Mertes v. Village of Mt. Prospect , 2024 IL App (1st) 221787 ( 2024 )

2024 IL App (1st) 221787Nos. 1-22-1787 & 1-22-1790 (consol.)
Opinion filed March 27, 2024
FIFTH DIVISION
IN THE
APPELLATE COURT OF ILLINOIS
FIRST JUDICIAL DISTRICT
ERIC J. MERTES and KENDRA MERTES, ) Appeal from the
) Circuit Court of
Plaintiffs-Appellants, ) Cook County
)
v. (No. 1-22-1787) ) No. 2020 CH 04379
)
THE VILLAGE OF MT. PROSPECT, ) Honorable
) Thaddeus Wilson,
Defendant-Appellee. ) Judge presiding.
THE VILLAGE OF MT. PROSPECT, ) Appeal from the
) Circuit Court of
Plaintiff-Appellant, ) Cook County
)
v. (No. 1-22-1790) ) No. 2020 CH 04409
)
ERIC J. MERTES and KENDRA MERTES, ) Honorable
) Thaddeus Wilson,
Defendants-Appellees. ) Judge presiding.
PRESIDING JUSTICE MITCHELL delivered the judgment of the court, with opinion.
Justice Mikva and Justice Lyle concurred in the judgment and opinion.
OPINION
¶1 In the first of two related appeals, plaintiff, the Village of Mount Prospect, appeals the
circuit court’s order affirming the Village hearing officer’s decision that defendant, Eric Mertes,
qualifies for health insurance benefits under the Public Safety Employee Benefits Act (820 ILCS
No. 1-22-1787 & 1-22-1790 (consol.)
320/1 et seq. (West 2022)) (appeal No. 1-22-1790). The issues in the Village’s appeal are whether
the hearing officer clearly erred in concluding that (1) Mertes’s disability was the result of injuries
sustained while responding to emergencies, therefore qualifying him for benefits, and (2) the
Village’s obligation to pay Mertes’s premiums under the Act attached when his injury was
declared catastrophic.
¶2 In the second appeal, Eric and Kendra Mertes appeal the hearing officer’s order that the
Village was not required to reimburse them for premiums paid to another insurer after the Village
stopped paying premiums on their Village-provided insurance (appeal No. 1-22-1787). At issue is
whether the Village’s obligation to pay Mertes’s premiums under the Act is obviated by the
availability of alternative insurance.
¶3 For the following reasons, we affirm the hearing officer’s conclusion that Mertes’s
catastrophic disability qualified him for benefits under the Act and that the Villages’ obligation
attached when Mertes’s injury was declared catastrophic (No. 1-22-1790). We reverse the hearing
officer’s conclusion that the Village had no obligation to pay Mertes’s insurance premiums, and
we remand for further proceedings (No. 1-22-1787).
¶4 I. BACKGROUND
¶5 Both appeals arise from the same facts.
¶6 Mertes worked as a firefighter and paramedic for the Village between 1997 and 2012.
Mertes’s duties included responding to fire calls, moving heavy duty fire hoses and ladders, and
performing search and rescue operations inside burning structures. As a paramedic, Mertes
provided emergency medical assistance at accident scenes, residences, and commercial locations,
which often required the lifting and transporting of citizens onto stretchers and into ambulances.
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No. 1-22-1787 & 1-22-1790 (consol.)
Prior to his employment with the Village, Mertes had never injured his back, had never received
treatment for back injuries, and had passed a preemployment physical examination and agility test.
¶7 Between 1999 and 2012, Mertes suffered numerous back injuries while responding to calls
where he provided advanced life support or transported a patient to a hospital. Mertes also injured
his back in several instances where he was not responding to an emergency. The parties agree that
Mertes suffered at least 17 distinct injuries to his lower back between 1999 and 2012. For most of
these injuries, emergency or nonemergency, Mertes was examined by Dr. Michael Fragen, who
provided medical services to Village employees, and Mertes was treated with either medication,
physical therapy, or both. After Mertes’s annual medical evaluation in 2006, Dr. Fragen
characterized his condition as a significant lumbar disk herniation as a result of his prior injuries.
