Margie Bridals, Inc. v. Mutual Benefit Life Insurance

379 N.E.2d 62, 62 Ill. App. 3d 542, 19 Ill. Dec. 547, 1978 Ill. App. LEXIS 2985
CourtAppellate Court of Illinois
DecidedJuly 5, 1978
Docket77-290
StatusPublished
Cited by11 cases

This text of 379 N.E.2d 62 (Margie Bridals, Inc. v. Mutual Benefit Life Insurance) 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
Margie Bridals, Inc. v. Mutual Benefit Life Insurance, 379 N.E.2d 62, 62 Ill. App. 3d 542, 19 Ill. Dec. 547, 1978 Ill. App. LEXIS 2985 (Ill. Ct. App. 1978).

Opinion

Mr. JUSTICE BUCKLEY

delivered the opinion of the court:

Margie Bridals, Incorporated, and Irwin May, as conservator of the estate and person of Deborah May, brought this action against Mutual Benefit Life Insurance Company for a declaration of their rights under a group health insurance policy issued by Mutual Benefit to Margie Bridals, Incorporated, the policyholder. Cross motions for summary judgment and supporting memoranda were filed and the trial court entered summary judgment in favor of plaintiffs and against Mutual Benefit. Defendant appeals from the entry of summary judgment in plaintiffs favor and from the denial of summary judgment in its own favor. 58 Ill. 2d R. 301, 303(a).

The sole issue on review is whether the trial court erred in finding that Deborah May was still a “full-time student in an accredited school” within a policy definition of “Eligible Dependent” even though she received a leave of absence from the university due to a medical condition which prevented her from attending classes.

On March 25,1970, defendant Mutual Benefit Life Insurance Company issued its group health insurance policy No. G9000 — F to the trustees of the Upper Midwest Employer’s Assocation Group Insurance Trust, in which group insurance plan Margie Bridals, Incorporated, participated. Pursuant to the employer’s participation under the group policy, a group insurance certificate was issued to Abe I. May, the father of Deborah May.

The relevant portions of the group policy provided:

eligible classes of the general group

“The eligible classes of the general group shall consist of each active, full-time employee, except any such person employed on a temporary basis.

0 0 0 0

effective date of individual insurance

A3 No insurance will be placed in effect on an eligible person until all requirements of Sections Al and A2 have been fulfilled with respect to such insurance. That insurance with respect to which a person has fulfilled the requirements of the foregoing Sections Al and A2 will become effective on the later of the fifteenth day of the month coinciding with or next following the day all requirements have been fulfilled and the effective date of this policy, provided he is then actively at work on a full-time basis at his usual place of business, otherwise on the first day thereafter upon which he returns to active work on a full-time basis at his usual place of business.

In the case of an eligible person whose Participating Employer became a participant in the Trust as of the first day of a calendar month, the effective date of individual insurance shall be such first day of the calendar month with respect to such an eligible person who satisfies all requirements of Sections Al and A2 on such date, provided he is actively at work on a full-time basis at his usual place of business, otherwise on the first day thereafter upon which he returns to active work on a full-time basis at his usual place of business.

definition of eligible dependent

A4 An eligible dependent is one of the following persons not otherwise eligible for insurance hereunder as a member of the general group.

(b) Each unmarried child of the person insured who has not reached his nineteenth birthday.

(c) Each unmarried child of the person insured who has reached his nineteenth birthday but has not reached his twenty-

fourth birthday who is a full-time student in an accredited school.

ft ft ft ft

definition of insured individual

A6 An insured individual means the person insured and any dependent insured of such person.

termination of dependent insurance

C5 The insurance provided under this policy on the dependents of a person insured shall automatically terminate upon the occurrence of the earliest of the following events:

(a) as to a particular dependent insured, termination of status as an eligible dependent as defined in Section A or accrual of the Maximum Amount of Benefit by such dependent insured;

extended benefit

C6 If the insurance of an insured individual terminates for a reason other than payment or accrual of the Maximum Amount of Benefit and if the insured individual is totally disabled by accidental bodily injury or sickness at the date of such termination, benefits shall accrue, subject to the other provisions and limitations of this policy, as though insurance had not terminated, for covered charges incurred (i) solely on account of such injury or sickness, (ii) during the uninterupted continance [sic] of such disability, and (iii) before the end of the calendar year next following the calendar year in which insurance terminated.

As used herein total disability means

(b) in the case of a dependent insured, disability which prevents him from-engaging in and performing his regular and customary duties or activities.”

This language is substantially the same as the language of the insurance certificate issued to Abe I. May.

Prior to October 14,1974, Deborah May was unmarried, over the age of 19, but less than the age of 24, and enrolled as a full-time student in the College of Arts and Sciences at Northwestern University, Evanston, Illinois. On or about October 14, 1974, Deborah May developed a condition known as anorexia nervosa and was hospitalized intermittently since that time. As a result, she officially withdrew from classes and obtained a leave of absence from Northwestern University. Since October 14,1974, Deborah May had neither been enrolled in nor attended classes at Northwestern University or at any other educational institution. 1

On October 31,1975, the Northwestern University Registrar wrote the following letter to Mutual Benefit Life Insurance Company:

“Our records show that Deborah May was enrolled in the College of Arts and Sciences at Northwestern University as a full time student in good standing from September, 1973, to October 24, 1974, at which time she officially withdrew from classes for medical reasons.* * *
[S]he is regarded as being on a leave of absence. This means that when she is prepared and able to do so, she may continue her course of study. She may register upon completion of an information from and, perhaps, a medical interview.”

The record discloses no genuine issue of any material fact and we need only determine if the plaintiff was entitled to judgment as a matter of law. (Joseph W. O’Brien Co. v. Highland Lake Construction Co. (1972), 9 Ill. App. 3d 408, 292 N.E.2d 205

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Bluebook (online)
379 N.E.2d 62, 62 Ill. App. 3d 542, 19 Ill. Dec. 547, 1978 Ill. App. LEXIS 2985, Counsel Stack Legal Research, https://law.counselstack.com/opinion/margie-bridals-inc-v-mutual-benefit-life-insurance-illappct-1978.