Klem v. Mann

665 N.E.2d 514, 279 Ill. App. 3d 735
CourtAppellate Court of Illinois
DecidedMay 6, 1996
Docket1-94-1762
StatusPublished
Cited by17 cases

This text of 665 N.E.2d 514 (Klem v. Mann) 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
Klem v. Mann, 665 N.E.2d 514, 279 Ill. App. 3d 735 (Ill. Ct. App. 1996).

Opinion

JUSTICE WOLFSON

delivered the opinion of the court:

This case concerns a group health plan’s attempt to recover some of the money it paid for medical expenses incurred by a six-year-old after he was hit by a car.

The trial judge, relying on a long-standing rule that subrogation liens against recoveries received by the estates of minors are invalid, found that the plan was not entitled to any recovery. We agree with that conclusion, but we disagree with the trial court’s dismissal of the plan’s amended intervening complaint against the minor’s father.

FACTS

On April 24, 1990, six-year-old Andrew Klem (Andrew) was injured when he was hit by a car driven by Claudia Mann (Mann). Andrew’s medical expenses of $26,739.37 were paid by the Anchor Organization for Health Maintenance (Anchor), a group health care plan sponsored by the City of Chicago. Andrew’s father, Edmund Klem, was employed by the city.

Anchor was authorized by the plan to extend benefits to members injured in accidents caused by third parties. The subscription certificate, which is the contract of insurance, provided that a "Member/ Beneficiary shall mean either a Subscriber or a Family Dependent.”

The certificate had a reimbursement provision which read:

"Section 9.4: Right of Recovery from Third Party *** ANCHOR retains *** the right to be reimbursed in the event of a recovery from [third] parties. Therefore, the beneficiary or anyone acting on his or her behalf, agrees:
(a) to fully cooperate with ANCHOR in obtaining information about the loss and its cause;
(b) to notify ANCHOR of any claim for damages made on behalf of the beneficiary in connection with the loss;
(c) to include the amount of the benefits paid by ANCHOR on behalf of the beneficiary in any claim for damages made against other parties;
(d) that ANCHOR (i) shall have a lien on all sums recovered by or on behalf of the beneficiary in connection with the loss to the extent of its payments; and (ii) may give notice of that lien to any party who may have contributed to the loss; and
(e) to reimburse ANCHOR from any funds received from these other parties by or on behalf of the beneficiary whether received by settlement, judgment, or otherwise. *** If the funds from the other parties are received by settlement, the amount ANCHOR is to be reimbursed will be the lesser of: (1) the amount paid by ANCHOR for the loss; or (2) 50% of the settlement.”

On June 21, 1990, Andrew’s parents, Edmund Klem and Salvina Klem (the Klems), filed a suit against Mann in both their individual capacities and as parents and next friends of Andrew.

In count I of their complaint, the Klems, as parents and next friends of Andrew, sought damages for the injuries Andrew received in the accident. In count II of their complaint, the Klems, in their individual capacities, sought damages for medical expenses under the Rights of Married Persons Act (Ill. Rev. Stat. 1991, ch. 40, par. 1015 (now 750 ILCS 65/15 (West 1992))) (the Family Expense Act).

On July 17, 1990, and on August 20, 1990, Anchor sent a letter to the Klems asking them to complete a "RUSH-ANCHOR Third Party Recovery Authorization.” The Klems did not do so.

On August 9,1991, Anchor sent a letter to the plaintiffs’ attorney, informing the attorney of the contractual provision in the insurance policy that gave Anchor a lien on any recovery from a third party for damages for which Anchor paid benefits. On December 23, 1993, Health Cost Controls of Illinois, Inc. (HCC), an assignee of Anchor, sent a notice of lien to the plaintiffs’ attorney.

On December 30,1993, the plaintiffs’ attorney wrote HCC, informing it that the parents would be dismissing their claim for medical expenses. On January 21, 1994, the parents filed a notice of motion stating that they intended to dismiss count II of their complaint on that date. The notice of motion did not name HCC as a recipient. On January 21, the plaintiffs dismissed their claim for damages under the Family Expense Act and the plaintiffs’ attorney wrote HCC to inform it of the dismissal.

On January 25, 1994, the plaintiffs signed a release settling their suit against Mann for $15,000.

On February 22, 1994, the plaintiffs filed a notice of motion stating that on February 23, 1994, they would dismiss their complaint against Mann. This motion did name HCC as a recipient. On February 22 or 23 (the order is stamped "February 22” but the plaintiffs claim the order was issued February 23), the'plaintiffs dismissed their action against Mann.

On March 2, 1994, the plaintiffs filed a motion to adjudicate the lien received from HCC. On March 17, 1994, HCC’s attorney filed an appearance and presented HCC’s petition to intervene and its response to the plaintiffs’ motion.

On May 9, 1994, HCC filed an amended intervening complaint. In its complaint, HCC claimed that it was entitled to receive from the plaintiffs the money due under the insurance plan. HCC claimed that it had a valid lien on any monies paid to or on behalf of Andrew and that it was entitled to receive monies from the settlement fund. HCC attached a copy of the insurance subscription certificate.

On May 16, 1994, the trial court held a hearing to adjudicate HCC’s lien. It found no basis for the lien and adjudicated the amount to $0. HCC’s amended complaint was dismissed with prejudice. This appeal followed.

OPINION

1. HCC’s Subrogation Lien Against the Minor’s Estate

When the case against Mann was settled, the count asking for damages on Andrew’s behalf was the only remaining count. The settlement was for the benefit of Andrew’s estate.

A firm line of appellate cases has established the rule that subrogation liens against recoveries received by minors’ estates are not valid. Estate of Aimone v. State of Illinois Health Benefit Plant Equicor, 248 Ill. App. 3d 882, 619 N.E.2d 185 (1993); In re Estate of Hammond, 141 Ill. App. 3d 963, 491 N.E.2d 84 (1986); Estate of Woodring v. Liberty Mutual Fire Insurance Co., 71 Ill. App. 3d 158, 389 N.E.2d 211 (1979).

The reasoning that supports those decisions applies to this case.

The medical bills were addressed to Edmund Klem, not Andrew. Under the Family Expense Act (750 ILCS 65/15 (West 1992)), the Klems, not Andrew, were responsible for those bills.

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Bluebook (online)
665 N.E.2d 514, 279 Ill. App. 3d 735, Counsel Stack Legal Research, https://law.counselstack.com/opinion/klem-v-mann-illappct-1996.