¶8 On May 5, 2011, Mertes was carrying a patient out of a house on a stretcher when the
stretcher slid off a step and began to fall. Mertes grabbed it, supporting the full weight of the 50-
pound stretcher and the patient on top of it. Mertes stressed his lower back, requiring him to be
transported to the hospital. After a referral to a neurosurgeon, Mertes underwent a spinal fusion
surgery followed by physical therapy and was out of work for six months to recover. Though
Mertes did return to work in early 2012, he continued to experience pain in his back that prevented
him from performing his duties as efficiently as before.
¶9 In April 2012, Mertes again injured his back when he was struck by another vehicle while
driving a department ambulance from an automotive shop. Mertes missed several shifts but
returned to work two weeks later. He worked until October 2012 when he suffered two injuries in
the same day, one during a fire hose training exercise and another while responding to an
automobile accident. After seeing his physician, he was given leave from the department and did
not work another shift. He underwent a second spinal fusion surgery in April 2013 to repair the
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No. 1-22-1787 & 1-22-1790 (consol.)
wear to the initial fusion site. Mertes filed for a line-of-duty disability pension as a result of his
injuries. The Village of Mount Prospect Firefighters’ Pension Fund voted on March 18, 2014, to
grant Mertes the line-of-duty pension and issued a written decision on March 26. Mertes’s line-of-
duty pension was made effective retroactively to January 1, 2014.
¶ 10 Throughout his employment, Mertes and his family were covered by the Village’s group
health insurance plan, pursuant to a collective bargaining agreement. Since April 2014, Mertes has
been covered by his wife’s insurance plan through her employer, MetLife. On the same date the
Fund issued its decision, the Village sent Mertes a letter informing him that his coverage under the
group plan ended as of December 31, 2013. The letter also informed Mertes that he could continue
his coverage, but he would be responsible for the entirety of his premiums going forward. Mertes,
through counsel, sent the Village a demand that it pay his premiums pending the determination of
his eligibility under the Act. The Village sent Mertes a benefits application which he submitted in
May 2014.
¶ 11 In 2017, the Merteses filed a declaratory judgment action in the circuit court of Cook
County demanding the payment of Eric Mertes’s premiums pursuant to the Act. The complaint
was dismissed without prejudice pursuant to a stipulation that the Village provide Mertes with a
hearing on his application. In June 2019, the hearing officer appointed by the Village granted
Mertes’s application for benefits but denied that the Village had any obligation to pay the
premiums on the MetLife plan: “The obligation of the Village is to only pay to Claimant [Mertes]
any portion of the premium of the Village-sponsored health insurance plan paid by Claimant from
March 14, 2014 to the date that the Claimant commenced coverage under the MetLife Plan”—
approximately one month.
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No. 1-22-1787 & 1-22-1790 (consol.)
¶ 12 The Village filed a complaint for administrative review in the circuit court of Cook County
challenging only the hearing officer’s conclusion that Mertes was eligible for benefits. The
Merteses filed their own complaint for administrative review challenging the conclusion that the
Village was not obligated to reimburse the premiums under the MetLife policy. The cases were
consolidated, and the circuit court issued separate orders affirming the hearing officer’s decisions.
The Merteses and the Village each timely filed separate notices of appeal. Ill. S. Ct. R. 303(a) (eff.
July 1, 2017). Each case was fully briefed independently, without consolidation, however, in the
interest of judicial economy, both appeals are addressed in this opinion.
¶ 13 II. ANALYSIS
¶ 14 Village’s Appeal (No. 1-22-1790)
¶ 15 A.
¶ 16 The Village first argues that the hearing officer clearly erred in concluding that Mertes’s
injuries were sustained while responding to what he reasonably believed to be an emergency
because Mertes suffered numerous injuries over the course of his career, some during
nonemergencies. The Village contends that the hearing officer improperly considered the
cumulative effect of those injuries on Mertes’s ultimate disability. Mertes argues in response that
his disability did not need a single, remote cause, and the hearing officer correctly concluded that
the collective contribution of the injuries he sustained during emergency calls was sufficient.
