Health Cost Controls v. Sevilla

850 N.E.2d 851, 365 Ill. App. 3d 795, 303 Ill. Dec. 46, 2006 Ill. App. LEXIS 324
CourtAppellate Court of Illinois
DecidedApril 20, 2006
Docket1-04-2406 Rel
StatusPublished
Cited by14 cases

This text of 850 N.E.2d 851 (Health Cost Controls v. Sevilla) 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
Health Cost Controls v. Sevilla, 850 N.E.2d 851, 365 Ill. App. 3d 795, 303 Ill. Dec. 46, 2006 Ill. App. LEXIS 324 (Ill. Ct. App. 2006).

Opinion

JUSTICE GREIMAN

delivered the opinion of the court:

Counterplaintiffs-appellants Richard Sevilla and his attorney, Edward M. Burnes, appeal from the circuit court’s dismissal of certain counts of their amended counterclaim against counterdefendants Health Cost Controls of Illinois, Inc., and Health Cost Controls of America, Inc. (collectively, HCC), and third-party defendant Continental Assurance Company (CNA) as well as the denials of their multiple motions to certify several classes of counterplaintiffs or alternative classes of counterdefendants. For the reasons that follow, we affirm in part and reverse in part.

HCC is an Illinois corporation with its principal place of business in Schaumburg. Its primary business consists of asserting subrogation rights on behalf of health maintenance organizations, health.insurance carriers, and other health care plans against parties who may be liable in tort to those organizations’ insureds. HCC also asserts the contractual rights of health care plans against their members and insureds.

CNA would often contract with HCC to assert subrogation claims and reimbursement liens on its behalf against tortfeasors and insureds. The contracts provided that CNA would assign its rights to assert and collect reimbursement liens to HCC, that HCC would have broad authority and discretion in asserting and pursuing the assigned liens, that HCC would assume liability and indemnity in pursuing the liens on CNA’s behalf, and that HCC would comply with state and federal laws in asserting subrogation claims and reimbursement liens.

At issue in this case are the circuit court’s denials of counterplaintiffs’ motions to certify four distinct classes consisting of plaintiff insureds in counterclaims against defendants HCC and the health plans on whose behalf HCC asserted reimbursement liens against the insureds without reduction pursuant to the common fund doctrine. The four class actions counterplaintiffs sought to certify are as follows: (1) all individuals in all states who were insured by health plans on whose behalf HCC asserted reimbursement liens, versus HCC; (2) all CNA-insureds in all states versus HCC; (3) all insureds of all plans residing in Illinois versus HCC; and (4) all CNA-insureds residing in Illinois versus HCC.

The facts underlying the initial litigation are undisputed. In May 1992, Sevilla was covered under a health insurance policy issued by CNA through his employer. That month, he was involved in a car accident and suffered injuries. CNA disbursed $2,483.71 in medical benefits for treatment of Sevilla’s injuries. Through his attorney Burnes, Sevilla subsequently filed suit against the individuals believed responsible for the accident. Sevilla and the party he sued eventually entered into a settlement for $22,000.

While settlement negotiations were pending, HCC asserted a lien against Sevilla and on behalf of CNA in subrogation for the $2,483.71 CNA had disbursed in medical benefits. HCC sent a notice of lien to Burnes for the amount CNA had paid for Sevilla’s medical care costs incurred as a result of his injuries. HCC sought reimbursement of the $2,483.71 CNA had disbursed to Sevilla pursuant to a provision in his insurance policy. The tortfeasor’s insurer, Allstate Insurance Company, issued a check payable to Sevilla, Burnes, and HCC, for the amount of HCC’s claimed lien and issued another check for the remaining balance of the settlement proceeds to Sevilla and Burnes.

