Municipal Employees – Appellate Court Considers the Overlap between (some) Duty Disability & WC Claims
A recent appellate court ruling discussed the interaction of the Worker’s Compensation Act with the Pension Code as it relates to work injuries sustained by firefighters and, by inference, policeman. In The City of Chicago v. Illinois Workers’ Compensation Commission, 2014 IL App (1st) 121507 WC (January 6, 2014), the claimant suffered kidney failure while undergoing training to become a paramedic with the Chicago Fire Department. He was restricted from working following his May 6, 2008 incident and then later released to work at various degrees on separate dates by different doctors. The claimant filed for a duty disability pension with the city’s Pension Board, which determined that he was capable of returning to work as a firefighter as of August 3, 2009. The Board therefore denied the claimant’s application for a disability pension. The claimant did not resume employment with the fire department, however, and on October 6, 2009, he began part-time work with a different employer. He filed an Application with the Worker’s Compensation Commission, and his case went to hearing on his claim for TTD through October 5, 2009 and TPD benefits for his diminished earnings in his new job.
The court first addressed, and rejected, the city’s argument that the claimant could not file for benefits under the Worker’s Compensation Act, due to the unique status of Chicago firefighters under the Act, whose claims are barred by statute other than for disfigurement claims. This prohibition does not apply to firefighters elsewhere in the State.
The city next argued that by virtue of the Pension Board’s determination denying petitioner’s duty related disability benefit, his claim for benefits for work-related injury before the Commission was barred by res judicata and collateral estoppel. The Court’s ruling on this issue does apply to firefighters (and policeman) throughout the State.
The court rejected the res judicata argument, which would have barred the claim entirely, relying on the fact that the Pension Board did not determine whether petitioner was or was not injured in the course and scope of his employment. In fact, the Court found that the implication from the Board’s decision was that he was injured in the line of duty. Regardless, the Pension Board’s determination that the claimant could resume the full duties of a firefighter as of August 3, 2009 – based on the medical examinations conducted by the Board and introduced into evidence during the hearing of the pension claim – meant that he was not disabled from duty as a firefighter and therefore could not receive a duty disability pension. This was a different issue than determining whether petitioner was injured in the course and scope of his employment. The court thus allowed the petitioner to proceed on his claim for benefits under the Act.
In further ruling, however, the court found that the claimant was barred from relitigating certain issues in his workers’ compensation claim, due to collateral estoppel. Specifically, the claimant was barred from relitigating whether he was disabled after August 3, 2009 and whether he was able to return to work. The Court ruled that the petitioner was prevented from claiming entitlement to benefits after August 3, 2009 at the Commission because the Pension Board had found that he was not disabled after that date and could return to work with the fire department. Because this issue was identical in both cases, the parties in both proceedings were the same or in privity with each other, and because the claimant had a full and fair opportunity to contest the issue before the Board, his claim for benefits after August 3, 2009 was barred by collateral estoppel.
It is important that municipal employers consider the similarities and differences between a workers’ compensation claim and proceedings before the city’s pension board involving its firefighters and police personnel. Even though claimants will be able to seek benefits from both sources simultaneously, decisions made in a proceeding for a disability pension may prevent a claimant from attempting to litigate those issues a second time before the IWCC.
According to our friends at the Illinois Chamber of Commerce, HB 6218 was sent to the House Labor Committee earlier this week. HB 6218 amends the Workers’ Compensation Act and establishes a new causation standard. In addition to defining the terms “accident” and “injury,” the bill provides that “injury” includes the aggravation of a pre-existing condition by an accident arising out of and in the course of the employment, but only for so long as the aggravation of the pre-existing condition continues to be the major contributing cause of the disability. An injury resulting directly or indirectly from idiopathic causes also would not be compensable.
