Steadfast Insurance Co. v. Caremark Rx, Inc.

869 N.E.2d 910, 373 Ill. App. 3d 895, 311 Ill. Dec. 897, 2007 Ill. App. LEXIS 550
CourtAppellate Court of Illinois
DecidedMay 22, 2007
Docket1-06-1221 Rel
StatusPublished
Cited by16 cases

This text of 869 N.E.2d 910 (Steadfast Insurance Co. v. Caremark Rx, Inc.) 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
Steadfast Insurance Co. v. Caremark Rx, Inc., 869 N.E.2d 910, 373 Ill. App. 3d 895, 311 Ill. Dec. 897, 2007 Ill. App. LEXIS 550 (Ill. Ct. App. 2007).

Opinion

JUSTICE HOFFMAN

delivered the opinion of the court:

Steadfast Insurance Company (Steadfast) appeals from an order of the circuit court denying its motion for restitution of costs it paid defending Caremark Rx, Inc., and Caremark, Inc., in two underlying federal actions. For the reasons that follow, we affirm in part, reverse in part, and remand the cause for further proceedings.

Caremark Rx, Inc., and its subsidiary, Caremark, Inc. (hereinafter collectively referred to as Caremark), administer prescription drug benefits for health plans throughout the country. In 2001, Steadfast issued a managed care professional liability policy to Caremark. Pursuant to the policy, Steadfast agreed to pay those sums in excess of the policy’s deductible that Caremark might become legally obligated to pay as “Damages” for “Claims” made by reason of any negligent act, error, or omission committed by Caremark arising out of its rendering or failing to render “Professional Services” in the course of business. The policy excluded claims for intentional, criminal, or fraudulent acts. Under the policy, Steadfast was required to defend any “Claim” against Caremark seeking “Damages” payable under the terms of the policy, even if the allegations were groundless, false, or fraudulent.

In 2002, members of health plans administered by Caremark filed two lawsuits in federal court. The federal actions alleged that, in managing the plans’ prescription-drug benefits, Caremark breached its fiduciary duties under the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. §1001 et seq. (2000)) by conspiring with drug manufacturers to obtain for its own benefit undisclosed discounts, rebates, and “kickbacks” for favoring certain higher-priced drugs. The complaints also charged Caremark with misrepresentation and failure to disclose material information and sought an accounting. Caremark tendered the defense of these two suits to Steadfast.

In letters dated April 11, 2002, June 17, 2002, and July 10, 2002, Steadfast stated that it had no obligation to defend or indemnify Care-mark in the federal actions. Thereafter, Caremark filed a declaratory judgment action against Steadfast in the United States District Court for the Northern District of Illinois, seeking a finding that Steadfast had an obligation to defend and indemnify it with regard to the underlying federal actions. Caremark’s federal declaratory judgment action was subsequently dismissed for lack of subject matter jurisdiction.

Steadfast then filed a complaint for declaratory judgment in the circuit court of Cook County, seeking a declaration that it had no duty to defend or indemnify Caremark in the two federal actions. Caremark filed a counterclaim, seeking a declaration that Steadfast owed a duty to defend and indemnify it in the underlying actions. Caremark also sought attorney fees pursuant to section 155 of the Illinois Insurance Code (215 ILCS 5/155(1) (West 2002)), claiming that Steadfast’s denial of coverage was vexatious and unreasonable.

Steadfast and Caremark filed cross-motions for summary judgment. On September 23, 2003, the circuit court entered summary judgment in favor of Caremark, denied Steadfast’s cross-motion for summary judgment, and found that Steadfast had a duty to defend Caremark in the two underlying actions. The circuit court subsequently granted Steadfast’s motion for a finding of appealability pursuant to Supreme Court Rule 304(a) (155 Ill. 2d 304(a)). The court, however, refused to stay enforcement of the order pending the outcome of an appeal.

Steadfast appealed the circuit court’s order dated September 23, 2003. Steadfast Insurance Co. v. Caremark Rx, Inc., 359 Ill. App. 3d 749, 835 N.E.2d 890 (2005) (Steadfast I). In the appeal of Steadfast I, this court concluded that the factual allegations in the underlying complaints failed to assert conduct constituting a negligent act, error, or omission, and, as a consequence, Steadfast had no duty to defend or indemnify Caremark. Steadfast I, 359 Ill. App. 3d at 760-61. We, therefore, reversed the circuit court’s order granting Caremark’s motion for summary judgment and denying Steadfast’s motion, and entered summary judgment in favor of Steadfast regarding its duty to defend and indemnify. Steadfast I, 359 Ill. App. 3d at 762. As Care-mark’s claim for attorney fees under section 155 of the Illinois Insurance Code (215 ILCS 5/155(1) (West 2002)) was still pending in the circuit court, we remanded the matter for resolution of that claim. Steadfast I, 359 Ill. App. 3d at 762.

On remand, the circuit court denied Caremark’s claim for attorney fees. Steadfast filed a “motion for restitution,” seeking to recover the defense costs it expended in the two underlying federal actions. Attached to the motion was the affidavit of Nelson Tavares, the director of health care claims at Steadfast’s parent company, Zurich American Insurance Company. Tavares attested that Steadfast had paid $964,846.43 for Caremark’s defense in the federal actions.

The circuit court denied Steadfast’s motion for restitution, finding that Steadfast’s filing of a declaratory judgement action was the “functional equivalent” of an agreement to defend Caremark under a reservation of rights. Applying the Illinois Supreme Court’s holding in General Agents Insurance Co. of America, Inc. v. Midwest Sporting Goods Co., 215 Ill. 2d 146, 166, 828 N.E.2d 1092 (2005) (General Agents), that an insurer cannot recover defense costs paid pursuant to a reservation of rights absent a provision entitling it to such relief, the court concluded that, because the insurance policy in this case likewise contained no provision allowing Steadfast to recoup defense costs, Steadfast could not recover the costs it expended defending Caremark in the underlying actions. Steadfast subsequently filed a motion for reconsideration and a motion for leave to file a second amended complaint, seeking to add a claim for recovery of the defense costs on the basis of restitution, recoupment and/or unjust enrichment. Both motions were denied by the circuit court, and the instant appeal followed.

Steadfast contends that the circuit court erred in denying its motion for restitution. It alleges that it paid $964,846.43 in defense costs solely to comply with the circuit court’s order finding that it had a duty to defend Caremark in the underlying federal actions. Steadfast contends that, because the circuit court’s order was reversed, it is entitled to recover those defense costs.

Although it is unclear under which section of the Code of Civil Procedure (735 ILCS 5/1 — 101 et seq. (West 2004)) Steadfast’s motion for restitution was brought, similar motions have been treated as motions for summary judgment. See General Agents, 215 Ill. 2d at 153 (considering insurer’s motion for recovery of defense costs a motion for summary judgment).

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Bluebook (online)
869 N.E.2d 910, 373 Ill. App. 3d 895, 311 Ill. Dec. 897, 2007 Ill. App. LEXIS 550, Counsel Stack Legal Research, https://law.counselstack.com/opinion/steadfast-insurance-co-v-caremark-rx-inc-illappct-2007.