Till v. National General Accident & Health Insurance Co.

2024 IL App (3d) 220479-U
CourtAppellate Court of Illinois
DecidedFebruary 23, 2024
Docket3-22-0479
StatusUnpublished

This text of 2024 IL App (3d) 220479-U (Till v. National General Accident & Health Insurance Co.) 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
Till v. National General Accident & Health Insurance Co., 2024 IL App (3d) 220479-U (Ill. Ct. App. 2024).

Opinion

NOTICE: This order was filed under Supreme Court Rule 23 and may not be cited as precedent by any party except in the limited circumstances allowed under Rule 23(e)(1).

2024 IL App (3d) 220479-U

Order filed February 23, 2024 ____________________________________________________________________________

IN THE

APPELLATE COURT OF ILLINOIS

THIRD DISTRICT

CHARLES TILL, ) Appeal from the Circuit Court ) of the 18th Judicial Circuit, Plaintiff-Appellant, ) Du Page County, Illinois. ) v. ) Appeal No. 3-22-0479 ) Circuit No. 22-LA-320 NATIONAL GENERAL ACCIDENT AND ) HEALTH INSURANCE COMPANY, ) The Honorable ) Angelo J. Kappas, Defendant-Appellee. ) Judge, Presiding. ________________________________________________________________________

JUSTICE HETTEL delivered the judgment of the court. Presiding Justice McDade and Justice Brennan concurred in the judgment. ____________________________________________________________________________

ORDER

¶1 Held: Trial court properly dismissed plaintiff’s claims for breach of contract and bad faith against insurer based on res judicata where claims were based on same facts as plaintiff’s previously filed federal claim against insurer, which district court dismissed for failure to state a claim.

¶2 Plaintiff Charles Till filed a complaint against his medical insurer, defendant National

General Accident and Health Insurance Company, in federal court alleging that defendant violated

the Employment Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq.

(2018)). Defendant filed a motion to dismiss, asserting lack of subject matter jurisdiction and failure to state a claim. The district court dismissed plaintiff’s action for failure to state a claim.

Thereafter, plaintiff filed a complaint in Du Page County Circuit Court against defendant alleging

breach of contract and bad faith. Defendant filed a motion to dismiss asserting that plaintiff’s

complaint was barred by res judicata. The circuit court granted defendant’s motion and dismissed

plaintiff’s complaint on res judicata grounds. Plaintiff appeals that dismissal. We affirm.

¶3 BACKGROUND

¶4 On March 14, 2018, plaintiff went to the emergency room after losing consciousness.

According to plaintiff, emergency room medical staff did not perform any definitive examinations

or tests on him and did not provide him with a diagnosis. Plaintiff left the hospital the same day.

¶5 The next day, plaintiff purchased a short-term medical insurance policy from defendant,

effective March 16, 2018, to January 14, 2019. The policy had a “Pre-Existing Condition

Exclusion,” which stated: “Charges resulting directly or indirectly from a Pre-Existing Condition

are excluded from coverage hereunder.” The policy defined “Pre-Existing Condition” as “a

condition for which medical advice, diagnosis, care, or treatment (including receiving services and

supplies, consultations, diagnostic tests or prescriptive medicines) was recommended or received

within the 12 months immediately preceding the Effective Date.”

¶6 On March 17, 2018, plaintiff returned to the emergency room. At that time, medical staff

diagnosed plaintiff with a pulmonary embolism. Plaintiff received medical treatment for his

condition and remained in the hospital until March 21, 2018. Plaintiff sought coverage from

defendant for the medical expenses he incurred from March 17 to 21, 2018. Defendant denied

plaintiff coverage, asserting the pre-existing condition policy exclusion. Plaintiff filed an appeal

with defendant, which defendant denied. Plaintiff continued to appeal defendant’s decision, and

2 on March 2, 2020, defendant notified plaintiff that his internal and external appeal review rights

had been exhausted.

¶7 On May 31, 2021, plaintiff filed an action against defendant in the United States District

Court for the Northern District of Illinois, Eastern Division. In the opening paragraph of his

complaint, plaintiff stated: “This is an action seeking redress for Defendant National General

Insurance Company’s unlawful denial of benefits to the Plaintiff in violation of the Employment

Retirement Income Security Act (“ERISA”) 29 U.S.C. § 1132(a)(3); and Illinois statutory and

common law theories of recovery.” The sole count of plaintiff’s complaint alleged “Denial of

Benefits in Violation of the Employment Retirement Income Security Act.”

¶8 Defendant filed an answer to the complaint admitting that “the Court has jurisdiction over

the subject matter of this Complaint.” Defendant later filed a motion to withdraw its answer, as

well as a motion to dismiss, pursuant to Federal Rule of Civil Procedure 12(b)(1) and (6) (Fed. R.

Civ. P. 12 (eff. Dec. 1, 2009)), asserting lack of subject matter jurisdiction and failure to state a

claim.

¶9 On March 8, 2022, the federal district court issued its written memorandum opinion and

order. In the first paragraph of that order, the court stated:

“National General has moved to dismiss for lack of subject matter jurisdiction and failure

to state a claim. R. 16. The motion to dismiss for failure to state a claim is granted.” Till v.

National General Accident and Health Insurance Co., No. 21-C-1256, slip op. at 1 (March

8, 2022).

After discussing the facts alleged in plaintiff’s complaint, the court then turned to the issue of

subject matter jurisdiction, ruling that it had subject matter jurisdiction over plaintiff’s ERISA

claim. The court stated:

3 “Till’s invocation of ERISA provides the court subject matter jurisdiction to decide

whether ERISA covers his policy. And a finding that Till’s policy is outside ERISA’s scope

does not thereby deprive the Court of subject matter jurisdiction; it simply means that Till’s

claim must be dismissed.” Id. at 3.

The district court then discussed the standards for sufficiently stating a claim:

“A complaint must provide ‘a short and plain statement of the claim showing that the

pleader is entitled to relief,’ [citation], sufficient to provide defendant with ‘fair notice’ of

the claim and the basis for it. [Citation.] This standard ‘demands more than an unadorned,

the-defendant-unlawfully-harmed-me accusation.’ [Citation.] While ‘detailed factual

allegations’ are not required, ‘labels and conclusions, and a formulaic recitation of the

elements of a cause of action will not do.’ [Citation.] The complaint must ‘contain

sufficient factual matter accepted as true, to “state a claim to relief that is plausible on its

face.”’ [Citation.] ‘“A claim has facial plausibility when the plaintiff pleads factual content

that allows the court to draw the reasonable inference that the defendant is liable for the

misconduct alleged.’” [Citation.] In applying this standard, the Court accepts all well-

pleaded facts as true and draws all reasonable inference in favor of the non-moving party.

[Citation.]” Id. at 4-5.

The district court then examined ERISA’s provisions and the allegations of plaintiff’s complaint

related to the insurance policy plaintiff purchased from defendant and determined that “Till’s

policy is not covered by ERISA.” Id. at 7. The district court concluded:

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2024 IL App (3d) 220479-U, Counsel Stack Legal Research, https://law.counselstack.com/opinion/till-v-national-general-accident-health-insurance-co-illappct-2024.