Eddy v. Sybert

783 N.E.2d 106, 335 Ill. App. 3d 1136, 270 Ill. Dec. 531, 2003 Ill. App. LEXIS 2
CourtAppellate Court of Illinois
DecidedJanuary 3, 2003
Docket5 — 01 — 0235
StatusPublished
Cited by8 cases

This text of 783 N.E.2d 106 (Eddy v. Sybert) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Eddy v. Sybert, 783 N.E.2d 106, 335 Ill. App. 3d 1136, 270 Ill. Dec. 531, 2003 Ill. App. LEXIS 2 (Ill. Ct. App. 2003).

Opinion

JUSTICE GOLDENHERSH

delivered the opinion of the court:

April D. Eddy (plaintiff) appeals from an order of the circuit court of Madison County ordering plaintiff to pay State Farm Insurance Company (State Farm) its entire subrogation lien less attorney fees of one-third for the payment of State Farm’s medical-pay lien. The issue on appeal is whether the trial court erred in awarding State Farm its full subrogation lien, minus a reduction under the fund doctrine, for medical payments made by State Farm under its contract of insurance with plaintiff. We affirm and remand with directions.

BACKGROUND

Plaintiff and Floy E. Sybert (defendant), who takes no part in this appeal, were involved in an automobile accident on November 14, 1998. Both plaintiff and defendant were insured by State Farm. Defendant’s policy with State Farm provided for maximum liability limits of $100,000 per person. Plaintiff’s policy with State Farm provided medical-pay coverage in the amount of $25,000. The terms of the insurance policy issued by State Farm to plaintiff also contained a subrogation clause that allowed State Farm to obtain plaintiffs right to recover against a third party after State Farm paid plaintiffs medical bills. The subrogation provision provided in pertinent part as follows:

“b. Under medical payments coverage:
(1) we are subrogated to the extent of our payment to the right of recovery the injured person has against any party liable for the
bodily injury.
***
(3) if the person to or for whom we make payment recovers from any party liable for the bodily injury, that person shall hold in trust for us the proceeds of the recovery[ ] and reimburse us to the extent of our payment.” (Emphasis in original.)

Upon learning of the accident, State Farm sent plaintiff a letter dated November 18, 1998, in which it outlined the rights and obligations of both plaintiff and State Farm. In the letter, State Farm specifically advised plaintiff that her policy provided for reasonable expenses for necessary medical treatment caused by the accident up to a limit of $25,000 per person and that “[t]he expenses are covered for three years from the date of the accident for bodily injury, provided the injury is discovered and treated within one year of the accident date.” State Farm also advised plaintiff, via the letter, of its subrogation rights and asserted, “We will not subrogate for the amount we have paid if your recovery from the responsible party plus our payments do not exceed your damages.”

State Farm asked plaintiff to sign a medical authorization form to allow State Farm to obtain her medical records. Plaintiff declined to do so, opting instead to allow her attorney to obtain her medical records and bills and forward them to State Farm. State Farm made payments on behalf of plaintiff and sent letters informing plaintiff of the amounts of medical bills paid on her behalf. State Farm advised plaintiff that the medical payments made by State Farm on her behalf “are subject to [State Farm’s] right to subrogation or reimbursement.”

On December 15, 1998, plaintiff filed a lawsuit against defendant. On September 29, 1999, plaintiffs counsel made a settlement demand by letter for “payment in the range of $160,000.” The parties ultimately agreed to settle for the policy limits of $100,000. On November 24, 1999, an order was entered, pursuant to a stipulation of the parties, dismissing the case with prejudice. The order also stated that the trial court retained jurisdiction to resolve lien issues.

The record shows that between December 1, 1998, and July 2, 1999, State Farm paid $19,079.82 of plaintiffs medical bills. State Farm issued two separate checks to fulfill its payment obligations under the settlement. One check was in the amount of $12,719.88, made payable to plaintiff, her attorneys, and State Farm. State Farm refused to endorse the check unless plaintiff agreed to pay the $12,719.88 to State Farm pursuant to its right of subrogation.

After the settlement, plaintiff discovered that a bill in the amount of $2,985 owed to Dr. Anderson had not been paid. On February 4,

2000, plaintiffs attorney sent a letter to State Farm requesting the payment of Dr. Anderson’s bill. The letter also explained that the check for $12,719.88 had been placed in an escrow account. Pursuant to the fund doctrine, plaintiff requested a reduction for future medical bills, estimated at $3,000, and offered State Farm $11,719.88 to settle the subrogation claim. State Farm responded that it would not pay future medical bills and denied any responsibility for the unpaid $2,985 medical bill on the basis that it had not been made aware of that bill until six months after the case was settled.

On April 5, 2000, plaintiff filed a motion to adjudicate lien, in which she asked the trial court to enter an order “adjudicating the amount of any subrogation claim[,] including a deduction for attorneys fees and unpaid medical bills pursuant to the ‘fund doctrine.’ ” On October 12, 2000, State Farm filed a response to plaintiffs motion to adjudicate lien. State Farm claimed a lien for medical payments made under plaintiffs automobile policy for $19,079.88 and agreed to allow plaintiff a reduction of one-third of that total under the fund doctrine pursuant to Baier v. State Farm Insurance Co., 66 Ill. 2d 119, 361 N.E.2d 1100 (1977). However, State Farm claimed that it had no duty to pay future medical bills or a bill submitted after a claim was settled, “because by settlingt,] [pjlaintiff destroys any right of subrogation that State Farm may have.” State Farm claimed that it did not have Dr. Anderson’s bill until February 4, 2000.

In response, plaintiff submitted Dr. Anderson’s affidavit, in which he claimed: “[0]n or about November 19, 1998, Dr. Peter J. Anderson issued a physician’s lien to State Farm which notified State Farm Insurance that Illinois SW Orthopedics, Ltd.[,] asserted a lien for treatment, care, physician’s services[,] and maintenance upon any and all claims and causes of actions which April Eddy may assert against any persons for damages on account of personal injuries alleged to have been received in an accident that occurred on or about 11/14/98. The physician’s lien letter notified State Farm that the amount of lien was the balance at the time of settlement.” Dr. Anderson attached a copy of the lien letter, as well as the receipt for the lien letter signed by an agent for State Farm. Dr. Anderson further set forth in the affidavit that a member of his staff called State Farm on May 24, 1999, and informed State Farm that medical charges for the services of Dr. Anderson remained unpaid and that, prior to the telephone call, the bills had been sent to State Farm. Plaintiff asserted that a balance of $2,985 remained.

State Farm introduced evidence that it paid $19,079.82 in medical bills for plaintiff under the medical-pay provision in her policy.

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Cite This Page — Counsel Stack

Bluebook (online)
783 N.E.2d 106, 335 Ill. App. 3d 1136, 270 Ill. Dec. 531, 2003 Ill. App. LEXIS 2, Counsel Stack Legal Research, https://law.counselstack.com/opinion/eddy-v-sybert-illappct-2003.