by John E. Motylinski (Spring 2017)
In considering applications for disability pension benefits, pension boards are often called upon to weigh evidence and make findings of fact. Where there is a conflict in testimony or evidence, therefore, it is the pension board’s job to resolve the dispute one way or another — just as a trial court judge or jury would do.
While pension boards resolve contested facts in many situations, two of the most controversial scenarios arise when the doctors performing independent medical evaluations (“IMEs”) disagree as to whether the applicant is disabled or whether the disability occurred in the line of duty. In these cases, the pension board’s findings may deeply impact the trajectory of the matter.
Generally, Illinois courts afford pension boards a great deal of deference as to their conclusions of fact and weight of the evidence. In fact, if there is any evidence in the record supporting a pension board’s determination, Illinois courts usually that the pension board’s decision be upheld on appeal. Therefore, a court will typically uphold a pension board’s decision to give more weight to one IME doctor over the other two. But, as the recent case of Hopkins v. Board of Trustees of Firefighters Pension Fund of City of East St. Louis, 2016 IL App (5th) 160006, makes clear, the power to make such findings of fact is not unlimited.
In Hopkins, a firefighter suffered two major on-duty injuries that ultimately led him to file an application for disability benefits.
The first injury occurred in 2009, when the firefighter was hit on the head by an overhead door while fighting a fire. As a result of this injury, the firefighter underwent an IME with Dr. Katz as part of the underlying workers’ compensation proceedings. Dr. Katz found that the firefighter suffered a neck sprain, received appropriate treatment, and had reached maximum medical capacity.
Dr. Katz released the firefighter back to work at his secondary job at U.S. Steel, but found that the firefighter could not continue to perform as a firefighter because he had degenerative arthritis in his knees and had undergone two unrelated surgeries. Nevertheless, the firefighter resumed firefighting.
The second injury occurred in 2011. While responding to a fire, the firefighter was hit on the head by a heavy object that was blown off of a burning building. The firefighter was knocked unconscious and required to undergo neck surgery to repair the damage.
The firefighter was eventually released back to firefighting, but his symptoms reoccurred. After completing physical therapy and other treatment, the firefighter could not wear required headgear without pain. Therefore, he applied for disability benefits with his pension fund.
The pension board sent the firefighter to three IME physicians. Each IME doctor certified that the firefighter was disabled because of the 2009 and 2011 accidents. Nonetheless, the pension board denied the firefighter’s application for line of duty benefits. In so doing, the pension board rejected the IME physicians’ unanimous opinions and instead, relied upon Dr. Katz’s 2009 IME report to establish that the applicant was not disabled. The firefighter appealed.
On appeal, the Illinois Appellate Court reversed the pension board’s decision, finding that the board’s reliance on Dr. Katz’s opinion was erroneous and against the manifest weight of the evidence. First, the court noted Dr. Katz was not actually an impartial physician — he was a paid expert who was hired to testify on behalf of the City of East St. Louis in its defense of the firefighter’s workers’ compensation claim.
Furthermore, the appellate court stated that pension boards should not rely on the opinion of a doctor who “failed to consider or to base his opinion on relevant, material evidence that was key under the circumstances of the case.” In this instance, Dr. Katz’s IME took place in 2009 – two years prior to the 2011 injury that contributed to the firefighter’s claimed disability. Accordingly, even though the pension board had discretion to weigh the medical evidence, it could not give more credence to Dr. Katz, as he did not consider material evidence arising from the 2011 injury.
The Hopkins case clearly illustrates that the power of pension boards to make factual determinations is broad, but not unlimited. Even though a board’s factual determination will be accorded great deference, it must be based on competent evidence. Therefore, pension boards should exercise great care in supporting their determinations when considering disability matters, particularly where the IME physician upon whom they are relying is in the minority.