Could a Washington fire district buy medical insurance to satisfy its disabled firefighter care obligation?

Plain-English summary

The Washington Attorney General concluded in 1990 that a fire protection district could not discharge its statutory duty to provide medical, hospital and nursing care for a disabled firefighter merely by buying medical insurance. The old firefighter pension statute authorized payment for covered care, but not the use of pension money to purchase an insurance policy as a substitute.

The firemen's pension board had some discretion to specify authorized care providers if it used properly established procedures. That did not make an insurance policy with a restricted provider network a substitute for the board's care obligation.

Currency note

This opinion was issued in 1990. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

Could the pension fund pay premiums instead of care costs?
The opinion said no: the cited old pension law did not authorize insurance premiums in place of its medical-care benefit.

Could a pension board limit the choice of care providers?
The opinion said the board could exercise some discretion over authorized providers through properly established procedures.

Did the opinion cover every firefighter retirement system?
No. It addressed the medical-care obligation under the older chapter 41.18 pension provisions for covered firefighters.

Background and statutory framework

A legislator asked whether a fire district could fully satisfy its duty by buying a medical policy requiring disabled firefighters to see approved providers. The opinion distinguished direct payment for care under the old pension statute from the insurance program available under another retirement system. It also considered the pension board's separate authority over providers.

Citations and references

• Statutes discussed: RCW 41.18.060; RCW 41.18.015.

Source

• Landing page: https://www.atg.wa.gov/ago-opinions/firemen-pensions-disability-fire-protection-districts-medical-benefits

Original opinion text

Attorney General Ken Eikenberry

FIREMEN ‑- PENSIONS ‑- DISABILITY ‑- FIRE PROTECTION DISTRICTS ‑- MEDICAL BENEFITS

1. The obligation imposed by RCW 41.18.060 to provide medical care for a fireman who has been disabled cannot be fulfilled by the purchase of a medical insurance policy.

2. The Firemen's Pension Board established pursuant to RCW 41.18.015 may exercise some discretion in specifying authorized care providers if it does so through properly established procedures.

   ---

   August 21, 1990

Honorable Mike Padden
State Representative, 4th District
425 House Office Building
Olympia, WA 98504

Cite as: AGO 1990 No. 7

Dear Representative Padden:

By letter previously acknowledged, you have asked our opinion on a question we have rephrased as follows:

Can a fire protection district completely satisfy its obligation under RCW 41.18.060 by purchasing a medical insurance policy which requires disabled firemen to seek treatment from specified and approved care providers?

We answer your question in the manner set forth below.

ANALYSIS

Your question involves chapter 41.18 RCW, the Firemen's Relief and Pension Act of 1955. That Act provides various retirement and disability benefits for certain firefighters who [[Orig. Op. Page 2]] retired prior to March 1, 1970.1/

Furthermore, a firefighter who was covered by chapter 41.18 RCW prior to March 1, 1970, and who continued in full time employment as a firefighter after March 1, 1970, in some instances may receive benefits under chapter 41.18 RCW if such benefits exceed the benefits provided for in chapter 41.26 RCW. RCW 41.26.040(2).2/

The statute referenced in your question, RCW 41.18.060, provides in pertinent part as follows:

Whenever the retirement board, pursuant to examination by the board's physician and such other evidence as it may require, shall find a fireman has been disabled while in the performance of his duties it shall declare him inactive. For a period of six months from the time of such disability he shall draw from the pension fund a disability allowance equal to his basic monthly salary and, in addition, he shall be provided with medical, hospital and nursing care as long as the disability exists. . . .