HCC was given possession of the settlement check, but Sevilla and Burnes refused to endorse it, claiming HCC was not entitled to the full amount and that the amount of recovery was subject to the common fund doctrine and therefore had to be reduced by one-third for the attorney fees Sevilla incurred in obtaining the settlement. HCC filed suit in subrogation, seeking an order .requiring Sevilla and Burnes to endorse the check in satisfaction of HCC’s lien. In their answer, counterplaintiffs maintained that CNA was obligated to bear the costs of Sevilla’s attorney fees and asserted as an affirmative defense that HCC and CNA were obligated to bear the proportionate costs and expenses incurred by Sevilla’s attorneys in obtaining the settlement, pursuant to the common fund doctrine. Counterplaintiffs made similar allegations in a class action counterclaim against HCC and CNA on behalf of other CNA insureds against whom HCC had asserted reimbursement liens without reduction in consideration of the common fund doctrine.

In 1995, HCC attempted unsuccessfully to remove its suit to federal district court, claiming that the counterclaim raised issues justiciable only under the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq. (1994)). Counterplaintiffs filed a motion to remand the case to state court, which the federal district court granted, finding that only a defendant could seek removal pursuant to federal statute.

In 1997, in the circuit court, HCC moved to dismiss its own suit as well as Sevilla and Burnes’ counterclaims for lack of subject matter jurisdiction. In response, counterplaintiffs filed additional motions for class certification and for summary judgment. Ultimately, the circuit court ruled only on HCC’s motion to dismiss for lack of subject matter jurisdiction, which it granted, and dismissed all claims.

Afterward, in April 1998, counsel for HCC sent a letter to counter-plaintiffs’ counsel waiving HCC’s previously asserted claim for reimbursement of medical benefits. The letter purported to waive and release any and all rights HCC may have had to reimbursement or subrogation against Sevilla.

Counterplaintiffs appealed to this court, contending that the circuit court’s dismissal of all claims was erroneous in that the common fund doctrine was a question of state and not federal law and that the circuit court therefore maintained jurisdiction over them. HCC argued that the initial filing of its complaint in state court was erroneous because the claims it sought to litigate arose under ERISA. This court reversed, finding that the circuit court had jurisdiction over HCC’s claim as an action seeking enforcement of an asserted lien by an insurer, as well as subject matter jurisdiction over counterplaintiffs’ counterclaims as actions under the common fund doctrine, which were not preempted by ERISA. Health Cost Controls v. Sevilla, 307 Ill. App. 3d 582, 588-92 (1999).

On remand, counterplaintiffs were granted leave to replead their counterclaims and their motions for class certification. The circuit court gave precedence to HCC’s motion to dismiss on the basis of mootness, which counterplaintiffs challenged on grounds that a controversy continued to exist between the parties and that HCC’s tendered waiver was disingenuous. The circuit court denied HCC’s motion and granted counterplaintiffs’ request for leave to amend their previously filed class definitions.

In November 2000, HCC’s successor in interest, Primax Recoveries, Inc. (Primax), filed a new complaint against Sevilla in federal district court seeking a declaratory judgment establishing the relative rights and obligations of the parties and to enjoin Sevilla from intervening with CNA’s rights to subrogation and reimbursement.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Dewalt v. The City of Belleville
2022 IL App (5th) 200366-U (Appellate Court of Illinois, 2022)
Baker v. Autos, Inc.
2015 ND 57 (North Dakota Supreme Court, 2015)
Stefanski v. The City of Chicago
2015 IL App (1st) 132844 (Appellate Court of Illinois, 2015)
S37 Management v. Advance Refrigeration Co.
961 N.E.2d 6 (Appellate Court of Illinois, 2011)
S37 Management v. Advance Refrigeration Company
2011 IL App (1st) 102496 (Appellate Court of Illinois, 2011)
Cruz v. Unilock Chicago, Inc.
892 N.E.2d 78 (Appellate Court of Illinois, 2008)
Cruz v. Unilock Chicago
Appellate Court of Illinois, 2008
Rosolowski v. Clark Refining and Marketing
Appellate Court of Illinois, 2008
Ramirez v. MIDWAY MOVING AND STORAGE, INC.
880 N.E.2d 653 (Appellate Court of Illinois, 2007)

Cite This Page — Counsel Stack

Bluebook (online)
850 N.E.2d 851, 365 Ill. App. 3d 795, 303 Ill. Dec. 46, 2006 Ill. App. LEXIS 324, Counsel Stack Legal Research, https://law.counselstack.com/opinion/health-cost-controls-v-sevilla-illappct-2006.