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Margie Bridals v. Mutual Benefit Life Ins.

OPINION FILED JULY 5, 1978.

MARGIE BRIDALS, INC., ET AL., PLAINTIFFS-APPELLEES,

v.

MUTUAL BENEFIT LIFE INSURANCE COMPANY, DEFENDANT-APPELLANT.



APPEAL from the Circuit Court of Cook County; the Hon. RAYMOND K. BERG, Judge, presiding.

MR. JUSTICE BUCKLEY DELIVERED THE OPINION OF THE COURT:

Margie Bridals, Incorporated, and Irwin May, as conservator of the estate and person of Deborah May, brought this action against Mutual Benefit Life Insurance Company for a declaration of their rights under a group health insurance policy issued by Mutual Benefit to Margie Bridals, Incorporated, the policyholder. Cross motions for summary judgment and supporting memoranda were filed and the trial court entered summary judgment in favor of plaintiffs and against Mutual Benefit. Defendant appeals from the entry of summary judgment in plaintiff's favor and from the denial of summary judgment in its own favor. 58 Ill.2d R. 301, 303(a).

The sole issue on review is whether the trial court erred in finding that Deborah May was still a "full-time student in an accredited school" within a policy definition of "Eligible Dependent" even though she received a leave of absence from the university due to a medical condition which prevented her from attending classes.

On March 25, 1970, defendant Mutual Benefit Life Insurance Company issued its group health insurance policy No. G9000-F to the trustees of the Upper Midwest Employer's Association Group Insurance Trust, in which group insurance plan Margie Bridals, Incorporated, participated. Pursuant to the employer's participation under the group policy, a group insurance certificate was issued to Abe I. May, the father of Deborah May.

The relevant portions of the group policy provided:

eligible classes "The eligible classes of the general group shall of the general consist of each active, full-time employee, group except any such person employed on a temporary basis.

effective date of A3 No insurance will be placed in effect on an individual eligible person until all requirements of insurance Sections A1 and A2 have been fulfilled with respect to such insurance. That insurance with respect to which a person has fulfilled the requirements of the foregoing Sections A1 and A2 will become effective on the later of the fifteenth day of the month coinciding with or next following the day all requirements have been fulfilled and the effective date of this policy, provided he is then actively at work on a full-time basis at his usual place of business, otherwise on the first day thereafter upon which he returns to active work on a full-time basis at his usual place of business.

In the case of an eligible person whose Participating Employer became a participant in the Trust as of the first day of a calendar month, the effective date of individual insurance shall be such first day of the calendar month with respect to such an eligible person who satisfies all requirements of Sections A1 and A2 on such date, provided he is actively at work on a full-time basis at his usual place of business, otherwise on the first day thereafter upon which he returns to active work on a full-time basis at his usual place of business.

definition of A4 An eligible dependent is one of the eligible following persons not otherwise eligible for dependent insurance hereunder as a member of the general group.

(b) Each unmarried child of the person insured who has not reached his nineteenth birthday.

(c) Each unmarried child of the person insured who has reached his nineteenth birthday but has not reached his twenty-fourth birthday who is a full-time student in an accredited school.

definition of A6 An insured individual means the person insured insured and any dependent insured of such individual person.

termination of C5 The insurance provided under this policy dependent on the dependents of a person insured shall insurance automatically terminate upon the occurrence of the earliest of the following events:

(a) as to a particular dependent insured, termination of status as an eligible dependent as defined in Section A or accrual of the Maximum Amount ...


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