Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Marque Medicos Farnsworth, LLC v. Liberty Mutual Insurance Co.

Court of Appeals of Illinois, First District, Second Division

June 26, 2018

MARQUE MEDICOS FARNSWORTH, LLC, and MEDICOS PAIN & SURGICAL SPECIALISTS, S.C., Plaintiffs-Appellants,
v.
LIBERTY MUTUAL INSURANCE COMPANY and ADVANCED URETHANE TECHNOLOGIES, INC., d/b/a/ REM Innovations, Inc., and/or Sleep Innovations, Inc., Defendants-Appellees.

          Appeal 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.

          OPINION

          MASON PRESIDING JUSTICE

         ¶ 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).[1] 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 affirm.

         ¶ 2 BACKGROUND

         ¶ 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 cost."

         ¶ 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.

         ¶ 9 ANALYSIS

         ¶ 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, ΒΆΒΆ 1-4, in which medical providers who provided care to injured employees brought putative class actions against employers' workers' ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.