The measure is sponsored by Republican Leader Jim Durkin with co-sponsors Dwight Kay – Darlene J. Senger – Keith P. Sommer – C.D. Davidsmeyer, Ed Sullivan, Jr., David Reis, John D. Cavaletto, Chad Hays, Mike Fortner, Michael Unes, Adam Brown, John D. Anthony, Bill Mitchell, David Harris, Kay Hatcher, Thomas Morrison, Patricia R. Bellock, Jeanne M Ives, John M. Cabello, Dan Brady, JoAnn D. Osmond, David McSweeney, Ron Sandack, Michael W. Tryon and Barbara Wheeler
Partner Steven Murdock, along with our friends at the Illinois Chamber of Commerce and Dr. Babak Lami, will be discussing the AMA Impairment Ratings used in determining Permanent Partial Disability. Topics include:
- What is the law in Illinois?
- Impairment vs. Disability?
- How is the law applied?
- When should an Impairment Rating be obtained?
- Possible “Rules” for use of AMA Ratings?
- Examples from the IWCC.
- What should we expect from this new law?
- Use of the AMA Guide and definitions.
- When are Impairment Ratings performed?
- General concepts and Case Studies – And More
Thursday, April 17, 2014 7:30 am – 9:30 am Western DuPage Training Center, 306 Main St., West Chicago, IL 60185
To register or for more information call Pam Holleman, HR Specialist/Event & Publication Sales at (855) 239-6150 or email@example.com
Continental breakfast will be served at 7:30 am – time for networking
Price includes breakfast, credits, and all materials for course
Early Bird – (For Everybody) – Sign up before April 10 – $35
Member Price – (For members of Illinois Chamber and local Chamber partners) – $55
Retail Price – $75
This seminar has been pre-approved to offer 1.5 HRCI credits
This seminar has been submitted for approval to offer 1.5 CLE credits
Seminar is approved for 2 Insurance Industry CEU credits (Texas) provided by ExamWorks
The Commission recently affirmed the Arbitrator’s decision in a recent case - Job v. State of Illinois/Ann Kiley Center - in which benefits were denied after the Arbitrator found that the Petitioner failed to prove a sudden, severe emotional shock traceable to a definite time, place and cause.
As we recently wrote, a psychological disability can be compensable, without physical injury or physical contact, but it must arise in a situation of greater dimensions than the day-to-day emotional strain and tension that all employees experience.
In this case, the Petitioner worked as a supervisor for two state-run residential homes for adults with disabilities. She allegedly suffered disabling depression and anxiety due to harassment and stress caused by her supervisors and an increased workload. The Petitioner testified that she complained to her supervisors and requested that she supervise only one home because two homes were too stressful.
The Petitioner testified that she met with her supervisors in her office after she was given a 5-day suspension for disciplinary reasons. The supervisors questioned the Petitioner and assigned her additional work. When the petitioner objected, she was advised of the consequences of her failure to complete the assigned work. The Petitioner subsequently filed an incident report with the facility director and alleged that her supervisors yelled at her, harassed her and threatened her job. She indicated that she felt sick and anxious over the next 10 days and sought treatment. She was diagnosed with anxiety and major depression.
The Arbitrator noted that circumstances were limited for the compensability of a mental disability without any physical injury. In order to do so, a claimant must show that she suffered a severe, sudden, emotional shock traceable to a definite time, place and cause. In this case, the Arbitrator found that the evidence presented failed to reach that level and that the petitioner did not prove a compensable accident that arose out of and in the course of her employment. The Arbitrator’s decision was affirmed and adopted upon review by the Commission.
Thanks to I&F attorney Mark Carter for this case summary.
Inman & Fitzgibbons is excited to announce the opening of a new office in St. Louis, Missouri. Inman & Fitzgibbons has represented employers, insurers and TPAs throughout the entire state of Illinois since it’s founding in 1990. This new office will enable the firm to offer these services to our clients throughout the state of Missouri.
