Court of Appeals of Illinois, First District, Second Division
MARQUE MEDICOS FARNSWORTH, LLC, and MEDICOS PAIN & SURGICAL SPECIALISTS, S.C., Plaintiffs-Appellants,
LIBERTY MUTUAL INSURANCE COMPANY and ADVANCED URETHANE TECHNOLOGIES, INC., d/b/a/ REM Innovations, Inc., and/or Sleep Innovations, Inc., Defendants-Appellees.
from the Circuit Court of Cook County, Illinois. No. 13 L
13457 Honorable James E. Snyder, Judge Presiding.
PRESIDING JUSTICE MASON delivered the judgment of the court,
with opinion. Justices Pucinski and Hyman concurred in the
judgment and opinion.
1 This case arises out of defendant-appellant Liberty Mutual
Insurance Company's (Liberty) alleged failure to fully
pay plaintiffs-appellees, Marque Medicos Farnsworth, LLC, and
Medicos Pain & Surgical Specialists, SC (collectively,
the providers), for services they rendered to an injured
employee of codefendant-appellant, Advanced Urethane
Technologies, Inc., d/b/a REM Innovations, Inc., and/or Sleep
Innovations, Inc. (Sleep Innovations). The trial court
dismissed with prejudice the providers' claims for breach
of contract, breach of contract implied in law, breach of
contract implied in fact, and recovery under section 155 of
the Illinois Insurance Code (215 ILCS 5/155 (West 2012)).
Because we conclude that the providers have no direct action
against Liberty for its delay in paying medical bills, we
3 The providers filed suit against defendants in November
2013, alleging that they had not been paid for treatment they
provided to Martha Llamas, an injured employee of Sleep
Innovations. In their third amended complaint, at issue here,
the providers alleged that Llamas suffered a work-related
injury on March 25, 2009, for which they provided treatment
between March 26, 2009, and January 26, 2011. At the outset
of her treatment, Llamas authorized payment to be made
directly to the providers for insurance benefits payable to
her. Initially, the providers billed Sleep Innovations but
were soon directed to submit their bills directly to Liberty,
which issued the workers' compensation insurance policy
to Sleep Innovations.
4 The insurance policy provides that Liberty would "pay
promptly when due the benefits required of [Sleep
Innovations] by the workers compensation law," and goes
on to state that Liberty is "directly and primarily
liable to any person entitled to the benefits payable by this
insurance" and enforcement of this provision may be
against Liberty or Sleep Innovations. The policy also
prohibits Sleep Innovations from making payments, assuming
obligations, or incurring expenses "except at [its] own
5 On May 1, 2009, Llamas filed a claim before the Illinois
Workers' Compensation Commission (IWCC) for disability
benefits and medical expenses, which was ultimately settled
in December 2012. The settlement agreement named Llamas as
petitioner and Sleep Innovations as respondent, but left
blank the space to name respondent's insurance or service
company. The terms of the settlement provided that respondent
would pay "all necessary and related medical expense
pursuant to the fee schedule or negotiated rate, whichever is
less, that have been submitted to respondent prior to
contract approval." The settlement agreement was silent
on the amount of medical bills outstanding as of the date of
its execution. The complaint did not allege and the record
does not disclose that, prior to the settlement, Liberty ever
took the position that all or any portion of the medical
expenses reflected in the bills sent to it were not necessary
or related to Llamas's injuries or that the documentation
in the bills was insufficient.
6 Liberty eventually made late payments of medical bills in
the amount of $80, 000 to the providers, but over $5200 in
bills are still outstanding. In addition, Liberty failed to
pay any statutory interest on both the unpaid bills as well
as the late paid bills, and the amount of interest due as of
the date of the complaint exceeded $24, 000.
7 Based on these allegations, the providers alleged four
counts against both defendants: (1) breach of contract (based
on the insurance policy), (2) violation of section 8.2(d) of
the Workers' Compensation Act (Act) (820 ILCS 305/8.2(d)
(West 2012)), (3) breach of contract implied in law, and (4)
breach of contract implied in fact; one count was alleged
only against Liberty, namely, recovery under section 155 of
the Illinois Insurance Code (215 ILCS 5/155 (West 2012)).
8 Defendants filed a motion to dismiss the complaint pursuant
to section 2-615 of the Code of Civil Procedure (735 ILCS
5/2-615 (West 2012)). Ultimately, the trial court dismissed
with prejudice the providers' claims for breach of
contract, breach of contract implied in law, breach of
contract implied in fact, and violation of section 155 of the
Illinois Insurance Code. The providers timely appealed.
10 A motion to dismiss pursuant to section 2-615 of the Code
of Civil Procedure challenges the legal sufficiency of a
complaint based on defects apparent on its face. Marshall
v. Burger King Corp., 222 Ill.2d 422, 429 (2006).
Examining the legal sufficiency of a complaint requires us to
accept as true both well-pleaded facts and reasonable
inferences that we can draw from those facts. Id.
Further, we must construe the complaint's allegations in
the light most favorable to the plaintiff. Napleton v.
Village of Hinsdale, 229 Ill.2d 296, 305 (2008). A cause
of action should not be dismissed unless there is no set of
facts that can be proved that would allow recovery.
Pooh-Bah Enterprises, Inc. v. County of Cook, 232
Ill.2d 463, 473 (2009). We review de novo an order
dismissing a complaint under section 2-615. Id.
11 Turning first to the providers' claim for breach of
contract, this is premised on the allegation that the
providers are third-party beneficiaries of the workers'
compensation policy issued by Liberty to Sleep Innovations.
We answered this question in the negative in Marque
Medicos Fullerton, LLC v. Zurich American Insurance Co.,
2017 IL App (1st) 160756, ¶¶ 1-4, in which medical
providers who provided care to injured employees brought
putative class actions against employers' workers'