Whether Mertes’s injury occurred while responding to an emergency is a mixed question of law
and fact which we review under a “clearly erroneous” standard. Pedersen v. Village of Hoffman
Estates, 2014 IL App (1st) 123402, ¶ 52. An administrative decision is clearly erroneous only
where the reviewing court is “left with the definite and firm conviction that a mistake has been
committed.” AFM Messenger Service, Inc. v. Department of Employment Security, 198 Ill. 2d 380,
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No. 1-22-1787 & 1-22-1790 (consol.)
395 (2001) (quoting United States v. United States Gypsum Co., 333 U.S. 364, 395 (1948)).
¶ 17 The Act provides that full time law enforcement, correctional officers and firefighters
killed or catastrophically injured in the line of duty shall have the entirety of their health insurance
premiums paid by their public employer:
“(a) An employer who employs a full-time law enforcement, correctional or correctional
probation officer, or firefighter, who, ***suffers a catastrophic injury or is killed in the line
of duty shall pay the entire premium of the employer’s health insurance plan for the injured
employee, the injured employee’s spouse, and for each dependent child of the injured
employee until the child reaches the age of majority[.]
***
(b) In order for the law enforcement, correctional or correctional probation officer,
firefighter, spouse, or dependent children to be eligible for insurance coverage under this
Act, the injury or death must have occurred as the result of the officer’s response to fresh
pursuit, the officer or firefighter’s response to what is reasonably believed to be an
emergency, an unlawful act perpetrated by another, or during the investigation of a criminal
act.” 820 ILCS 320/10(a), (b) (West 2022).
Thus, eligibility requires a catastrophic injury sustained in what is “reasonably believed to be an
emergency, an unlawful act perpetrated by another, or during the investigation of a criminal act.”
Id. § 10(b).
¶ 18 Under Illinois law, a “catastrophic injury” is synonymous with an injury resulting in a line-
of-duty disability pension under the Illinois Pension Code. Krohe v. City of Bloomington, 204 Ill.
2d 392, 400 (2003); Village of Vernon Hills v. Heelan, 2015 IL 118170, ¶ 33. Because Mertes was
awarded a line-of-duty disability pension, neither party here disputes that he suffered a
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No. 1-22-1787 & 1-22-1790 (consol.)
“catastrophic injury” and has satisfied the first element.
¶ 19 The Village argues that only two of Mertes’s injuries were incurred while responding to
what could arguably be considered emergencies, that neither of these incidents ended his career,
and that the nonemergency automobile accident in April 2012 was the proximate cause of his
disability. Under section 10(b), an “emergency” is defined as an “unforeseen circumstance
involving imminent danger to a person or property requiring an urgent response.” Gaffney v. Board
of Trustees of Orland Fire Protection District, 2012 IL 110012, ¶ 64. An emergency is not limited
to situations where the public is in danger. Id. ¶ 67.
¶ 20 The Act provides that a first responder may qualify for benefits if their injury occurred
during “what is reasonably believed to be an emergency.” 820 ILCS 320/10(b) (West 2022). The
inclusion of the term “reasonably believed” allows for broad applicability to the many ways an
emergency may arise during a first responder’s employment. Gaffney, 2012 IL 110012, ¶ 68.
Where a first responder suffers multiple injuries, one or more of which occurs during an
emergency, those injuries will qualify him for benefits so long as they are a contributing cause of
his ultimate disability; they do not need to be the sole cause. Richter v. Village of Oak Brook, 2011
IL App (2d) 100114, ¶ 21; see Ivetic v. Bensenville Fire Protection District No. 2, 2023 IL App
(1st) 220879, ¶¶ 42-43 (holding exposure to carcinogens while responding to emergency situations
was cause or contributing cause of plaintiff’s cancer, satisfying emergency element and qualifying
plaintiff for benefits under the Act).
¶ 21 Here, the hearing officer concluded that it was sufficient for some, but not all, of Mertes’s
injuries to have occurred while responding to what he reasonably believed to be emergencies, so
long as those injuries contributed to his ultimate disability. The hearing officer relied on a series
of cases holding that a disability may result from multiple causes and may result from an
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No. 1-22-1787 & 1-22-1790 (consol.)