In addition to Illinois and Missouri, Inman and Fitzgibbons represents clients in Iowa, Wisconsin, and Indiana in the areas of Workers’ Compensation and General Liability Defense
Workers’ Compensation claimants who are fired for reasons that are completely unrelated to their claim may still be entitled to TTD benefits, as established by the well-known Interstate Scaffolding Inc. v. Illinois Workers’ Compensation Comm’n, 236 Ill.2d 132, 923 N.E.2d 266 (2010). Since Interstate Scaffolding, there has been a lack of clarity whether employees who have work restrictions and are fired are always entitled to total temporary disability benefits. In late 2012, the IWCC issued a decision, Walter Matuszczak vs. Wal-Mart, 10 IL.W.C. 11819 (Ill. Indus. Com’n Oct. 5, 2012), that revisited Interstate Scaffolding, distinguishing and elaborating on the Illinois Supreme Court ruling in that case.
In Matuszczak, the claimant worked as a product stacker when, on March 7, 2010, containers that weighed 150-200 pounds fell on him, causing injuries to his neck, back, and right arm. On March 10, 2010, the claimant was given light duty work restrictions, which were accommodated by the employer. By June of 2011, the claimant continued to work with light duty restrictions and was still treating.
On June 12, 2011, the claimant was terminated due to the fact that he repeatedly stole cigarettes from his employer. The claimant was unable to find a job that would accommodate his work restrictions and demanded TTD benefits, which the employer denied.
At arbitration, the claimant was awarded TTD benefits from the date of termination onward. The Arbitrator relied on Interstate Scaffolding, stating, “even when the employee has been discharged, whether or not the discharge was for cause … the inquiry for deciding his entitlement to TTD benefits remains, as always, whether the claimant’s condition has stabilized. More to the point, the court [in Interstate Scaffolding] noted that if the injured employee is able to show that he continues to be temporarily totally disabled as a result of his work related injury, the employee is entitled to these benefits.”
The employer appealed, and the Commission, providing a bit of hope to employers in Illinois, reversed and modified the Arbitrator’s decision on the issue of entitlement to TTD benefits. The employer had argued that the claimant’s decision to steal cigarettes amounted to a voluntary refusal of light duty work due to the fact that the claimant knew he might be fired for theft. The Commission then addressed Interstate Scaffolding in detail, asserting that Interstate Scaffolding does not prohibit a denial of TTD benefits in every situation where an employee with work restrictions is fired. The Commission stated, “We do not believe that the Interstate Scaffolding decision stands for the proposition that an injured employee, whose employment has been terminated, has an unqualified or absolute right to temporary total disability benefits[.]”
The Commission elaborated that while Interstate Scaffolding establishes that claimants who are terminated do not necessarily lose their entitlement to TTD benefits, a claimant is not entitled to benefits if the claimant is offered work by the employer that would accommodate their restrictions and the claimant voluntarily refuses to accept that work. The Commission noted that the claimant in this case testified that he knew that theft was a criminal act that could result in him being fired and that if he had not been fired then the employer would have likely continued to accommodate his work restrictions. Accordingly, the Commission found that the claimant’s decision to steal cigarettes on multiple occasions was effectively a decision to not accept the light duty work that the employer had offered him. Therefore, the Commission concluded that the claimant was not entitled to TTD benefits.
Unfortunately for Illinois employers, this story does not yet have a happy ending. On March 23, 2013 the DuPage County Circuit Court reversed the Commission, without providing a written decision, in 2012 MR 001631. The case has been appealed to the Second District Appellate Court, who will hopefully provide a clear and comprehensive analysis of the relationship between TTD benefits and the termination of an employee for cause. Check back with us soon, as we will be providing additional updates when the Appellate Court’s decision is published.
Thanks to I&F attorney Michael Bantz for the summary of this important case.
Lauren Waninski was recently interviewed in the 2013-2014 e-book edition of Ms. J.D regarding her perspective as a young attorney who went straight from undergraduate studies to law school. Lauren’s interview, which begins on page 10, can be accessed via the link joom.ag/iEUX.
Ms. JD seeks to support and improve the experiences of women law students and lawyers and strives to give voice to why it matters that women continue to overcome barriers to achieve gender parity in the legal profession. You can read more about Ms. JD here.