Ledingham v. Blue Cross Plan for Hospital Care of Hospital Service Corp.

330 N.E.2d 540, 29 Ill. App. 3d 339, 1975 Ill. App. LEXIS 2444
CourtAppellate Court of Illinois
DecidedJune 12, 1975
Docket74-149
StatusPublished
Cited by113 cases

This text of 330 N.E.2d 540 (Ledingham v. Blue Cross Plan for Hospital Care of Hospital Service Corp.) 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
Ledingham v. Blue Cross Plan for Hospital Care of Hospital Service Corp., 330 N.E.2d 540, 29 Ill. App. 3d 339, 1975 Ill. App. LEXIS 2444 (Ill. Ct. App. 1975).

Opinion

Mr. JUSTICE EBERSPACHER

delivered the opinion of the court:

This is an appeal from a judgment entered on a general jury verdict for the plaintiffs in the amount of $9200 and costs in the circuit court in Madison County, Illinois. Suit was brought in three counts, Count I for wilful and wanton conduct requesting both actual and punitive damages, Count II for negligence requesting compensatory damages, and Count III for breach of contract requesting only compensatory damages. Count II was dismissed by plaintiffs during trial, and the case went to judgment on Counts I and III.

Plaintiffs contracted with Blue Cross Plan for Hospital Care of Hospital Service Corporation and Blue Shield of Illinois Medical Service, a corporation, for coverage. Pursuant to an application made after July 15, 1969, a policy was issued with an effective date of August 1, 1969. No physical examination was required of the insureds. The policy contained an exemption for illnesses that occurred within 270 days before the effective date.

Since 1967 Mrs. Ledingham had adopted a health routine of having a gynecological examination and Tap Test’ each 6 months. She had such test approximately a month before she initiated her search for a health insurer. The results of the test were negative.

However on August 3, 1969, Mrs. Ledingham experienced prolonged and excessive bleeding. After bed rest and medication were prescribed, taken, and failed to produce the cure desired, a diagnostic dilatation and curettage was performed. Her condition stabilized until about September 9, 1969, when she hemorrhaged and was given medication. Her condition again stabilized, and then degenerated again. Finally, on November 25, 1969, a hysterectomy was performed.

Claims for medical and hospital bills, which total $1549.60 were submitted in proper form and in a timely fashion, but the defendants refused payment on the grounds that the condition from which Mrs. Ledingham suffered was excluded under an exclusion in the policy for preexisting illnesses. No evidence is presented that the defendants’ refusal was based on any other reason than a good faith belief that the illness could not have been contracted, and then developed to its severity on August 3, 1969; that is, in 2 days. In the report to the defendants, plaintiffs’ doctor stated that he could not be certain whether the condition was preexisting on August 1, 1969, or not. The defendants did not use harsh or threatening language in their refusal to pay on the policy. There was a dispute over whether the condition was preexisting on August 1, 1969, based upon a report of December 5, 1969, from Doctor Morrison to the defendants. In that report the doctor, pursuant to their request, discussed the existence of the two conditions prior to August 1, 1969. He stated that the existence was unknown, that is, not established; that symptoms first appeared after August 1, 1969; and that no treatment for such conditions had been furnished during 1 year prior to August 1, 1969. The defendants presented no evidence at trial, although they asserted the affirmative defense of preexisting condition. No evidence was presented that would tend to establish that, at any time, the defendant companies attempted to use their superior economic position to force any type of settlement. The defendants did not delay the trial of the case.

The issue to be decided in this case is whether punitive damages may properly be awarded in an action brought by a policyholder of a health insurance plan where the insurance company allegedly wrongfully denied benefits to the insured on the basis of a preexisting illness exclusion in the policy. The insurers’ basis for denying benefits was the statement by the doctor of the insured that he could not tell whether the illness existed prior to the date of issuance of the policy.

The insurers’ contentions are that this insurance policy is just like every other contract, and that the rule in Illinois is that punitive damages are not properly allowed in a suit on a contract. They argue the trial court erred in allowing punitive damages to be assessed in this case. They rely on several recent Illinois cases.

In Alsip Homebuilders, Inc. v. Shusta, 6 Ill.App.3d 65, 284 N.E.2d 509, a contractor built a home which did not meet the contract specifications. The contractor failed “* * * to construct and complete, in a good substantial and workmanlike manner, a residence, * * *.” The builder also forged the signature of the purchaser on a certificate of acceptance to obtain the mortgage money from the lender. The appellate court held that the trial court erred in allowing punitive damages to be assessed.

