Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Wiacek v. Hospital Service Corp.

OCTOBER 31, 1973.

JOSEPHINE WIACEK ET AL., PLAINTIFFS-APPELLANTS,

v.

HOSPITAL SERVICE CORPORATION (BLUE CROSS) ET AL., DEFENDANTS-APPELLEES.



APPEAL from the Circuit Court of Cook County; the Hon. GEORGE OROS, Judge, presiding.

MR. JUSTICE JOHNSON DELIVERED THE OPINION OF THE COURT:

This is an appeal from a judgment for the defendants in a contract suit involving two (2) policies of insurance. The plaintiffs, Josephine Wiacek and Robert A. Wiacek, her husband, purchased insurance on January 1, 1969 from Hospital Service Corporation (Blue Cross) and Illinois Medical Service (Blue Shield), the defendants.

After a trial without a jury, the court entered a judgment in favor of defendants and against plaintiffs.

The issues presented for review are whether the trial court erred in entering a judgment in favor of defendants and against plaintiffs on the following grounds:

1. Plaintiffs' notices of claims to the defendants were not verified.

2. Plaintiffs' only evidence of the nature of her illness were hearsay.

On June 1, 1969, Josephine Wiacek ate some food (pork) at a restaurant in the vicinity of Madison, Wisconsin. Minutes later she became sick and collapsed and hit her head. Her husband drove her to the Madison General Hospital in Madison, Wisconsin for emergency care. X rays were taken, blood test, blood count, blood pressure, temperature, urinalysis test, and other tests were made. The doctor who examined her advised that she be hospitalized but, because of her baby and her husband and the long distance from Chicago, she left after being hospitalized about six (6) hours. She again collapsed on June 3, 1969 and was confined for a period of three (3) hours at St. Joseph's Hospital in Chicago, Illinois. She received similar tests. She was treated as an out-patient at both hospitals and incurred bills in the sum of $65.60. She also incurred bills for doctors' services in the amount of $25.

Plaintiffs called the defendants and requested them to pay the bills as per contract. Defendants told plaintiffs to mail in the bills. Plaintiffs complied and sent a letter of explanation to each defendant. Defendants summarily denied both claims and refused to refund the premiums paid. Plaintiffs filed suit for judgment in the amount of $180 and costs against each defendant, this being the total amount of premiums paid at $20 per month for nine (9) months.

The contract of Illinois Medical Services (Blue Shield) did not require verified notice, only written notice, and plaintiffs complied with this requirement within 30 days. (VII — Claims, A, B, C.)

The contract between the plaintiffs and Hospital Service Corporation (Blue Cross) required verified notice within sixty (60) days. Plaintiffs gave written notice immediately, and defendants could have requested additional verified notice during the remainder of the sixty (60) day period; instead, defendants summarily denied the claim as not being covered under the policy, not on the grounds of failure or refusal to give proper notice. (VI — General Conditions, (c).)

• 1 Judicial decisions in Illinois will not bar plaintiffs who give adequate notice from recovery unless the defendants are prejudiced, sustain a loss, bear a hardship, or justice will not prevail.

In the case of Anderson v. Inter-State Accident Ass'n. (1933), 354 Ill. 538, 546, 188 N.E. 844, the court stated:

"The rule is well settled that contracts of insurance are to be construed liberally in favor of the insured and strictly against the insurance company. Budelman v. American Insurance Co. 297 Ill. 222.

Neither the policy nor the statute requires a claimant to use a prescribed form in making proof of loss, nor is it required that the proof of loss shall be verified. There is no provision that any penalty or forfeiture shall follow a failure to use the particular forms furnished by the insurer. In the absence of any policy or legal requirement, courts are not authorized to place such a construction upon the language of the policy as would virtually cause a forfeiture and prevent recovery by one who ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.