Terry v. State Farm Mutual Automobile Insurance

677 N.E.2d 1019, 287 Ill. App. 3d 8, 222 Ill. Dec. 485, 1997 Ill. App. LEXIS 128
CourtAppellate Court of Illinois
DecidedMarch 19, 1997
Docket2—96—0284, 2—96—0398 cons.
StatusPublished
Cited by13 cases

This text of 677 N.E.2d 1019 (Terry v. State Farm Mutual Automobile 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
Terry v. State Farm Mutual Automobile Insurance, 677 N.E.2d 1019, 287 Ill. App. 3d 8, 222 Ill. Dec. 485, 1997 Ill. App. LEXIS 128 (Ill. Ct. App. 1997).

Opinion

JUSTICE BOWMAN

delivered the opinion of the court:

In this declaratory judgment action, defendant State Farm Mutual Automobile Insurance Company (State Farm) appeals the trial court’s order granting the motion for summary judgment filed by defendant Village of Carpentersville (Village) and denying the motion for summary judgment filed by plaintiff, John W. Terry, in which State Farm joined by filing a response. The issues on appeal are: (1) whether an employer may assert a lien pursuant to section 5(b) of the Workers’ Compensation Act (Act) (820 ILCS 305/5(b) (West 1994)) against the proceeds of a claim under an employer-paid under-insured motorist insurance policy to recover benefits paid to the employee under a worker’s compensation plan; and (2) whether an underinsured motorist insurance carrier may set off from the amount due the injured employee the amount of worker’s compensation benefits paid to the employee. We reverse and remand.

On December 27, 1994, plaintiff filed a complaint seeking a declaration of the rights of the parties under a State Farm underinsured motorist policy. In his complaint, plaintiff alleged that, on October 7, 1989, he was employed by the Village as a police officer. He further alleged that, while operating a police car, he was injured in an automobile accident with another motorist. Plaintiff filed a complaint against the other driver, and that case was settled for the $25,000 per-person liability limits of the other driver’s insurance policy.

Plaintiff filed a worker’s compensation claim against the Village. Pursuant to the settlement agreement for that claim, plaintiff received $69,023.90. Moreover, the $25,000 settlement from the other driver’s insurance carrier (minus $6,250 in attorney fees and $363 in costs) was paid directly to the Village.

Plaintiff also filed an underinsured motor vehicle claim under a State Farm policy. Although the declarations page is not included in the record on appeal, the parties agree that the declarations page lists the Village as the named insured under the State Farm policy and that the Village paid the premiums for that policy. The Village then notified plaintiff’s attorney that it was asserting a lien for the worker’s compensation payments on any recovery under the underinsured motorist claim.

State Farm filed an answer which admitted that plaintiff had settled with the other motorist for $25,000 and that the gross amount of the worker’s compensation settlement was $69,023.90. The answer also requested a declaration that State Farm was entitled to a setoff or a reduction of any underinsured motorist payments to plaintiff in an amount equal to the gross worker’s compensation settlement.

The Village filed an answer that admitted all of the allegations of plaintiff’s complaint. The Village also filed a counterclaim that sought a declaration that the Village had a statutory lien for $33,380.93 on the proceeds of any recovery under the underinsured motorist claim. The Village calculated the amount of its lien by (1) reducing the $69,023.90 worker’s compensation claim by 25% for attorney fees and (2) subtracting $18,387 previously paid to it from the $25,000 settlement with the other driver’s insurance carrier.

State Farm filed an answer to the Village’s counterclaim in which it denied the applicability of the statutory lien and sought a declaration that State Farm was entitled to a setoff or reduction of any underinsured motorist benefits paid to plaintiff in an amount equal to the gross worker’s compensation settlement.

Plaintiff filed an answer to the Village’s counterclaim in which he denied that the Village was entitled to enforce a lien on the underinsured motorist benefits in an amount equal to the worker’s compensation benefits the Village paid to plaintiff.

The Village filed a motion for summary judgment. In its motion, the Village alleged that it was entitled to be reimbursed from State Farm in the amount of the worker’s compensation benefits the Village paid to plaintiff. The Village further alleged that the setoff provision in the State Farm policy was invalid.

Plaintiff filed a motion for summary judgment in which he argued that State Farm was entitled to a setoff of the entire amount of the worker’s compensation claim and that the Village had no right to enforce a lien against the proceeds of any recovery under the under-insured motorist policy. Plaintiff also filed a response to the Village’s motion for summary judgment. The Village filed a response to plaintiff’s motion for summary judgment.

State Farm filed a response to plaintiff’s motion for summary judgment in which it agreed that it had a right to assert its setoff and that the Village had no right to enforce a lien against the under-insured motorist claim. State Farm also filed a response to the Village’s motion for summary judgment based on these same arguments. The Village filed a combined reply to both responses.

On January 26, 1996, the trial court conducted a hearing on the motions. On February 9, 1996, the trial court denied plaintiff’s motion for summary judgment (in which State Farm joined by its response) and granted the Village’s motion for summary judgment.

In its order, the trial court found that there is a patent ambiguity in the policy and that this ambiguity should be construed against State Farm as the drafter of the policy. The court further found that, because the Village expended more than $25,000 in premiums, the Village’s reasonable expectation as the insured was that it would have coverage for the loss that is the subject of this suit. Therefore, the trial court found that the Village is entitled to a lien for $69,023.90 against the proceeds of any payment made by State Farm to plaintiff under the underinsured motorist claim.

On March 8, 1996, State Farm filed a notice of appeal. On that same date, plaintiff filed a motion for reconsideration and clarification. On March 25, 1996, the trial court entered an order finding that, since the Village has recovered $25,000 of its lien from the underinsured motorist’s insurance carrier, the Village may recover no more than $44,023.90 from the proceeds of the State Farm claim.

On April 1, 1996, State Farm filed a second notice of appeal. On May 6, 1996, we granted State Farm’s motion to consolidate the appeals.

The first issue on appeal is whether an employer may assert a lien pursuant to section 5(b) of the Act (820 ILCS 305/5(b) (West 1994)) against the proceeds of a claim under an employer-paid under-insured motorist insurance policy to recover benefits paid to the employee under a worker’s compensation plan. Section 5(b) of the Act provides in relevant part:

"(b) Where the injury or death for which compensation is payable under this Act was caused under circumstances creating a legal liability for damages on the part of some person other than his employer to pay damages ***.

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Cite This Page — Counsel Stack

Bluebook (online)
677 N.E.2d 1019, 287 Ill. App. 3d 8, 222 Ill. Dec. 485, 1997 Ill. App. LEXIS 128, Counsel Stack Legal Research, https://law.counselstack.com/opinion/terry-v-state-farm-mutual-automobile-insurance-illappct-1997.