Puritt v. Allstate Insurance

672 N.E.2d 353, 284 Ill. App. 3d 442, 219 Ill. Dec. 845
CourtAppellate Court of Illinois
DecidedOctober 15, 1996
Docket1-95-2678
StatusPublished
Cited by6 cases

This text of 672 N.E.2d 353 (Puritt v. Allstate 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
Puritt v. Allstate Insurance, 672 N.E.2d 353, 284 Ill. App. 3d 442, 219 Ill. Dec. 845 (Ill. Ct. App. 1996).

Opinion

JUSTICE WOLFSON

delivered the opinion of the court:

This case concerns an insured’s claim against his insurance company for medical payments benefits. It is more than a dispute about amounts. The insured, Wilburt Puritt (Puritt), contends Allstate Insurance Company (Allstate) has a regular policy and practice of underpaying the medical bills incurred by its insureds.

Puritt filed suit against Allstate. In it, he sought individual and class action relief. Dr. Kirsten Knudsen, assignee of the rights of five other Allstate insureds, also is a named plaintiff in these breach of contract and declaratory judgment claims against Allstate. Allstate filed motions to dismiss the complaint, contending the plaintiffs lacked standing to bring their lawsuit and that this is not a proper class action. The trial judge granted Allstate’s motions. We reverse and remand for further proceedings.

BACKGROUND

The contract provision that underlies this action is the automobile medical payments section in the insurance policy Allstate issued to Puritt and the five assignors. It provides:

"Allstate will pay to or on behalf of an insured person all reasonable expenses actually incurred for necessary medical treatment, medical services or medical products actually provided to the insured person.”

Later, in the medical payments section, under the heading of "Unreasonable or Unnecessary Medical Expenses,” the policy provides:

"If the insured person incurs medical expenses which are unreasonable or unnecessary, we may refuse to pay for those medical expenses and contest them. Unreasonable medical expenses are fees for medical services which are substantially higher than the usual and customary charges for those services. Unnecessary medical expenses are fees for medical services which are not usually and customarily performed for treatment of the injury, including fees for an excessive number, amount or duration of medical services.”

And then:

"If the insured person is sued by a medical services provider because we refuse to pay contested medical expenses, we will pay all defense costs and any resulting judgment against the insured person.”

The policy is silent on what happens to health provider claims that do not become lawsuits.

After Puritt’s complaint was dismissed with leave to amend, he and Dr. Knudson filed the "First Amended Class Action Complaint for Declaratory Relief and Damages” that is the subject of this appeal.

The amended complaint alleged that Puritt was a person covered by an Allstate insurance policy, that he had been injured in an automobile accident, that he had received medical treatment and agreed to pay for the services rendered, that he had submitted the medical claims to Allstate, and that the claims were not paid in full based on Allstate’s determination that the charges were unreasonable. He also alleged he paid his medical provider the balance of the charges not paid by Allstate.

Dr. Knudsen was identified in the complaint as a doctor of chiropractic medicine who treated five patients covered by Allstate policies. She alleged each of these patients had been involved in an automobile accident, had submitted claims to Allstate under medical payments provisions of the policy for treatment rendered by her, and had received only partial payment of the bills. Dr. Knudsen’s allegation that assignments from her patients placed her in their shoes for purposes of this lawsuit went unchallenged.

Both Puritt and Dr. Knudsen alleged, as individuals and on behalf of a purported class believed to be in excess of 5,000 members, that Allstate’s refusal to pay the full amount of the bills was unreasonable and represented breaches of the insurance contract. The core allegation is that Allstate has a policy and practice of rejecting all or part of legitimate medical claims by using a payment schedule that is unreasonably low and arbitrarily set, without regard to the "usual and customary” fees actually charged by similar medical care providers within the applicable geographic region.

Allstate brought motions seeking dismissal under sections 2 — 606, 2 — 615, and 2 — 619 of the Civil Practice Law (735 ILCS 5/2 — 606, 2 — 615, 2 — 619 (West 1992)). The trial judge dismissed the individual and class actions with prejudice.

When dismissing Puritt’s individual action, the trial judge went beyond the face of the pleadings to consider an affidavit submitted by Allstate. We assume that dismissal was under section 2 — 619. See Janes v. Albergo, 254 Ill. App. 3d 951, 626 N.E.2d 1127 (1993). Dismissal of Dr. Knudsen and the class appears to be based on section 2 — 615, since the trial judge found the plaintiffs’ pleadings failed to establish standing and precluded a class action as a matter of law. See Evers v. Edward Hospital Ass’n, 247 Ill. App. 3d 717, 617 N.E.2d 1211 (1993).

Either way, we review the trial judge’s orders de novo. See Sherman v. Kraft General Foods, Inc., 272 Ill. App. 3d 833, 651 N.E.2d 708 (1995); Crespo v. Weber Stephen Products Co., 275 Ill. App. 3d 638, 656 N.E.2d 154 (1995).

DECISION

1. Standing of the individual plaintiffs.

Allstate contends, and the trial judge apparently agreed, that Puritt lacked standing for two reasons. First, because he "manufactured” standing by paying his medical bills in full; second, because he did not and could not suffer any injury.

While we agree that a litigant cannot manufacture standing via "subsequent events” (CSM Insurance Building, Ltd. v. Ansvar America Insurance Co., 272 Ill. App. 3d 319, 323-24, 649 N.E.2d 600 (1995)), we find nothing like that happened here. Puritt paid his bills seven days before his first complaint was filed. The fact that he did not allege payment in his original complaint, but did in his first amended complaint, is of no consequence.

Allstate contends the only way Puritt could establish he was injured is by refusing to pay the bill, wait for a claim against him by the medical provider, then rely on Allstate to defend and indemnify him. Puritt does not have to wait for a lawsuit against him, says Allstate, despite the policy language that keeps the insurance company on the sidelines until its insured "is sued by a medical services provider.”

As proof that the policy means more than it says, Allstate filed an affidavit of its claims manager, John Valaitis:

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Bluebook (online)
672 N.E.2d 353, 284 Ill. App. 3d 442, 219 Ill. Dec. 845, Counsel Stack Legal Research, https://law.counselstack.com/opinion/puritt-v-allstate-insurance-illappct-1996.