APPELLATE COURT OF ILLINOIS, FIRST DISTRICT, THIRD DIVISION
549 N.E.2d 822, 193 Ill. App. 3d 53, 140 Ill. Dec. 171 1989.IL.2067
Appeal from the Circuit Court of Cook County; the Hon. Robert Sklodowski, Judge, presiding.
JUSTICE RIZZI delivered the opinion of the court. FREEMAN, P.J., and CERDA, J., concur.
DECISION OF THE COURT DELIVERED BY THE HONORABLE JUDGE RIZZI
Defendant-appellant, Washington National Insurance Company , appeals from an order of the circuit court of Cook County which granted summary judgment in favor of plaintiff-appellee, Pioneer Screw and Nut Company (Pioneer). On appeal, WNIC argues that the trial court erred in granting summary judgment in favor of Pioneer. We reverse.
Pioneer drafted and adopted the Pioneer Screw and Nut Company Group Benefit Plan (the Plan), which provided medical coverage for qualified employees and their dependents as of January 1, 1980. Pioneer subsequently entered into an individual stop-loss and aggregate stop-loss agreement with WNIC (the WNIC Agreement), effective January 1, 1985. The WNIC Agreement provided that WNIC would reimburse Pioneer for payment of expenses covered under the Pioneer Plan and the WNIC Agreement, after Pioneer had satisfied its $100,000 deductible.
Judith Hirsch, the wife of Pioneer's chairman of the board, Howard Hirsch, was a covered dependent under the Pioneer Plan who experienced a mental illness which required hospitalization and treatment. Mrs. Hirsch refused to agree to voluntary treatment, and her spouse, Howard, instituted legal proceedings for her involuntary commitment and for the appointment of a guardian who would have authority to consent to medical treatment on her behalf. Mr. Hirsch, Mrs. Hirsch and the guardian each retained separate legal counsel to litigate the commitment issue. The attorney fees and psychiatrists' witness fees totaled $132,254.50. Pioneer thereafter paid Howard Hirsch for the legal fees and expenses incurred in the involuntary commitment of his wife and sought reimbursement from WNIC. WNIC refused to reimburse Pioneer for the money expended for legal fees because, in its view, neither the Pioneer Plan nor the WNIC Agreement provided for reimbursement for legal fees and expenses.
In June 1987, Pioneer filed a complaint for declaratory judgment which requested that the court order WNIC to reimburse Pioneer for the money expended for legal fees and expenses in accordance with the terms of the Plan and the WNIC Agreement. Thereafter, both parties filed motions for summary judgment. After briefing and oral argument, the trial court entered an order granting summary judgment in favor of Pioneer and denying WNIC's motion for summary judgment. This appeal followed.
On appeal, WNIC argues that the trial court erred in granting summary judgment in favor of Pioneer and in denying its motion for summary judgment. It is WNIC's position that the express terms of the Plan and the WNIC Agreement preclude Pioneer's recovery for legal expenses. We agree.
Section 3.2(d) of the Plan provides:
"3.2 Eligible expenses are defined as and limited to the following necessary expenses to the extent that they are usual and customary and are recommended by the attending physician:
(d) Expenses for medical care and treatment and the performance of a surgical ...