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Country Preferred Insurance Co. v. Groen

Court of Appeals of Illinois, Fourth District

January 27, 2017

COUNTRY PREFERRED INSURANCE COMPANY, Plaintiff-Appellee,
v.
LORI GROEN, Defendant-Appellant.

         Appeal from Circuit Court of Sangamon County No. 14MR580. Honorable Chris Perrin, Judge Presiding.

          JUSTICE HARRIS delivered the judgment of the court, with opinion. Presiding Justice Turner and Justice Appleton concurred in the judgment and opinion.

          OPINION

          HARRIS, JUSTICE

         ¶ 1 Following an accident that occurred during the course of her employment, defendant, Lori Groen, received benefits under the Illinois Workers' Compensation Act (Act) (820 ILCS 305/1 to 30 (West 2010)) in excess of $400, 000. In addition, she sought benefits from plaintiff, Country Preferred Insurance Company, under an uninsured motorist policy, which contained a provision entitling plaintiff to reduce the amount of its liability by any payments made or due under the Act (setoff provision). Ultimately, the trial court granted summary judgment in favor of plaintiff. Defendant appeals, arguing that the court erred in granting summary judgment because plaintiff is prohibited from reducing the amount of its available uninsured motorist coverage by the amount of medical expenses paid by her employer. Specifically, she argues (1) medical payments made pursuant to the Act are not "for" an insured and, therefore, are not subject to setoff under her uninsured motorist policy; (2) alternatively, the setoff provision is ambiguous as to whether medical payments made by an employer under the Act are subject to setoff and, therefore, should be construed in her favor; and (3) the setoff provision "is unenforceable because it violates the *** Act." We affirm.

         ¶ 2 I. BACKGROUND

         ¶ 3 On October 7, 2013, defendant was struck as a pedestrian by an uninsured motor vehicle and suffered injuries. At the time of the accident, defendant was working and was acting within the scope of her employment. As a result, defendant sought and received workers' compensation benefits under the Act. Specifically, she received temporary total disability benefits in the amount of $328.33 per week beginning on October 7, 2013, and up to at least July 28, 2014, the date defendant signed an affidavit in the within action. In addition, as of July 22, 2014, defendant's employer had paid $410, 266.63 in medical bills pursuant to the Act.

         ¶ 4 In addition to receiving workers' compensation benefits, defendant sought benefits from plaintiff under an uninsured motorist policy with limits of $250, 000 per person and $500, 000 per occurrence.

         ¶ 5 In June 2014, plaintiff filed a complaint for declaratory judgment, seeking a declaration of the parties' rights and obligations under the uninsured motorist policy, which, in relevant part, provides as follows:

"Amounts payable for damages under Uninsured-Underinsured Motorists, Coverage U, will be reduced by the present value of all amounts paid or payable under any workers' compensation, disability benefits or any similar law."

         Plaintiff asserted that defendant was not entitled to benefits under her uninsured motorist policy because she had already collected more than $250, 000 in workers' compensation benefits.

         ¶ 6 In March 2015, plaintiff filed an amended motion for summary judgment, asserting defendant could not maintain an uninsured motorist claim, since she had already received workers' compensation benefits in excess of the uninsured motorist policy's limits. In August 2015, defendant filed a cross-motion for summary judgment, asserting that the setoff provision (1) violated the Act and was unenforceable and (2) excluded medical payments made by her employer directly to her medical providers. Following a December 2015 hearing on the motions, the trial court granted plaintiff's amended motion for summary judgment and denied defendant's motion for summary judgment. In its written order, the court found the setoff provision was enforceable, unambiguous, and not against public policy.

         ¶ 7 This appeal followed.

         ¶ 8 II. ANALYSIS

         ¶ 9 On appeal, defendant asserts the trial court erred in granting summary judgment in favor of plaintiff because plaintiff is prohibited from reducing its available uninsured motorist coverage by the amount of medical expenses paid by her employer pursuant to the Act. Specifically, defendant argues (1) medical payments made pursuant to the Act are not "for" an insured and, therefore, are not subject to setoff under her uninsured motorist policy; (2) alternatively, the setoff provision is ambiguous as to whether medical payments made by an employer under the Act are ...


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