aggravation of a preexisting physical condition. See, e.g., Richter, 2011 IL App (2d) 100114; Wade
v. City of North Chicago Police Pension Board, 226 Ill. 2d 485 (2007); Bahr v. Bartlett Fire
Protection District, 383 Ill. App. 3d 68 (2008); Phalin v. McHenry County Sheriff’s Department,
381 Ill. App. 3d 185 (2008). The hearing officer credited Mertes’s testimony that he believed that
many of the calls were emergencies, as well as official reports indicating that several calls required
the provision of advanced life support. On review, we are not left with the definite and firm
conviction, (Cinkus v. Village of Stickney Municipal Officers Electoral Board, 228 Ill. 2d 200,
211), that the hearing officer was mistaken in his determinations that: (1) Mertes suffered a series
of injuries in the line of duty, (2) many of those injuries occurred during what Mertes reasonably
believed to be emergencies, and (3) those injuries caused or contributed to his ultimate disability.
Consequently, the hearing officer’s conclusion that Mertes sustained a catastrophic injury in what
he reasonably believed to be an emergency was not clearly erroneous.
¶ 22 The Village maintains that apart from the two injuries it concedes occurred in response to
emergencies, Mertes was only otherwise injured on nonemergency calls and “patient lifts,” where
responders assist a person with a physically debilitating injury or illness. In support, the Village
cites Wilczak v. Village of Lombard, 2016 IL App (2d) 160205, ¶ 24, where a firefighter’s injury
while lifting a disabled citizen was found to not have occurred in response to an emergency.
However, Wilczak is distinguishable because it concerned the reasonableness of the plaintiff’s
belief that he was responding to an emergency and contained a focused analysis of the facts in that
case, where the evidence indicated the call was not an emergency and the plaintiff’s belief to the
contrary was not reasonable. Id.¶ 23 Moreover, the number of injuries that occurred in nonemergency situations is not
controlling; rather, it is the degree to which the injuries that did occur during emergencies
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No. 1-22-1787 & 1-22-1790 (consol.)
contributed to Mertes’s ultimate disability. The hearing officer credited the medical evidence that
the failure of Mertes’s spinal fusion was the catalyst for his disability. That spinal fusion was made
necessary after the May 2011 back injury (which the Village concedes was an emergency)
aggravated his condition. The hearing officer acknowledged that while some incidents may not
have been emergencies, the injuries suffered during emergencies sufficiently contributed to
Mertes’s disability.
¶ 24 B.
¶ 25 The Village next argues that the hearing officer erred in concluding that Mertes was eligible
because prior to applying for benefits, Mertes discontinued coverage under the Village’s plan and
elected to receive coverage under his wife’s MetLife plan. The Village argues its obligation to pay
Mertes’s premiums should have attached only once it was determined he was eligible, and because
he was not covered by the Village’s plan when he applied, Mertes was not qualified to receive
benefits. Mertes responds that the Village’s obligation to pay his premiums attached on the date
he was granted his line-of-duty disability pension, while he and his family were still covered by
the Village’s plan. The question of Mertes’s eligibility to apply for benefits presents a question of
statutory construction, a question of law, which we review de novo. Heelan, 2015 IL 118170, ¶ 18.
¶ 26 The obligation to pay a claimant’s insurance premiums attaches at the time the claimant is
deemed “catastrophically injured,” which typically coincides with the grant of a line-of-duty
disability pension. Nowak v. City of Country Club Hills, 2011 IL 111838, ¶ 29. The attachment of
the employer’s obligation under section 10(a) is not the same as a determination of eligibility under
section 10(b). See Cronin v. Village of Skokie, 2019 IL App (1st) 181163, ¶ 36. Public policy
supports a uniform date of attachment to account for cases where a date of injury is not readily
determinable. Nowak, 2011 IL 111838, ¶ 21. This case presents such a circumstance: a case “in
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No. 1-22-1787 & 1-22-1790 (consol.)
which the date of injury will be difficult, if not impossible, to pin down.” Id. Mertes suffers from
a disability that did not result from “a discreet, one-time injury but rather from the accumulation
of several prior injuries or the aggravation of a preexisting injury or condition.” Id.¶ 27 Often, whether the injury satisfies section 10(b) is not in dispute, and eligibility is
established simultaneously with the determination that the injury was catastrophic. Here, however,
the Village argues that Mertes’s eligibility was still an open question, and the Village’s obligation
should not have attached until that question was resolved.
