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09/21/95 DAVID COLE ET AL. (DAVID COLE v. LOIS BYRD

September 21, 1995

DAVID COLE ET AL. (DAVID COLE, APPELLANT),
v.
LOIS BYRD ET AL. (COMMUNITY GRAIN COMPANY ET AL., APPELLEES).



The Honorable Justice Nickels delivered the opinion of the court:

The opinion of the court was delivered by: Nickels

JUSTICE NICKELS delivered the opinion of the court:

The issue presented in this matter is whether an insurer is entitled to reimbursement from a plaintiff for payments the insurer made to a consulting firm, purportedly on the plaintiff's behalf. The insurer seeks reimbursement from proceeds the plaintiff recovered from third-party tortfeasors. The circuit court of De Witt County found that the services provided by the consulting firm were case-management services, and the insurer was not entitled to reimbursement under the Workers' Compensation Act (Act) (820 ILCS 305/1 (West 1992)). The appellate court reversed the circuit court, finding that the services provided were medical treatment services and that the insurer was entitled to reimbursement from the plaintiff. (265 Ill. App. 3d 798.) We granted the plaintiff's petition for leave to appeal (145 Ill. 2d R. 315).

FACTS

Plaintiff David Cole suffered serious injuries when a truck he was driving collided with a school bus. At the time of the collision, plaintiff was employed by Community Grain Company (hereinafter the employer), and plaintiff suffered the injuries during the course of his employment. The employer carried workers' compensation insurance, provided by Farmland Mutual Insurance Company (hereinafter the insurer). Plaintiff received workers' compensation benefits for his injuries.

In addition to receiving workers' compensation benefits from the employer's insurer, plaintiff broughtan action in the circuit court against the driver of the school bus and the school district. The employer and the insurer were allowed to intervene in this action in order to protect their right to reimbursement for workers' compensation benefits paid or payable to plaintiff. A jury returned a verdict of $1,752,037 in favor of plaintiff and against the bus driver and school district. The driver and school district are not involved in this appeal. This appeal involves only plaintiff and the intervenors.

At trial, plaintiff sought recovery for numerous items of special damages relating to his injuries. One of these items was a bill for $12,577.96 in services rendered by Professional Rehabilitation Management (PRM). Nancy Peck, an employee of PRM and a registered professional nurse, performed these services. Peck is a medical rehabilitation coordinator. She acted as a consultant in this case to assure that proper medical care was given to plaintiff. At a hearing conducted outside of the jury's presence, the circuit court heard testimony from Peck to determine if plaintiff could recover the cost of Peck's services as special damages from the bus driver and the school district.

We note that the circuit court heard this testimony as part of the common law action against the third-party tortfeasors. At this stage, plaintiff sought to recover the cost of Peck's services from the third-party tortfeasors. The circuit court ruled that plaintiff could not recover Peck's services from the third-party tortfeasors. Thus, the jury was not informed of these services and did not consider them in awarding damages.

After the jury awarded damages, the insurer sought to enforce its workers' compensation lien against plaintiff's damage award. The insurer's lien included a charge for Peck's services. At this post-trial stage, the insurer sought to recover the cost of Peck's services from plaintiff. The circuit court ruled that the insurer could not receive reimbursement for Peck's services.

Peck's testimony establishes the nature of the services that are in dispute, and we therefore discuss her testimony in detail. Peck first testified about her relationship to plaintiff and the insurer and stated that she considered her services to be management:

"Q. Who do you in this relationship have an obligation to answer to: the patient or the insurance company?

A. I make recommendations to the insurance company. That is what I am hired for.

Q. Whose interests are you-as a professional, whose interests do you believe you are obligated to protect in this assignment: the insurance company or the patient?

A. The patient, to see that that person gets the best medical care, ends up being as good a person medically as he or she can be.

Q. Would you consider this to be medical treatment or management of the workers compensation case?

A. Management.

Q. Of the claim on behalf of the insurance company?

A. It's still objective. In other words, I make the recommendation to the insurance company that I feel is most appropriate to that case.

Q. Is one of the considerations that you have trying to keep down the costs for the workers comp insurance carrier?

A. If appropriate, some cost effectiveness is entered in.

Q. You certainly would never recommend sacrificing the effect of good medical ...


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