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Brown v. Stonebridge Life Ins. Co.

Court of Appeals of Illinois, Third District

May 30, 2013

THOMAS W. BROWN, JR., and DAWN BALICKI, Special Administrator of the Estate of Margaret Jane Brown, Deceased, Plaintiffs-Appellants,
v.
STONEBRIDGE LIFE INSURANCE COMPANY, a Foreign Corporation, and MONUMENTAL LIFE INSURANCE, a Foreign Corporation, Defendants-Appellees.

Appeal from the Circuit Court of the 13th Judicial Circuit, No. 09-CH-388 La Salle County, Illinois, Honorable Joseph P. Hettel, Judge Presiding.

PRESIDING JUSTICE WRIGHT delivered the judgment of the court, with opinion, Justices McDade and O'Brien concurred in the judgment and opinion.

OPINION

WRIGHT, PRESIDING JUSTICE.

¶ 1 Plaintiffs Thomas W. Brown, Jr., and Dawn Balicki (collectively plaintiffs) brought an action for declaratory relief against defendants Stonebridge Life Insurance Co. (Stonebridge Life) and Monumental Life Insurance Co. (Monumental Life) asking the trial court to declare that each defendant was liable to pay benefits, to plaintiffs, under accidental death insurance policies issued to their mother, Margaret Jane Brown (Brown). Defendants each moved for summary judgment based on the medical treatment exclusion of their respective policies.

¶ 2 After finding Brown's death arose from the ongoing medical treatment for lower back pain, the court granted summary judgment for each defendant and dismissed the cause of action with prejudice. Plaintiffs appeal the court's decision to grant summary judgment for each defendant. We affirm.

¶ 3 BACKGROUND

¶ 4 On June 4, 2002, Brown enrolled in a group accidental death insurance plan through Monumental Life and named her daughter, appellant Dawn Balicki as the beneficiary. Monumental Life issued a certificate of insurance to Brown, effective June 12, 2002, providing the terms, conditions, limitations, and exclusions for accidental death and dismemberment benefits in the amount of $25, 000.

¶ 5 On February 24, 2004, Brown applied for additional accidental death coverage with Stonebridge Life, also for $25, 000. Stonebridge Life issued a certificate of insurance to Brown that provided the terms, conditions, limitations, and exclusions for accidental death and dismemberment benefits with an effective date of March 2, 2004, and named both her children, Dawn and Thomas Brown, Jr., as the beneficiaries. These policies remained in effect at the time of Brown's death on December 20, 2007.

¶ 6 Brown suffered from a history of chronic low back pain and had undergone three spine surgeries since 1999. From March 15, 2004, through October 18, 2007, Dr. Maria Pilar Estilo provided medical treatment to Brown for her chronic back pain, including administering epidural steroid injections and prescribing various types of narcotic pain medications. In 2005, Dr. Estilo prescribed a Fentanyl patch, a pain medication, and gradually increased the dosage of Brown's Fentanyl patch from June 2005 through October 2006. The prescribed dosage, as of October 26, 2006, was 125 micrograms per hour. On October 18, 2007, Dr. Estilo examined Brown and continued the fentanyl patch prescription at the 125 micrograms per hour dosage.

¶ 7 On December 20, 2007, Brown died from "Fentanyl intoxication." The death certificate lists the cause of death as "accidental" fentanyl intoxication, in that Brown"[i]ngested [a] lethal amount of Fentanyl." The autopsy report showed that Brown had two fentanyl patches on her upper back at the time of death, a 100-microgram-per-hour patch and a 25-microgram-per-hour patch. However, Dr. Estilo testified that prior to her death, Brown did not exhibit symptoms indicative of fentanyl intoxication during her last office examination on October 18, 2007 and nothing indicated that Brown was misusing the patch.

¶ 8 In April 2008, plaintiffs presented proof of accidental death to both Monumental Life and Stonebridge Life. Monumental Life responded by letter, on June 24, 2008, claiming their policy did not cover Brown's death because of the sickness and medical treatment exclusions listed in the policy. This letter indicated the autopsy and toxicology reports of the medical examiner showed that Brown's concentration of fentanyl was "9.7 ng/mL, " a level in excess of the amount prescribed by her medical doctor.

¶ 9 Stonebridge Life also responded by letter on June 24, 2008, rejecting plaintiffs' claim for benefits based on Brown's death. The Stonebridge Life letter stated that the exclusions section of the insurance policy barred benefits for injury due to disease or medical treatment. The letter from Stonebridge Life explained that the Brown's death certificate documented death from ingesting a lethal amount of fentanyl (fentanyl intoxication), and the medical examiner's toxicology report revealed the concentration of fentanyl in Brown's system exceeded the amount prescribed by her physician.

¶ 10 On June 4, 2009, plaintiffs filed a complaint for declaratory judgment against Stonebridge Life, in the LaSalle County circuit court, asking the trial court to review the terms of the insurance policy and declare that Stonebridge Life was required to pay the $25, 000 accidental death benefit. Thereafter, on June 22, 2010, plaintiffs filed a second amended complaint for declaratory judgment, against both Stonebridge Life (count I) and Monumental Life (count II) (collectively defendants), asking the trial court to review the terms of the accidental death insurance policies and find that both of the insurance companies were required to pay plaintiffs $25, 000 each under the terms of the policies.[1]

ΒΆ 11 The express language in the Stonebridge Life certificate of insurance includes loss of life as a "loss" under its definitions. The policy further defines injury ...


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