In addition to workers’ compensation and PERA disability benefits, Minnesota’s police officers and firefighters who suffer disabling injuries while performing inherently dangerous duties are also eligible for continued health insurance coverage.
Minnesota statute § 299A.465 requires that an employer of a police officer or firefighter who has been awarded PERA Duty Disability benefits continue to pay their share of the police officer or firefighter’s health insurance premiums until the officer or firefighter reaches age 65. If the officer or firefighter’s dependents had coverage through the employer at the time of the officer or fighter’s injury, the employer must also continue to pay its share of the insurance premiums for those dependents.
In plain English, that means that if you are a Minnesota police officer or firefighter, and you suffer a career-ending injury that was incurred while you were performing inherently dangerous duties, your employer has to continue to offer you the same health insurance and continue to pay their share of the premium, as though you remained on the payroll through age 65.
Although this statute seems pretty straight-forward, Meuser Law Office, P.A. has seen a huge increase in the frequency of litigation on these claims. Given the rising costs of health insurance, more and more employers are trying to deny these types of claims, and we are seeing more and more situations where it isn’t 100% clear how this statute should apply.
Here are a few of the situations the attorneys at Meuser Law Office, P.A. have seen recently and how the courts have been deciding these issues. Notably, we are seeing different courts arrive at different conclusions.
Employer Contested Case Hearings
After an officer or firefighter is awarded PERA Duty Disability benefits, an employer has the right to “appeal” that determination by requesting a Contested Case Hearing at the Office of Administrative Hearings in front of a neutral Administrative Law Judge within 60 days of notice of PERA’s Duty Disability approval. Usually “appeals” in this context are based on an employer’s argument that the police officer or firefighter doesn’t meet the Duty Disability criteria for one reason or another. We have litigated several of these cases to a favorable conclusion in front of an Administrative Law Judge, and we have settled several other contested cases for a lump sum cash settlement. A Contested Case Hearing is like an informal trial, at which evidence and testimony will be submitted, and the Administrative Law Judge makes a decision as to whether the officer or firefighter is eligible for benefits. This is considered a final determination, and either side can appeal to the Minnesota Court of Appeals.
Our office recently had an interesting case involving two employers. Arguably, the officer’s post-traumatic stress disorder was caused by his traumatic exposures at two different law enforcement agencies, and arguably, both are partially responsible for his health insurance coverage. One employer requested a Contested Case Hearing, and the other did not. The employer who did not request a Contested Case Hearing filed a Motion for Summary Judgment, arguing that he had waived his right to future health insurance coverage via Minn. Stat. § 299A.465 because he had signed an employment law release in exchange for a severance when he left that department. The Court disagreed. In fact, the Court held that employer had no right to even contest this officer’s eligibility health insurance coverage since it failed to request a Contested Case Hearing within the statutory time frame.
Suing an Employer in District Court
Even though Minn. Stat. § 299A.465 says that an employer has to request a Contested Case Hearing within 60 days of PERA’s notice of approval for Duty Disability benefits, often employers don’t do that. Instead, they admit that the disabled officer or firefighter meets the eligibility requirements for Duty Disability, but they argue that the disabled officer or firefighter is ineligible for Continued Health Insurance benefits for other reasons. Usually, these cases must then be sued out in district court. We have a couple cases currently pending in district court involving these issues, and we’ve been able to settle a few cases as well. Usually, the issues involved in cases in district court revolve around whether the disabled officer or firefighter is barred from health insurance because of a gap in coverage, because they were covered as a dependent on a spouse’s policy, or because they waived coverage in exchange for a cash benefit.
Cases Involving More Than One Employer
As mentioned, we now have a handful of cases involving multiple employers. Two cases involved post-traumatic stress disorder that was caused by an officer’s exposure to traumatic events at two different agencies, and a third case involved an officer who suffered a back injury that was re-injured with a different agency. In one of the post-traumatic stress disorder cases, notwithstanding both employers’ arguments to the contrary, the Administrative Law Judge held that even though Minn. Stat. § 299A.465 doesn’t explicitly address that situation, that a court may equitably apportion responsibility for continued health insurance coverage to two or more employers who may both be responsible for the officer’s underlying disabling condition. The second post-traumatic stress disorder case is still in litigation. On the case involving the back injury, even though two employers were both arguably responsible for the officer’s back injury, his most recent employer voluntarily agreed to pay his ongoing health insurance coverage.
Cash Incentive Insurance Waivers
With ever-rising health insurance costs, we are seeing litigation involving cash incentive waiver plans much more frequently because we are seeing more and more public employers offering such plans. Employers can offer a variety of different types of cash waiver plans, but the concept is that an officer or firefighter waives health insurance coverage through their public employer in exchange for a monthly, quarterly, or annual cash benefit. For example, an officer may have the option of waiving health insurance coverage through his employer, go on his spouse’s family plan as a dependent, and receive $250 per month from his employer as an incentive for waiving coverage. Sounds like a pretty good deal, right? Well, not necessarily. In almost every case we have seen with a cash waiver plan, the employer has argued that the officer or firefighter is ineligible for health insurance benefits. What if that officer or firefighter’s spouse loses his or her job and insurance? What if the officer or firefighter goes through a divorce or their spouse dies? What if the officer or firefighter’s spouse retires? Who pays for that officer or firefighter’s insurance?
At this point, it is unclear. We have had different results in different courts on this issue. There is a Court of Appeals case our office handled a few years ago which found that a disabled firefighter who was a dependent on his spouse’s insurance policy was eligible for Continued Health Insurance Benefits in accordance with Minn. Stat. § 299A.465, even though he was not individually covered on the city’s health insurance plan.
We also recently had an Administrative Law case where the officer had elected to waive his coverage in exchange for cash benefit, and he was a dependent on his wife’s family policy. The employer argued that he gave up his right to benefits under Minn. Stat. § 299A.465 because he accepted the cash benefit and waived coverage. The court disagreed, holding that the employer was required to continue to offer him coverage.
We currently have a case in District Court involving three officers/firefighters from the same employer that all elected the cash waiver plan offered by their employer. We expect that this case will go to the Minnesota Court of Appeals to hopefully definitively answer whether an employer is required to “continue” health insurance for a disabled officer or firefighter who waived coverage.
Occasionally run into other types of cases involving disputes over exactly what benefits are provided by Minn. Stat. § 299A.465, including a case involving a cash incentive for waiver of family coverage, cases involving HSA contributions, and cases involving reimbursement for COBRA coverage.
This is a very complex and evolving area of law. If you are a Minnesota police officer or firefighter with questions about your rights under Minn. Stat. § 299A.465, we are happy to help.
There are a variety of benefits available for Minnesota’s disabled police officers and firefighters, including, but not limited to, workers’ compensation benefits, PERA disability benefits, Continuation of Health Insurance benefits, and third-party liability claims. Contact the knowledgeable attorneys at Meuser Law Office, P.A. to learn more about your rights. Call us today at 1-877-746-5680.