¶ 28 By the terms of the Act, every claimant eligible to receive benefits will have suffered a
catastrophic injury, and therefore the attachment of the obligation on that date is uniform for all
claimants. If a claimant is deemed ineligible, the Village has no obligation, and the dispute as to
when the obligation attached is moot. If the claimant is eligible, then there remains a uniform date
upon which the obligation to pay the premiums attached. Such a result promotes judicial economy
by preventing this issue from being relitigated after every eligibility determination, however long
each may take. In the 12 years since Nowak, the General Assembly has not seen fit to upset the
supreme court’s conclusion by amending the Act, and absent any such input, its holding stands.
International Ass’n of Fire Fighters, Local 50 v. City of Peoria, 2022 IL 127040, ¶ 18 (“[O]ur
interpretation is considered part of the statute itself until the legislature amends it contrary to that
interpretation.” (Internal quotation marks omitted.)). Therefore, the Village’s obligation to pay
Mertes’s premiums attached when he was granted his line-of-duty pension.
¶ 29 The Village argues, however, that because Mertes was not enrolled in the Village’s plan at
the time he applied for benefits, he is not eligible to receive them. However, the Village’s
obligation began on the date Mertes was granted his line-of-duty pension, so any benefits to which
he is entitled are a continuation of that obligation.
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No. 1-22-1787 & 1-22-1790 (consol.)
¶ 30 Accordingly, the hearing officer’s conclusion that Mertes had satisfied the statutory
requirements to receive health benefits under the Act was not clearly erroneous.
_________________________________
¶ 31 Mertes’s Appeal (No. 1-22-1787)
¶ 32 In their appeal, Eric and Kendra Mertes argue that the hearing officer erred in concluding
that the Village is not obligated to reimburse them for premiums paid on the MetLife plan between
2014 and the present—the time between the Pension Board’s determination and the adjudication
of their claim under the Act. The Village argues that section 10(a)(1) of the Act reduces its
obligation to zero when benefits are payable from another source, and that the availability of the
MetLife plan triggered that reduction and entirely eliminated the Village’s obligation to pay
Mertes’s premiums. Because this issue hinges on the interpretation of this statutory language, our
review is de novo. Heelan, 2015 IL 118170, ¶ 18.
¶ 33 The Act requires a public employer to pay the entirety of a catastrophically injured
qualified claimant’s health insurance premiums, but creates an offset for other insurance benefits
payable from another source. Again, reviewing the language of the Act, it provides in relevant
part, as follows:
“(a) An employer who employs a full-time law enforcement, correctional or correctional
probation officer, or firefighter, who, *** suffers a catastrophic injury or is killed in the
line of duty shall pay the entire premium of the employer’s health insurance plan for the
injured employee, the injured employee’s spouse, and for each dependent child of the
injured employee until the child reaches the age of majority ***. However:
(1) Health insurance benefits payable from any other source shall reduce benefits
payable under this Section.” 820 ILCS 320/10(a)(1) (West 2022).
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No. 1-22-1787 & 1-22-1790 (consol.)
The hearing officer concluded that the Act only requires the Village to pay premiums under its
Village-sponsored insurance plan, and as a consequence, it had no obligation to reimburse
premiums Mertes paid on the MetLife plan that he obtained through his wife’s employment.
¶ 34 The language of the Act mandates that the public employer pay the “entire premium of the
employer’s health insurance plan” for a catastrophically injured or killed first responder that
otherwise qualifies. Indeed, our supreme court has held that this mandate expresses the very
purpose of the Act:
“[The Public Safety Employee Benefits Act] was enacted to protect officers who already
have been forced into retirement by a line-of-duty injury. It provides a postemployement
benefit, designed to ensure that the termination of an officer’s employment, whether by
death or by injury, does not likewise precipitate the termination of his or her family’s
employer-sponsored health insurance coverage.” (Emphasis in original.) Nowak, 2011 IL
111838, ¶ 16.
