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Pfluger v. Sundstrand Corp.

OPINION FILED MAY 15, 1980.

ROBERT A. PFLUGER, D.D.S., ET AL., PLAINTIFFS-APPELLANTS,

v.

SUNDSTRAND CORPORATION, DEFENDANT-APPELLEE.



APPEAL from the Circuit Court of Winnebago County; the Hon. ROBERT C. GILL, Judge, presiding.

MR. JUSTICE UNVERZAGT DELIVERED THE OPINION OF THE COURT:

Robert A. Pfluger, a dentist, and Daniel P. Person, a former employee of Sundstrand Corporation, brought a declaratory judgment action against Sundstrand to recover certain dental fees which Sundstrand refused to pay under its health plan. Pfluger was dismissed out at the pleading stage, and the trial court granted a motion to dismiss as to Person's case at the close of his evidence.

Sundstrand's health plan is a private plan which is self-insured. In connection with certain dental work Sundstrand requires periapical X rays (full mouth) to be taken as a precondition of payment under the plan. Dr. Pfluger refused to take and submit such X rays, and Sundstrand refused to pay Person's dental bill.

In this appeal, Dr. Pfluger contends that it was error to dismiss him as a party plaintiff at the pleading stage as he came within the meaning of "interested party" as stated in section 57.1 of the Civil Practice Act (Ill. Rev. Stat. 1977, ch. 110, par. 57.1) relating to declaratory judgments and that there was an actual controversy between him and Sundstrand Corporation, thus giving him standing. It is our opinion, however, that Dr. Pfluger has misconstrued the statute and we do not consider him to be an "interested party" under the facts of this case. Pfluger argues that he is an "interested party" to the controversy between Person and Sundstrand because "Dr. Pfluger's relationship with his patient is affected by the position taken by Sundstrand and his ability to continue to perform services for other patients employed by Sundstrand and to be paid for such services is jeopardized." (Emphasis added.) Dr. Pfluger does not contend that he has any contract with Sundstrand or that its health plan is in any way a contract for his benefit as a third-party beneficiary. What he obviously means is simply that the source from which he receives payment for dental work on Sundstrand employees may be cut off if Sundstrand enforces its rule requiring periapical X rays.

In our opinion, Dr. Pfluger's concern about the source of his fees does not make him a person interested in the controversy between Person and Sundstrand within the intent of the declaratory judgment statute. Dr. Pfluger did not perform the dental work for Sundstrand but for Person's wife — it was a personal contract and a personal obligation between Person and Pfluger. Pfluger's interest in the Sundstrand health plan is likewise personal to him. Although Sundstrand may, for the sake of convenience, make a direct payment to a doctor or dentist to whom benefits have been assigned, this does not affect Person's obligation to Pfluger or make Sundstrand a party to the contract between them.

• 1 Thus, we see no reason to regard Dr. Pfluger as being a person "interested" in the controversy between Person and Sundstrand. As stated in the recent case of Underground Contractors Association v. City of Chicago (1977), 66 Ill.2d 371, 376:

"The word, `interested' does not mean merely having a curiosity about or a concern for the outcome of the controversy. Rather, the party seeking relief must possess a personal claim, status, or right which is capable of being affected."

Under the facts of this case we see no "personal claim, status, or right" on Dr. Pfluger's part which is capable of being affected by the controversy between Person and Sundstrand since Sundstrand has no obligation to Pfluger and there is no relationship between them arising out of Person's being both an employee of Sundstrand and a patient of Pfluger. It does not seem to us that this relationship gives Pfluger either a "personal claim" — since he has no relationship — a "status" — since he is not an employee — nor a "right" — since he has no contract with Sundstrand. He, therefore, is not a person "interested" in the controversy within the intent of the statute. We think the trial court was correct in dismissing Pfluger at the pleading stage as not having standing to sue in declaratory judgment.

Person, whose case was dismissed on defendant's motion at the close of his evidence, raises four points in his appeal: (1) that Sundstrand's requirement that X rays be furnished before certain claims will be considered violates the public policy of Illinois; (2) that the requirement that X rays be furnished infringes on the professional relationship between a dentist and his patient and violates section 5 of "An Act to regulate the practice of dental surgery and dentistry in the State of Illinois, and to repeal certain acts therein named" (Ill. Rev. Stat. 1977, ch. 111, par. 2217), since it constitutes the practice of dentistry by a corporation; (3) the requirement as to X rays violates the contract rights of Person under his contract with Sundstrand since the Sundstrand health plan does not contain such mandatory requirement, and (4) the court's ruling granting the motion to dismiss was contrary to the weight of the evidence.

