Court Opinion

ID: 9779704
Source: CourtListenerOpinion
Date Created: 2023-08-30 00:36:39.472524+00
Date Added: 2024-06-11T07:33:38.125091
License: Public Domain

JUSTICE STEWART, concurring in part and dissenting in part: I concur in all aspects of the majority decision except the determination that the collateral source rule does not apply to claims under the Workers’ Compensation Act. From that portion of the majority decision, I respectfully dissent. Although the majority treats this as a matter of first impression, it is my belief that our supreme court has addressed this issue. In Hill Freight Lines, Inc. v. Industrial Comm’n, 36 Ill. 2d 419, 223 N.E.2d 140 (1967), the claimant’s medical bills had been paid through the Union Health and Welfare Fund, which operated a medical and hospital benefit plan for its members. The employer argued that it should not be required to “reimburse an employee for medical bills which have never been tendered to him for payment and which are not shown to be his debts.” Hill Freight Lines, Inc., 36 Ill. 2d at 423, 223 N.E.2d at 143. The supreme court held as follows: “It is our opinion that the reasonable value of the medical services rendered to an employee are recoverable against the party causing the injury, regardless of whether the employee pays for the medical services by cash, credit or some insurance or benefit plan. As he did not receive the insurance benefits gratuitously and the reasonable value of the medical and hospital services rendered herein were proven, the employer’s contention is without merit.” Hill Freight Lines, Inc., 36 Ill. 2d at 423-24, 223 N.E.2d at 143. Although the collateral source rule was not directly addressed, the principle espoused is the same. In a claim under the Act, the employee recovers “the reasonable value of the medical services rendered” regardless of whether the bills were paid through a third-party insurance or benefit plan. Accordingly, this court has consistently applied a standard of reasonableness to determine the amount an employer is required to pay for medical expenses. Nabisco Brands, Inc. v. Industrial Comm’n, 266 Ill. App. 3d 1103, 1108, 641 N.E.2d 578, 583 (1994). “The proper standard is that which is usual and customary for similar services in the community where the services were rendered.” Nabisco Brands, Inc., 266 Ill. App. 3d at 1108-09, 641 N.E.2d at 583. As the majority notes, the version of section 8(a) of the Act in effect on the date of the claimant’s industrial accident provided that “[t]he employer shall provide and pay for all the necessary first aid, medical and surgical services, and all necessary medical, surgical and hospital services thereafter incurred, limited, however, to that which is [necessary] to cure or relieve from the effects of the accidental injury.” 820 ILCS 305/8(a) (West 2004). I agree with the majority that it is our function to ascertain and give effect to the intent of the legislature. However, couching its decision in terms of statutory construction, the majority transforms a requirement that the employer pay its employees’ medical bills incurred as a result of an industrial accident into a provision that only requires payment of whatever discounted amount the medical providers are required to accept through contractual agreements or, perhaps, government benefit plans. In my view, the majority misinterprets the statute. The Act contains no provision which prevents the application of the collateral source rule to workers’ compensation claims. Although the legislature has amended the Act on numerous occasions, it has not expressly restricted the application of the collateral source rule in claims under the Act, despite having done so in other areas. See 735 ILCS 5/2—1205 (West 2008). In determining legislative intent, “[a] court presumes that the legislature amends a statute with knowledge of judicial decisions interpreting the statute.” Hubble v. Bi-State Development Agency of the Illinois-Missouri Metropolitan District, 238 Ill. 2d 262, 273, 938 N.E.2d 483, 492 (2010). Thus, the failure of the legislature to expressly restrict application of the collateral source rule, with presumptive knowledge of case law requiring that an employer pay the reasonable value of medical services rendered to an employee in claims under the Act, indicates legislative acquiescence in the court’s interpretation of the Act. Further, as the majority points out, when section 8(a) was amended in 2005, the legislature expressly required that the employer pay the lesser of the health care provider’s actual charges or the amount set forth in the fee schedule. 820 ILCS 305/8(a) (West 2006). No provision was made for a reduction of the amount billed to the amount paid to the medical provider through a third-party health insurance contract. “In ascertaining legislative intent, courts may consider subsequent amendments to a statute.” City of East Peoria v. Group Five Development Co., 87 Ill. 2d 42, 46, 429 N.E.2d 492, 494 (1981). Finally, “in determining legislative intent, a court may properly consider not only the language of the statute, but also the purpose and necessity for the law, the evils sought to be remedied and the goals to be achieved, and the consequences that would result from construing the statute one way or the other.” Hubble, 238 Ill. 2d at 268, 938 N.E.2d at 489. I believe the majority decision thwarts a fundamental policy consideration underlying the Act. One of the purposes of the Act is to ensure that “ ‘the burdens of caring for the casualties of industry should be borne by industry and not by the individuals whose misfortune arises out of the industry, nor by the public.’ ” BoyerRosene Moving Service v. Industrial Comm’n, 48 Ill. 2d 184, 186, 268 N.E.2d 415, 417 (1971) (quoting Hoeffken Brothers, Inc. v. Industrial Comm’n, 31 Ill. 2d 405, 407-08, 202 N.E.2d 5, 6 (1964)). In determining that the collateral source rule does not apply to workers’ compensation cases, the majority allows employers to reap the benéfit of bargains to which they were not parties, and thereby shift the burden of caring for the casualties of industry to others. Further, the majority provides an incentive for employers to deny claims in anticipation of receiving the benefit of a reduced charge negotiated by a third party. Here, the employer refused to pay the claimant’s medical bills, so he had no choice but to submit them for payment by his wife’s group health insurance carrier. At the arbitration hearing, the employer did not object to the admission of the claimant’s medical bills on the ground that they were unreasonable. Rather, the employer’s objections were limited to liability, causal connection, and whether it should reap the benefits of the discounts provided the claimant’s insurance carrier. I believe the Commission correctly ordered the employer to pay the full reasonable amount of the claimant’s medical bills. For the foregoing reasons, I would affirm in all respects the decision of the circuit court confirming the decision of the Commission.