APPEAL from the Circuit Court of Cook County; the Hon. ARTHUR
L. DUNNE, Judge, presiding.
MR. JUSTICE JIGANTI DELIVERED THE OPINION OF THE COURT:
Plaintiff, Anthony Campione, filed a complaint for declaratory judgment against defendant Lincoln National Life Insurance Company (Lincoln National) requesting a declaration that Lincoln National be prevented from enforcing the language of the group policy and certificate under which Campione was insured and which limited coverage for a pre-existing medical condition to $2500. The trial court dismissed Campione's complaint with prejudice and Campione appeals.
Campione was insured under a policy of health and accident insurance with his former employer, Sunbeam Corporation. When he left Sunbeam in November of 1974, he had the option of continuing that insurance plan or accepting the life, health and accident policy provided as a fringe benefit by his new employer, T.V. Time Foods. The new insurer was Lincoln National.
Campione had an angina condition which first appeared in August of 1974. He first consulted his physician in October, 1974 at which time he had a mild class #1 angina condition. During the three-month period after he began to work for T.V. Time in November of 1974 that angina condition worsened to a class #4 and required open heart surgery in February 1975. The surgical and related expenses were approximately $20,000. Lincoln National refused to pay more than $2500 according to a clause in the policy which appeared at pages 9 and 10 of the certificate of insurance issued to Campione. That clause in the certificate reads in pertinent part:
Except for an initial payment up to $2500, charges for the care and treatment of illness existing on the date of coverage are not covered * * *."
Campion was not aware that Lincoln National would not pay for the surgery until the bills were submitted and Lincoln National refused to pay more than $2500. Campione argues that had he been aware that Lincoln National would pay only $2500 toward the expenses involved in treating his pre-existing angina condition he would have exercised his option to continue the coverage he had had with his former employer. He argues that because the limitation in coverage was not clearly and prominently displayed in the certificate of insurance he was not aware of the $2500 limitation.
Campione appeals contending that the trial court erred in dismissing his complaint since Lincoln National did not comply with the Illinois Insurance Code requirement that the form and content of the certificate of insurance be approved by the Director; that an insurance carrier cannot enforce an exclusion unless it is clearly and prominently displayed in the certificate; and that the doctrine of reasonable expectations applies to an insurance contract.
The Illinois Insurance Code (Ill. Rev. Stat. 1973, ch. 73, par. 613 et seq.) governs the conduct of insurance carriers in the State of Illinois. Section 143(1) of the Illinois Insurance Code entitled "Policy Forms (1) Life, Accident and Health," (Ill. Rev. Stat. 1973, ch. 73, par. 755(1)) states in pertinent part:
"No company transacting the kind or kinds of business enumerated in Class 1 of section 4 [that is, Life, Accident & Health] shall issue or deliver in this State a policy or certificate of insurance * * * in this State until the form and content of such policy, certificate * * * has been filed with and approved by the Director."
Plaintiff claims and defendant does not dispute that in this case Lincoln National submitted the policy to the Director for approval, but did not submit the certificate for approval. Lincoln National argues that they need not comply with section 143 since section 367 of the Code entitled "Group accident and health insurance" (Ill. Rev. Stat. 1973, ch. 73, par. 979) specifically covers group insurance and therefore supersedes section 143 which refers to life, health and accident policies in general. They argue further that "Class 1 of section 4" as stated in section 143 does not apply to group insurance.
1 Section 367 of the Code (Ill. Rev. Stat. 1973, ch. 73, par. 979) provides that the Director approve the form of the group policy, which is issued to the employer, and that the insurer issue a certificate to the employee "setting forth a statement as to the insurance protection to which he is entitled * * *." While this section requires that the Director approve the form of the policy, Lincoln National points out that there is no provision in section 367 which requires that the certificate be similarly approved. Lincoln National argues that section 367 supersedes section 143. Logic and public policy considerations would compel a contrary conclusion.
There is no provision in section 367 which exempts group insurance from the general provisions of section 143 which covers companies "transacting the kind or kinds of business enumerated in Class 1 of section 4." There are only three classes of insurance listed in section 4. They are: Class 1 "Life, Accident and Health"; Class 2 "Casualty, Fidelity and Surety"; and Class 3 "Fire and Marine, etc." Section 5 of the Code (Ill. Rev. Stat. 1973, ch. 73, par. 617) requires that all companies authorized to transact business in Illinois be classified according to their functions into one or more of the classes of insurance enumerated in section 4. There is no special category for group insurance as opposed to individual insurance. Since Lincoln National's group policy with ...