• 2, 3 The theory of Person's first contention is based on the public policy section (section 2) of the Radiation Protection Act (Ill. Rev. Stat. 1977, ch. 111 1/2, par. 212) which reads as follows:

"Whereas ionizing radiations and their sources can be instrumental in the improvement of the health and welfare of the public if properly utilized, and may be destructive or detrimental to life or health if carelessly or excessively employed or may detrimentally affect the environment of the State if improperly utilized, it is hereby declared to be the public policy of this State to encourage the constructive uses of radiation and to prohibit and prevent exposure to ionizing radiation in amounts which are or may be detrimental to health. * * *."

It is obvious that the quoted language does not prohibit the use of X rays but merely states it is the public policy of Illinois "to prohibit and prevent exposure to ionizing radiation in amounts which are or may be detrimental to health." Person's argument that the requirement that X rays be submitted per se violates the public policy of this State as set out in section 2 of the Radiation Protection Act is far too sweeping. It is clear that the language of section 2 is designed to voice a note of caution as to the use of X rays generally, while at the same time approving their "constructive uses." Whether periapical X rays were actually necessary in this particular case for proper diagnosis may be debatable among dentists but all that the State condemns is the use of X rays done "carelessly" or "excessively." There is no showing that Sundstrand's policy of requiring periapical X rays in certain types of problems necessarily encourages excessive or careless use of X rays. An exhibit introduced by the plaintiff taken from the manual of the Illinois Dental Society indicates that the requirement of "mandatory submission of radiographs in every instance" is not recommended by the society for a plan offered to the public for group purchase of dental care. However, this is for a plan offered to the public generally and whether the rejections of mass X rays on an indiscriminate basis is based on economic, administrative or health grounds, the guidelines indicated are not necessarily relevant to the Sundstrand health plan. That plan embraces only a restricted group — its own employees — and both because it is free and self-insured and because of the special relationship between employer and employee a more careful approach under their plan may be justified. We do not consider the plaintiff's argument based on the guidelines suggested for plans for group purchase of dental care offered to the public generally to be relevant here. Moreover, the Illinois Dental Society guidelines state that "third parties" — that is, we assume, other parties than the patient or the dentist "may make reasonable requests for radiographs." What is reasonable in the context of a plan for group purchase of dental care does not necessarily set the standard of reasonableness for the special conditions of Sundstrand's employee health plan. We do not regard the Illinois Dental Society's guidelines as setting the public policy of Illinois, which is delimited by the Radiation Protection Act. Thus, if Sundstrand's requests for X rays were reasonable considering their limitations, nature and purpose in the light of the Sundstrand plan's needs and objectives, it does not appear to us that the public policy of Illinois was violated. We reject this argument.

• 4 The contention that the Sundstrand plan requirement that X rays be submitted in certain instances infringes on the relationship between dentist and patient and amounts to the practice of dentistry by a corporation does not require any extended comment. Sundstrand provided a health plan to its employees, which involved dental care. The requirements of the plan, including the submission of X rays, relates only to qualification for payment for services rendered by the chosen dentist of the employee. Sundstrand by its plan makes no attempt to control, limit or direct the dental care needed by the employee, but in certain cases requires proof of its need by way of X rays. The thrust of the requirement is clearly toward establishing a condition which is compensable under the plan — how the condition is remedied or whether it is remedied at all is clearly up to the dentist and the patient. We see no infringement on the professional relationship between patient and dentist in the Sundstrand health plan requirement.

• 5 There is also an argument made to the effect that Sundstrand is a corporation in some manner or other practicing dentistry by requiring X rays and diagnosing the conditions revealed thereby in evaluating claims. Again, the X ray requirement is aimed at establishing the necessary proof for payment of a claim — it has no professional implications. The employees are not told they should or should not have an X ray taken — it is a qualification for payment by Sundstrand under its health plan that X rays be submitted in certain instances, but the requirement is aimed at payment, not at treatment. The argument that Sundstrand by refusing to pay a claim without X-ray proof of its necessity is somehow practicing dentistry we find to be quite unpersuasive. The plaintiff cites People ex rel. Illinois Society of Orthodontists v. United States Dental Institute, Inc., (1978), 57 Ill. App.3d 1029, but we find that case distinguishable from the case before us. Sundstrand is using professional dentists to evaluate the need for dental work performed or proposed to be performed by the employee's own dentist. It is clear that in so doing Sundstrand is merely corroborating the claim presented so as to know whether or not payment of the cost thereof should be made. Its purpose is not to practice dentistry but to verify claims. On the other hand, in the Illinois Society of Orthodontists case, the primary purpose of the ...


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