¶ 35 The Act is silent, however, on the issue presented in the Mertes’ appeal: who bears the
financial burden for the catastrophically injured first responder’s health insurance premiums from
the time he is determined to be catastrophically injured and no longer able to work (here March
18, 2014) until it is determined that he qualifies for benefits under the Act? The hearing officer’s
conclusion that Mertes qualifies for benefits under the Act, but nonetheless forfeited his right to
such benefits by obtaining alternative insurance, seems particularly anomalous since Mertes’ need
for the alternative insurance was occasioned by the Village terminating his benefits after he was
catastrophically injured and no longer able to work as a first responder. The text, structure, or
purpose of the Act does not support the notion that a catastrophically injured first responder must
sacrifice insurance coverage for himself and his family while he awaits a determination on his
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No. 1-22-1787 & 1-22-1790 (consol.)
eligibility for benefits under the Act. Quite the contrary, the Act “ensures a continuation of health
insurance coverage following the termination of the officer’s employment.” (Emphasis in original.)
Nowak, 2011 IL 111838, ¶ 17.
¶ 36 There is language in the Act that purports to “reduce benefits” payable under the Act by
health insurance benefits payable from another source. 820 ILCS 320/10(a)(1). It is this provision,
the Village contends, that extinguishes its obligation to provide health insurance benefits under the
Act. But again, Mertes’ need for MetLife policy arose because the Village terminated his health
insurance. This was not some duplicative coverage already in place. The Village refused to pay
Mertes’ health insurance premiums 1 and informed Mertes that to continue his coverage under
COBRA, he would be required to pay the entirety of his premiums. 2 The MetLife plan available
through Mertes’ wife’s employer was significantly less expensive than the Village’s plan, and it
was perfectly reasonable for Mertes to elect that option while he waited for a determination of his
eligibility for benefits under the Act. To credit the Village’s interpretation of section 10(a)(1)
would create a perverse incentive for a public employer to deny all health insurance benefits
pending an eligibility determination in the expectation that the catastrophically injured first
responder would obtain alternative benefits in the interim, which would then extinguish the public
1 In fact, after Mertes’s line-of-duty pension was granted in March 2014 and made
retroactive to January 1, 2014, the Village demanded reimbursement of expenses incurred related
to his insurance coverage between January and March (during which time he was both employed
and covered by the Village). Mertes paid the demanded reimbursement.
2 Enclosed with his application for benefits, the Village provided Mertes with a document
entitled “Public Safety Employee Benefit Act Procedure,” outlining the applicants responsibilities
in seeking benefits from the Village. This document does not require applicants to maintain
coverage under the Village’s plan during the pendency of their application, it merely informs them
that they “may remain on the Village’s health insurance plan,” (emphasis added) provided they
pay 100% of the premium cost.
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No. 1-22-1787 & 1-22-1790 (consol.)
employer’s obligation to provide any benefits under the Act. Such an absurd result is incompatible
with the purpose of the Act.
¶ 37 Similarly flawed is the contention that the mere availability of other health insurance
(regardless of entitlement, level of coverage, or cost) disqualifies a catastrophically injured first
responder receiving benefits under the Act. Under such a reading, the availability of health
insurance in the open marketplace or through the Patient Protection and Affordable Care Act (42
U.S.C. § 18001 et seq.) would seemingly always eliminate the public employer’s obligation under
the Act. A public employer would then rarely, if ever, be obligated to fulfill the requirements of
the Act, a result the legislature surely did not intend. See Chapman v. Chicago Department of
Finance, 2023 IL 128300, ¶ 29 (“[S]tatutory provisions should be read so that no term is rendered
superfluous or meaningless.”).
¶ 38 In reality, public employers in Illinois do not treat their catastrophically injured first
responders in such a shabby manner. The General Assembly’s Commission on Government
Forecasting and Accountability has issued a report on the implementation of the Act, and it has
found that nearly 20% of claimants under the Act simultaneously receive benefits from alternative
plans, with 7% of claimants receiving benefits from plans provided by their spouse’s employer.
Comm’n on Gov’t Forecasting and Accountability, Ill. Gen. Assem., Study of the Public Safety
Employee Benefits Act Pursuant to P.A. 98-0561 8 (2022). Thus, in practice, the existence of
additional insurance does not operate to foreclose a claimant’s eligibility for benefits under the
Act. This reality is certainly more congruous with the Act’s purpose.
¶ 39 In arguing for a contrary result, the Village relies on a trilogy of appellate court cases that
have held that Medicare eligibility can reduce or eliminate benefits under the Act. See Pyle v. City
of Granite City, 2012 IL App (5th) 110472, ¶ 24; McCaffrey v. Village of Hoffman Estates, 2021
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No. 1-22-1787 & 1-22-1790 (consol.)
