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08/13/87 In Re Estate of Fallscher (William Fallscher

August 13, 1987

IN RE ESTATE OF FALLSCHER (WILLIAM FALLSCHER, AS ADM'R OF


APPELLATE COURT OF ILLINOIS, SECOND DISTRICT

the Estate of James E. Fallscher, Deceased,

Plaintiff-Appellant, v.

Pinecrest Golf Club, Inc., Defendant-Appellee)

512 N.E.2d 387, 159 Ill. App. 3d 302, 111 Ill. Dec. 271 1987.IL.1171

Appeal from the Circuit Court of McHenry County; the Hon. Michael J. Sullivan, Judge, presiding.

APPELLATE Judges:

JUSTICE INGLIS delivered the opinion of the court. HOPF and DUNN, JJ., concur.

DECISION OF THE COURT DELIVERED BY THE HONORABLE JUDGE INGLIS

Plaintiff, William Fallscher, as administrator of the estate of James E. Fallscher, deceased, brought this action against defendant, Pinecrest Golf Club, Inc. (Pinecrest), decedent's employer, on the theory that decedent was the third-party beneficiary of an insurance contract between Pinecrest and Bankers Life Company (Bankers Life). The court entered summary judgment for Pinecrest. Plaintiff has appealed. We affirm.

Decedent began employment with Pinecrest in April 1983 and worked as a groundkeeper. On November 9, 1983, decedent was injured while in the scope of his employment. He subsequently died as a result of his injuries.

While decedent was employed by Pinecrest, Pinecrest maintained a group life and health insurance plan for its employees pursuant to a contract with Bankers Life. The contract provided life insurance and accidental death and dismemberment insurance for Pinecrest's full-time employees. Pursuant to the terms of the contract, Pinecrest was eligible to provide this insurance for its employees by maintaining 75% employee participation in the plan. The contract further provided that Pinecrest's failure to maintain that level of participation would result in termination of Pinecrest as a participating employer, and consequently, termination of insurance under the plan.

To be covered under the plan, employees were required to complete an enrollment card when hired. Each employee enrolled would become eligible for coverage upon completion of one month of regularly scheduled full-time employment (25 hours per week). Insurance became effective on the later of: (a) the date the one-month waiting period was completed; or (b) the date the enrollment card was completed; or (c) when properly requested, the date Bankers Life approved a statement of health form.

Decedent was aware that the insurance plan existed and, pursuant to conversations with his employer, assumed he was enrolled in the group plan. However, decedent never filled out the enrollment card requesting insurance, and Pinecrest never paid any premiums on his behalf. In fact, a majority of Pinecrest's employees were similarly not enrolled, thus causing the employee participation level to fall below the required 75%.

After decedent's death, plaintiff discovered that decedent was not enrolled in the group insurance program. Plaintiff then brought the instant action on behalf of decedent as third-party beneficiary against Pinecrest for breach of its contract with Bankers Life. Pinecrest filed a motion for summary judgment stating that it was entitled to judgment as a matter of law because plaintiff could not show that Bankers Life had any enforceable rights against Pinecrest pursuant to the contract under ...


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