Court Opinion

ID: 9543856
Source: CourtListenerOpinion
Date Created: 2023-08-07 16:49:56.510852+00
Date Added: 2024-06-11T15:11:19.412229
License: Public Domain

PRESIDING JUSTICE McCULLOUGH, dissenting: I do not agree that the instant case is similar to the facts in Kaskaskia. The facts in this case are similar to those in Schumann. As the majority states, there was an accident and the employer is responsible for the medical expenses within the limitations period. Also, as pointed out, section 8(a) of the Act requires the employer pay the medical expenses. Section 8(a) specifically provides: “The furnishing by the employer of any such services or appliances is not an admission of liability on the part of the employer to pay compensation. The furnishing of any such services or appliances or the servicing thereof by the employer is not the payment of compensation.” Ill. Rev. Stat. 1985, ch. 48, par. 138.8(a). An apparent reason for not calling medical payments compensation is to encourage employers to keep abreast of its employees’ medical conditions with respect to injuries. The employer is also responsible for penalties for failure to pay medical expenses. The supreme court on the same day filed Schumann and Kaskaskia. Neither Justice Kluczynski in Schumann nor Justice Goldenhersh in Kaskaskia referred to the other case. The only reference to the two cases is in the dissent of Justice Ryan in Kaskaskia. A quote from Schumann applies to this case. In Schumann, the supreme court stated: “A review of the record, however, reveals a complete absence of any showing of fraud or undue pressure to deprive claimant of compensation. His own testimony discloses that all conversations with Hoya, the insurance broker for the employer, related solely to questions regarding the payment of medical bills and contained no references to compensation. There is no testimony pertaining to any statement or representation by Hoya attempting to mislead claimant concerning the distinction between the payment of medical bills and the payment of compensation upon which the statute of limitations is based. Claimant’s only contact with the insurance company occurred over one year after the date of the accident. Moreover, when he was informed that the insurance company would no longer pay his medical expenses because he had not filed an application for adjustment of claim, he delayed for almost 6 months before he filed the application. Claimant has failed to establish any misrepresentation or statement by Hoya, or a representative of the insurance company, upon which he relied to his detriment.” (Schumann, 61 Ill. 2d at 247, 335 N.E.2d at 429.) In Kaskaskia, there were conversations with the insurance carrier concerning the claim and the claimant received TTD. Claimant had been injured on June 18, 1971. In August 1972, the respondent paid the physician’s treatment services which were rendered in May and June 1972. The TTD payment in Kaskaskia had been made on March 29, 1972. In March 1973, the insurance company representative came to talk to the claimant. The supreme court suggests that in the month that the statute of limitations would run, the insurance company representatives met with the claimant and did not mention the statute of limitations. On April 2, 1973, the respondent notified the claimant that it would deny liability and one day later, the claimant filed his application for adjustment of claim. No TTD was ever paid by respondent. The majority gives importance to the respondent’s contact with claimant or the doctors. They are six in number of which two were after the statute of limitations had expired and do not contribute to any estoppel. During the three-year limitations period, the insurance carrier for the respondent had only two direct contacts with the claimant, the first being April 1984 when an investigator spoke with the claimant and in March 1985 when the respondent insurance company notified the claimant to make an appointment for an independent medical exam. With respect to the April 1984 meeting, more than IV2 years before the statute of limitations date, between claimant and an insurance investigator, the record shows nothing in that conversation that would lull claimant or commit the respondent. The March 1985 contact was merely to determine the need for further medical treatment. After the April 9, 1986, notification that the respondent would not pay any further medical bills, the claimant waited until October 9, 1986, some six months later, to file a claim. The independent contacts by the respondent’s insurance company with the medical providers is not evidence upon which the claimant can rely. The record is silent as to claimant’s even being aware of these contacts. As the employer was responsible for the medical expenses, their contacts were legitimate as well as authorized by the Act. As to claimant’s knowledge, a person who does not have knowledge of the acts done, and which are claimed to result in estoppel, cannot invoke the doctrine since there cannot be any reliance on the acts which were unknown. JUSTICE RAKOWSKI joins in this dissent.