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James W. Pyle v. the City of Granite City

October 16, 2012

JAMES W. PYLE,
PLAINTIFF-APPELLEE,
v.
THE CITY OF GRANITE CITY, RON SELPH, JUDY WHITAKER, LYNETTE KOZER, KIM MAC TAGGART, GAIL VALLE, AND EDWARD HAGNAUER,
DEFENDANTS-APPELLANTS.



Appeal from the Circuit Court of Madison County. No. 04-MR-231 Honorable Clarence W. Harrison II, Judge, presiding.

The opinion of the court was delivered by: Justice Wexstten

NOTICE

Decision filed 10/16/12. The text of this decision may be changed or corrected prior to the filing of a Petition for Rehearing or the disposition of the same.

JUSTICE WEXSTTEN delivered the judgment of the court, with opinion. Presiding Justice Donovan and Justice Goldenhersh concurred in the judgment and opinion.

OPINION

¶ 1 The plaintiff, James W. Pyle, a former Granite City firefighter, filed suit in the circuit court of Madison County against the defendants, the City of Granite City, Ron Selph, Judy Whitaker, Lynette Kozer, Kim Mac Taggart, Gail Valle, and Edward Hagnauer (collectively the City). Pyle sought declaratory judgment and mandamus relief asserting that the City had improperly denied payment for health insurance premiums it owed pursuant to section 10(a) of the Public Safety Employee Benefits Act (the PSEBA) (820 ILCS 320/10(a) (West 2000)). The circuit court granted Pyle's motion for summary judgment, finding that Pyle was entitled to the payments during his lifetime.

¶ 2 The City appeals, arguing that the circuit court erred in determining that Pyle was catastrophically injured pursuant to the PSEBA, that Pyle's benefits were for his lifetime, and that the City's obligation to pay health insurance premiums for Pyle continued even though Pyle received Medicare benefits. We affirm in part and reverse in part.

¶ 3 FACTS

¶ 4 Pyle was employed as a City firefighter from 1977 to 2000. While responding to emergencies between March 1998 and September 1999, he sustained injuries to his right shoulder and lower back while moving a water hose at two separate residential fires. He was treated for this condition with physical therapy and epidural injections and underwent surgery in November 1999 and March 2006. Pyle ultimately sought a line-of-duty disability pension, alleging that the effects of his injuries prevented him from returning to work as a firefighter. Effective November 3, 2000, and pursuant to section 4-110 of the Illinois Pension Code,*fn1 the City's pension board awarded Pyle a disability pension for the injuries he sustained in the line of duty, and his City employment ceased.

¶ 5 On April 19, 2004, Pyle filed his complaint against the City. In his complaint, Pyle alleged that he sustained "a number of catastrophic injuries" to his right shoulder and lower back while responding to emergency calls between March 1998 and September 1999, that he had been awarded a line-of-duty disability pension due to the fact that he was found to be permanently disabled from performing the essential physical responsibilities of his firefighting position, and that he was therefore entitled to the City's payment of health insurance premiums on his behalf pursuant to the PSEBA (820 ILCS 320/10 (West 2000)). Pyle sought lifetime benefits, reimbursement for any past premium payments he had made, prejudgment interest, out-of-pocket litigation expenses, and attorney fees. On March 24, 2011, Pyle moved for summary judgment, asserting that he had been wrongfully denied the PSEBA benefits from the City.

¶ 6 The City countered Pyle's assertions by arguing that a genuine issue of material fact existed as to whether Pyle had suffered a "catastrophic injury." The City argued that the Illinois Supreme Court's definition of "catastrophic injury," as set forth in Krohe v. City of Bloomington, 204 Ill. 2d 392 (2003), should be revised for public policy reasons and to bring the definition of "catastrophic" in accord with common understanding and legislative intent. Alternatively, the City asserted that if required to make payment for Pyle's health insurance premiums, its duty to make such payments encompassed only premium payment amounts due until Pyle attained age 65 and became Medicare eligible in 2008. The City argued that the PSEBA did not entitle Pyle to receive a lifetime benefit of premiums paid.

¶ 7 After hearing arguments on April 8, 2011, the circuit court granted Pyle's motion for summary judgment, finding him eligible for benefits pursuant to the PSEBA. On August 26, 2011, after hearing further arguments on the issue of damages, the circuit court ordered the City to reimburse Pyle for premium amounts due from the date of his disabling line-of-duty retirement until he became Medicare eligible. The circuit court further ordered the City, upon Pyle's Medicare eligibility, to pay policy premiums to supplement Medicare until his death. The circuit court held that the amount that the City would be liable for would be capped at the amount paid for the supplemental policy and would "not go in excess of what the City pays for other beneficiaries." The circuit court stated that its ruling was a preliminary one subject to the entry of a final order.

¶ 8 Because the City had not paid health insurance premiums on his behalf, Pyle paid premium payments until April 8, 2011, the date the circuit court entered summary judgment. The Union Relief and Welfare Fund paid 80% of Pyle's health insurance premium for the first year of disability and thereafter paid 60% of his health insurance premium for each year after until he attained age 65 and became Medicare eligible in August 2008. At that point, the plaintiff accepted the primary Medicare coverage and acquired the supplemental policy to protect against deductibles, copayments, and medical fee limitations.

ΒΆ 9 On October 3, 2011, the circuit court entered its final order granting Pyle's motion for summary judgment and awarding Pyle $22,440.80 for past premiums paid. The circuit court found that on August 3, 2008, Pyle had accepted health insurance through the federal Medicare program. The circuit court ordered the City to continue paying $350.66 as health insurance premiums for supplemental Medicare coverage on behalf of Pyle "without limitation." The circuit court ordered the defendants "to continue making said premium payments for health insurance subject to periodic increases required by the insurance carrier; provided, however, the monthly insurance payment made on behalf of [p]laintiff James W. Pyle shall not exceed the monthly insurance payment being made on behalf ...


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