Court Opinion

ID: 9740400
Source: CourtListenerOpinion
Date Created: 2023-08-26 20:34:37.998204+00
Date Added: 2024-06-11T07:24:08.148846
License: Public Domain

JUSTICE McDADE, concurring in part and dissenting in part: The majority has found that it must reverse the trial court’s order because plaintiff is not a third-party beneficiary of the workers’ compensation policy and therefore his complaint for breach of contract based on that policy must be dismissed. 388 Ill. App. 3d at 1024. The majority has also found that this court may not address plaintiff’s argument that the trial court improperly dismissed his unjust enrichment claim because plaintiff failed to file a cross-appeal of that judgment. 388 Ill. App. 3d at 1024.1 concur in the majority’s holdings that (a) plaintiff is not a third-party beneficiary of the workers’ compensation policy, and (b) that plaintiffs failure to file a cross-appeal results in his waiver of the issue of the dismissal of his unjust enrichment claim for our review. Because I would affirm the trial court’s judgment based on my finding that plaintiff has a valid cause of action against defendant, I respectfully dissent from that portion of the majority’s holding reversing the trial court’s order certifying the class as to count IV of plaintiff’s complaint. I agree that “before deciding if the necessary requisites for a class action have been met, the trial court must find that the plaintiff has asserted a valid cause of action.” 388 Ill. App. 3d at 1019. I disagree with the majority’s holding that “[sjince plaintiffs breach of contract claim is the only cause of action upon which his class action was allowed, plaintiff’s class action against defendant must also be dismissed.” 388 Ill. App. 3d at 1024. I find that plaintiff has a valid cause of action against defendant. The majority asserts that “[tjhe issue we must decide in this case [is] whether a medical provider is a third-party beneficiary of a workers’ compensation policy.” 388 Ill. App. 3d at 1020. I disagree. The issue we must decide is whether plaintiff has a valid cause of action for breach of contract. I conclude that plaintiffs cause of action does not in fact assert his patients’ right to insurance coverage under the Workers’ Compensation Act nor a right — belonging to himself or his patient — to payment for covered health care expenses under defendant’s contract with the employer. Plaintiff is not seeking to recover based on rights under the workers’ compensation insurance contract. I agree that plaintiff is not entitled to the benefits payable by the insurance because he is not a party entitled to workers’ compensation benefits. However, he is owed payment from defendant for the services he rendered. Plaintiff is simply seeking to recover payment due. He is limiting the source of his recovery to the employee’s workers’ compensation insurance provider. That plaintiff is so limiting the pool from which he seeks to recover does not transform his simple claim for payment into a claim under the workers’ compensation insurance contract. Rather, plaintiffs cause of action centers on the application and alleged misappropriation, by defendant, of PPO discounts to which it was not entitled. Plaintiffs complaint does not involve defendant’s workers’ compensation insurance contract and does not involve a claim under the Workers’ Compensation Act. Accord Roche v. Travelers Property Casualty Insurance Co., No. 07 — CV—302—JPG (S.D. Ill. July 24, 2008). Regardless of the reasons the trial court gave for certifying the class or its statement of the common question of law to members of the class, nothing in plaintiff’s complaint relies on any of the class members being third-party beneficiaries of the defendant’s contracts with the class members’ patients’ employers. Moreover, no dispute exists that defendant is obligated to pay members of the class for covered health care expenses. The litigation seeks only to resolve how much, and whether, the defendant can unilaterally reduce the amount the providers charged based on discounts the providers negotiated with other parties in contracts to which defendant is not a party. Despite plaintiffs argument that he is a third-party beneficiary of defendant’s contract with the patient’s employer, the real question in this case is not whether the class members are third-party beneficiaries of defendant’s contracts with the employers, but whether defendant is a third-party beneficiary of the class members’ contracts with their respective PPO networks. I agree with the majority to the extent it holds that “plaintiffs breach of contract claim is the only cause of action upon which his class action was allowed.” 388 Ill. App. 3d at 1024. However, I believe the majority is implicitly relying on a belief, admittedly engendered by plaintiff, that the contract at issue is the workers’ compensation contact. Count IV of plaintiffs complaint is titled simply as a claim for breach of contract. “[A] pleading will not be held to be bad in substance if it contains sufficient information as will reasonably inform a defendant of what he must defend against ***.” In re Beatty, 118 Ill. 2d 489, 499, 517 N.E.2d 1065, 1070 (1987). Defendant admits that it “asserts that PPO agreements may allow [defendant] to pay discounted rates by express agreement of the parties.” The only “parties” implicated in that question are plaintiff, the other health care providers, and defendant. That question does not involve the employer, the employee, or, consequently, the Workers’ Compensation Act. I find that nothing in the pleadings precludes my view of the true nature of this case. See Knox College v. Celotex Corp., 88 Ill. 2d 407, 427, 430 N.E.2d 976, 986 (1981) (“ ‘Since the passage of the Civil Practice Act in Illinois, our courts have consistently held that pleadings should be liberally construed’ ”), quoting Psyhogios v. Village of Skokie, 4 Ill. App. 3d 186, 191 (1972). On the real question raised by plaintiffs complaint (as conceded by defendant) involving defendant’s alleged rights under plaintiff’s PPO contracts, plaintiff has demonstrated that he has a cause of action against defendant. Moreover, the questions of fact and law in his claim are common to the members of the purported class, and plaintiff can adequately represent the class. Finally, I believe that a class action is an appropriate method for the fair and efficient adjudication of this controversy. Accordingly, I would affirm.