IL App (1st) 200395, ¶ 21; Barry v. City of Chicago, 2021 IL App (1st) 200829, ¶ 27. Medicare
presents comprehensive federal health insurance “guaranteed to working individuals in the United
States who reach a designated retirement age and have paid Medicare taxes.” Pyle, 2012 IL App
(5th) 110472, ¶ 26. The holding in these cases is difficult to square with the Act’s expansive
promise to pay “the entire premium” for the “injured employee, injured employee’s spouse, and
for each dependent child.” 820 ILCS 320/10(a)(1). However, it is a tension that we need not resolve
here since those cases by their own terms are limited to the Medicare context. Those cases simply
do not speak to the situation presented in this case.
¶ 40 In short, we conclude that the hearing officer erred in his interpretation of the Act. By
securing alternative insurance when the Village stopped paying for his insurance, Mertes did not
forfeit his right to benefits under the Act. He in essence sought “cover” and mitigated his damages
pending a determination as to his eligibility for benefits under the Act. See Kelly v. Chicago Park
Dist., 409 Ill. 91, 98 (1951) (holding that a plaintiff’s duty to mitigate damages arises in virtually
any type of civil action). Mertes’s decision to avail himself of alternative insurance coverage
through his wife’s employment was a reasonable effort to limit the harm caused by the Village’s
decision to stop paying for his health insurance. In light of the hearing officer’s conclusion that
Mertes was eligible for benefits under the Act (a conclusion which we affirm in the Village’s
appeal (No. 1-22-1790)), and that the right to those benefits attaches upon the determination that
the first responder is catastrophically injured (Nowak), there is no principled reason to deny Mertes
reimbursement for the premiums he paid while waiting for that determination. Cf. Pyle, 2012 IL
(5th) 110472, ¶ 32 (affirming circuit court order that city pay insurance premiums for a period of
time). In order to put the Merteses in the same position that they would have been had the Village
paid “the entire premium” from the date of Mertes’s disability determination, the Village must
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No. 1-22-1787 & 1-22-1790 (consol.)
reimburse the Merteses for the premiums they paid on the MetLife policy.
¶ 41 Accordingly, we affirm the hearing officer’s ruling ordering the Village to reimburse
Mertes for the premiums paid between March 18, 2014, and the date he enrolled in the MetLife
plan. We reverse the hearing officer’s ruling that the Village is not obligated to reimburse Mertes
for the premiums paid under the MetLife plan. We remand for an accounting of all premiums paid
by Mertes on that plan between March 18, 2014, and the present, and order that the Village
reimburse Mertes for the premiums he paid on the MetLife policy. Further, the hearing officer is
directed to order that Mertes be enrolled in the Village’s open enrollment period, should he so
choose, whereafter his premiums will be paid by the Village in accordance with section 10(a) of
the Act.
¶ 42 III. CONCLUSION
¶ 43 For the foregoing reasons, the ruling of the hearing officer granting Mertes’s application
for benefits under the Act is affirmed. The hearing officer’s ruling that the Village is only obligated
to pay the premiums incurred on its own plan is affirmed in part, reversed in part, and remanded
with directions.
¶ 44 No. 1-22-1790 – Affirmed.
¶ 45 No. 1-22-1787 – Affirmed in part, reversed in part, remanded with directions.
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No. 1-22-1787 & 1-22-1790 (consol.)
Mertes v. Village of Mt. Prospect, 2024 IL App (1st) 221787Decisions Under Review: Appeal from the Circuit Court of Cook County, No. 20-CH-
04379; the Hon. Thaddeus L. Wilson, Judge, presiding.
Appeal from the Circuit Court of Cook County, No. 20-CH-
04409; the Hon. Thaddeus L. Wilson, Judge, presiding.
Attorneys Thomas W. Duda, of Law Offices of Thomas W. Duda, of
for Palatine, Illinois, for appellants.
Appellant:
Attorneys Jason Guisinger, Anne Skrodzki, of Klein, Thorpe, & Jenkins,
for Ltd., of Chicago, for appellee.
Appellee:
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