an “act of duty” is: “Any act imposed on an active fireman by the ordinances of a city, or by the rules or regulations of its fire department, or any act performed by an active fireman while on duty, having for its direct purpose the saving of the life or property of another person.” 40 ILCS 5/6-110. 22

Illinois Pension CodePolice Pension Code:   “Any act of police duty inherently involving special risk, not ordinarily assumed by a citizen in the ordinary walks of life, imposed on a policeman by the statutes of this State or by the ordinances or police regulations of the city in which this Article is in effect or by a special assignment; or any act of heroism performed in the city having for its direct purpose the saving of the life or property of a person other than the policeman.” 40 ILCS 5/5-113.23

Pension Board HearingsClaimant must show a physical or mental impairment that renders he or she no longer able to work. Case by case basisBoard considers evidence and 3 IMEsAppeals governed by Administrative Review Law.24

Pension Code and Worker’s Compensation Some claims under the Pension Code will also have a workers’ compensation claim arising out of the same accident.May be necessary for municipality to intervene or monitor the pension proceedings. 25

Illinois Workers’ Compensation Act 820 ILCS 305/126

Illinois Workers’ Compensation ActProvides compensation to employees for injuries that arise out of and in the course of the employment of the injured worker. The injuries must also be causally related to the accident.27

Arising out of...An injury arises out of the employment if, at the time of the occurrence, the employee is performing acts the employee was instructed to perform by the employer, acts the employee has a common-law or statutory duty to perform, or acts the employee might reasonably be expected to perform incident to assigned duties. Caterpillar Tractor Co. v. Industrial Commission,129 Ill.2d 52, 541 N.E.2d 665, 133 Ill.Dec. 454 (1989).28

In the Course of...Time PlaceCircumstance29

Notice Section 6(c) of the Act provides that notice of the accident will be given to the employer within 45 days after the accident. Orally or in writing defects or inaccuracies in the notice do not bar the claim unless there is evidence of undue prejudice30

Benefits For compensable injuries, employers must pay for causally related medical treatment and compensation at 2/3 of the employee’s average weekly wage (TTD) for any lost income if the employee is unable to work for more than three working days. Permanent disability benefits 31

Res JudicataA final judgment on the merits by a court of competent jurisdiction is conclusive as to the rights of the parties and their privies, and as to them, constitutes an absolute bar to a subsequent action involving the same claim, demand, or cause of action. 32

Res JudicataRequires: An identity of the parties or their privies;An identity of the causes of action; andA final judgment on the merits.33

Collateral EstoppelMost commonly applied in these cases. A branch of res judicata34

Collateral EstoppelRequires: The issue decided in the prior adjudication is identical to that presented in the current action;The party against whom the estoppel is asserted was a party to or in privity with a party to the prior adjudication; and,The prior adjudication resulted in a final judgment on the merits. 35

Res Judicata/Collateral EstoppelDempsey v. City of Harrisburg , 3 Ill.App.3d 696, 279 N.E.2d 55 (1971).Applied res judicata, finding that the issues of “arising out of” before the Workers’ Compensation Commission and “in the performance of duty” under the Pension Code were for all intents and purposes identical. Pension Board was an agent of the City. 36

Res Judicata/Collateral EstoppelMcCulla v. Industrial Commission , 232 Ill. App. 3d 517, 597 N.E.2d 875, 173 Ill. Dec. 901 (1st Dist. 1992).Appellate Court collaterally estopped firefighter from relitigating whether injuries were causally related to his employment. 37

Res Judicata/Collateral EstoppelDemski v. Mundelein Police Pension Board, 358 Ill.App.3d 499, 294 Ill.Dec. 754, 831 N.E.2d 704 (2005).Court did not apply collateral estoppel, finding that “arising out of” and “act of duty” were not identical issues due to the “special risk” requirement for an act of duty of a police officer. 38

Res Judicata / Collateral EstoppelMabie v. Village of Schaumburg, 364 Ill. App.3d 756, 847 N.E.2d 796, 301 Ill.Dec. 786 (1st Dist. 2006). Appellate Court collaterally estopped firefighter’s claim because there is no meaningful difference between the line of duty disability test under PEDA and the arising out of the employment test under workers’ compensation.39

Commonality or Privity of PartiesCollaboration Common identityCommon constituencyCommon interest40

Commonality or Privity of Parties?? Pension Board = Municipality ?? Recent cases suggest no.Rhoads v. Board of Trustees of the City of Calumet City’s Policemen’s Pension Fund, 293 Ill.App.3d 1070, 689 N.E.2d 266, 228 Ill.Dec. 394 (1st Dist. 1997).Dowrick v. Village of Downers Grove, 362 Ill.App.3d 512, 840 N.E.2d 785, 298 Ill.Dec. 672 (2nd Dist. 2005).BUT, Garcia v. Village of Mount Prospect, 360 F.3d 630 (7 th Cir. 2004). 41

Final Judgment on the MeritsA judgment is deemed to be “on the merits” when it amounts to a decision as to the rights and liabilities of parties based on the ultimate facts or the state of the facts disclosed by pleadings, evidence, or both, on which the right of recovery depends. Fried v. Polk Brothers, 190 Ill.App.3d 871, 878, 138 Ill.Dec. 105, 546 N.E.2d 1160 (2nd Dist. 1989). Richter v. Village of Oak Brook, 2011 Ill.App.2d 100114, 958 N.E.2d 700, 354 Ill.Dec. 768 (2nd Dist. 2011) 42

Best Practices for MunicipalitiesProper documentation Investigation/SurveillanceOpen lines of communicationBe aware of protections provided by statute/case law43

THANK YOU!44