The appellate court also refused to allow punitive damages in Sears v. Weissman, 6 Ill.App.3d 827, 286 N.E.2d 777, where a corporation sold a bomb shelter to a 75-year-old woman, and then quietly dissolved itself without building the shelter, or in any way meeting its obligation.

Both of these cases rely on Ash v. Barrett, 1 Ill.App.3d 414, 274 N.E.2d 149, where the court was dealing with a contract to lease a house. The owner refused to execute the lease, and the lessee sued for compensatory and punitive damages. The court allowed the compensatory damages to stand, but reversed the award of punitive damages. The court said:

“Finally, defendant contends that the award for punitive damages was improper. Plaintiffs amended their complaint several times during the course of trial in an attempt to conform their allegations to the rule applied in some jurisdictions. The rule being that punitive damages are permissible in exceptional cases for a breach of contract when the breach amounts to an independent willful tort. 22 Am.Jur.2d, Damages, Sec. 245. Here, the breach was evidenced by the defendant’s refusal of possession knowing that plaintiffs were living in a motel together with defendant’s willfully allowing the house to remain vacant. Both events occurred after the breach. This, in our opinion, does not make an unusual case for breach of contract and was properly remedied by compensatory damages.
The rule in Illinois is that in an action for breach of contract there can be no claim for punitive damages. Hayes v. Moynihan, (1869), 52 Ill. 423, 426.” 1 Ill.App.3d 414, 418-19.

It is significant that the court in Ash did not find that the rule, applied in some jurisdictions, that punitive damages are permissible in exceptional cases for a breach of contract when the breach amounts to a willful, independent tort, was incorrect or misstated the law. They merely stated that on the facts of the case, the plaintiff had not presented “* * * an unusual case for breach of contract.”

The courts have pursued this distinction between tort and contract without disapproving of it in Alsip Homebuilders, Inc. There the court stated:

“It is significant that both counts of the counterclaim in this case were based upon tire contract. Although Count II of the counterclaim alleges fraudulent conduct on the part of Alsip, the allegations are not those of a tort action.

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

Related

Rodez v. Founders Insurance Co.
2023 IL App (1st) 220975-U (Appellate Court of Illinois, 2023)
Strahin v. Sullivan
647 S.E.2d 765 (West Virginia Supreme Court, 2007)
Voyles v. Sandia Mortgage Corp.
Appellate Court of Illinois, 2000
Koehler v. First National Bank of Louisville
597 N.E.2d 1261 (Appellate Court of Illinois, 1992)
Emerson v. American Bankers Insurance Co. of Florida
585 N.E.2d 1315 (Appellate Court of Illinois, 1992)
National Surety Corp. v. Fast Motor Service, Inc.
572 N.E.2d 1083 (Appellate Court of Illinois, 1991)
Calcagno v. Personalcare Health Management, Inc.
565 N.E.2d 1330 (Appellate Court of Illinois, 1991)
York v. Globe Life & Accident Insurance
734 F. Supp. 340 (C.D. Illinois, 1990)
Buehler Ltd. v. Home Life Insurance
722 F. Supp. 1554 (N.D. Illinois, 1989)
Raprager v. Allstate Insurance Co.
539 N.E.2d 787 (Appellate Court of Illinois, 1989)
Highway Equipment Co. v. Caterpillar, Inc.
707 F. Supp. 954 (S.D. Ohio, 1989)
Disario v. Enesco Imports Corp.
520 N.E.2d 766 (Appellate Court of Illinois, 1987)
Kaniuk v. Safeco Insurance Co.
492 N.E.2d 592 (Appellate Court of Illinois, 1986)
Matter of Boughton
60 B.R. 373 (N.D. Illinois, 1986)
F/H Industries, Inc. v. National Union Fire Insurance
635 F. Supp. 60 (N.D. Illinois, 1986)
Langendorf v. Travelers State Insurance
625 F. Supp. 1103 (N.D. Illinois, 1985)

Cite This Page — Counsel Stack

Bluebook (online)
330 N.E.2d 540, 29 Ill. App. 3d 339, 1975 Ill. App. LEXIS 2444, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ledingham-v-blue-cross-plan-for-hospital-care-of-hospital-service-corp-illappct-1975.