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.

Siegal v. Health Care Serv. Corp.

OPINION FILED FEBRUARY 5, 1980.

SOL SIEGAL ET AL., PLAINTIFFS-APPELLEES,

v.

HEALTH CARE SERVICE CORP., D/B/A BLUE CROSS-BLUE SHIELD, DEFENDANT-APPELLANT.



APPEAL from the Circuit Court of Cook County; the Hon. RUSSELL R. DeBOW, Judge, presiding.

MR. JUSTICE STAMOS DELIVERED THE OPINION OF THE COURT:

This action was brought to recover benefits under a major medical insurance policy issued by defendant. Plaintiffs' complaint in two counts was predicated on a contract theory for breach of the medical insurance policy and a wilful tort theory for breach of implied duty to deal in good faith. The jury returned a verdict of $20,000 compensatory damages for breach of contract and $55,000 punitive damages for the wilful tort. Defendant filed a post-trial motion seeking either judgment notwithstanding the verdict or a new trial. From the judgment on the verdict and the denial of the post-trial motions defendant appeals, contending that the proof was insufficient to support the jury verdict, and a new trial or directed verdict should have been granted; that punitive damages were improperly assessed against a not-for-profit corporation, Blue Cross-Blue Shield; and that certain errors in the admission of evidence and the presentation of instructions to the jury were committed by the trial court.

Defendant, Health Care Service Corporation, d/b/a Blue Cross-Blue Shield, issued a comprehensive major medical policy to plaintiff Sol Siegal which provided for family coverage. The initial policy of April 1, 1976, provided:

"(15) `Covered Medical Expenses' means the regular and customary charges incurred by a Beneficiary for necessary services or other items, subject to the Exclusions of IV, as follows:

(k) Private nursing services of an actively practicing nurse, other than a nurse who ordinarily resides in the Beneficiary's home, or is a member of the Beneficiary's immediate family, as follows:

(2) Other than in a Hospital, services of a registered nurse (R.N.);

ARTICLE IV — EXCLUSIONS

No benefits shall be provided hereunder on account of

(6) Services or supplies not necessary to treatment of injury or illness; * * *."

On April 1, 1977, plaintiffs' insurance group purchased a different plan which provided coverage, inter alia, for:

"(22) Private Duty Nursing Services When services of an actively practicing registered nurse or licensed practical nurse, other than a nurse who ordinarily resides in a Member's home or is a member of the Member's immediate family, when the attending Physician verifies the medical necessity for active treatment.

ARTICLE V

EXCLUSIONS

A. No payment will be made under Article IV of Part `C' for any expenses incurred ...


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.