Disability allowances and costs of medical, hospital and nursing care provided for under RCW 41.18.060 are paid from the firemen's pension fund of the respective fire protection district. See RCW 41.16.010(8), 41.18.010(12). The firemen's pension funds consist of contributions deducted from firefighters' salaries, moneys collected through local tax levies, and other miscellaneous sources. RCW 41.16.050, [41.16].060; 41.18.010(12). The firemen's pension board for the fire protection district, rather than the employing fire protection district itself, disburses moneys from the fund for medical, hospital and nursing care. RCW 41.18.060.3/

[[Orig. Op. Page 3]]

Your question seems to have two parts. The part that appears to be of foremost concern to you relates to whether RCW 41.18.060 authorizes or permits the purchase of a medical insurance policy to pay for medical, hospital and nursing care. We addressed this issue in AGLO 1975 No. 59 (copy enclosed). In that letter opinion, we compared RCW 41.18.060 to RCW 41.26.150, the section of the Law Enforcement Officers' and Firefighters' Retirement System, which addresses payment of medical expenses. We concluded as follows:

In the case of those municipal firemen who had retired before March 1, 1970, and thus did not become members of the LEFF system, the only benefits which may be legally paid to them out of a municipality's chapter 41.16 RCW firemen's pension fund are those payable in accordance with either chapter 41.16 or chapter 41.18 RCW, as the case may be; i.e., the particular pre‑1970 pension program by which a particular fireman was covered at the time of his retirement. While both [chapters 41.16 and 41.18 RCW] include provisions for the payment of disability pensions in one form or another, as well as certain medical costs related to the particular disability in question, neither law has anything in it comparable to the medical insurance program provided for by RCW 41.26.150(4) . . . Therefore, while monies [moneys] in the subject "old" firemen's pension funds may be used to pay, directly, for such medical services as are contemplated and provided for by the earlier pension laws,no legal authority exists for any disbursement of those monies [moneys] for the payment of either medical or dental insurance premiums to provide insurance against the costs of those medical services provided by the prior acts.

AGLO 1975 No. 59 at 5 (footnote omitted, emphasis added). Thus, the obligation to provide the medical care specified in RCW 41.18.060 cannot be fulfilled by the purchase of a medical insurance policy.

The second part of your question relates to whether the disabled firemen can be required to seek treatment from specified and approved care providers. This issue has also been addressed by us in a previous opinion, AGO 1967 No. 28 (copy enclosed). RCW 41.18.020 states that a firemen's pension board has power to:

(2) Pass upon and allow or disallow applications for pensions or other benefits provided by this chapter;
. . .

[[Orig. Op. Page 4]]

(4) Make rules and regulations not inconsistent with this chapter for the purpose of carrying out and effecting the same . . . .

In AGO 1967 No. 28, we analyzed chapter 41.18 RCW and concluded as follows:

[A]s we view it, the duty of the pension board, upon request by a qualified disabled fireman, is to provide appropriate hospital, medical and nursing care in accordance with procedures established by rule or regulation. . . . However, [the board should not] be simply regarded as liable for any and all medical, hospital and nursing costs incurred by the disabled fireman without regard to whether the fireman has made a prior application, and received prior approval in accordance with established procedures.

AGO 1967 No. 28 at 6-7 (citation omitted). Accordingly, it is our opinion that a firemen's pension board may, through properly established procedures, exercise some discretion in specifying authorized care providers.

In summary, although there is no authority under RCW 41.18.060 to purchase a medical insurance policy requiring disabled firemen to obtain treatment from specified and approved care providers, it is possible for a firemen's pension board to exercise some control over who the care providers shall be, so long as the board acts in compliance with established procedures.

We trust the foregoing will be of assistance to you.

Very truly yours,

KENNETH O. EIKENBERRY
Attorney General

JEAN M. WILKINSON
Assistant Attorney General

*** FOOTNOTES ***

1/A firefighter first employed as such prior to the 1955 Act may have remained and retired under the coverage of a firemen's pension act adopted prior to 1955. See AGO 1961-62 No. 45.

2/A firefighter who first became employed as such on or after March 1, 1970, is covered by chapter 41.26 RCW, the Law Enforcement Officers' and Firefighters' Retirement System and not by chapter 41.18 RCW. See RCW 41.26.040(1).

3/The Firemen's Pension Board for a fire protection district consists of five members: the chairman of that district's fire commissioners, the county auditor, the county treasurer, and two regularly employed firemen. RCW 41.18.015.