Acuity v. Decker
| Citation | 46 N.E.3d 402 |
| Decision Date | 23 December 2015 |
| Docket Number | No. 2–15–0192.,2–15–0192. |
| Parties | ACUITY, Plaintiff–Appellant, v. Donald DECKER, Defendant–Appellee (Groot Industries, Inc., Defendant). |
| Court | United States Appellate Court of Illinois |
Bradley A. Bertkau and Jason Orleans, both of Chilton, Yambert & Porter LLP, Waukegan, for appellant.
Thomas D. Campe, Jr., of Linn, Campe & Rizzo Ltd., Waukegan, for appellee.
¶ 1 Defendant Donald Decker suffered personal injuries from an automobile accident while working for his employer, defendant Groot Industries, Inc. (Groot).1 Decker received workers' compensation benefits from plaintiff, Acuity, which was Groot's insurance carrier. Decker settled his claim against USAA, the insurer for Carol Hunter, the third-party tortfeasor, for the full policy limit, and Decker paid Acuity the portion of that settlement required for satisfaction of the workers' compensation lien. Decker filed an underinsured motorist (UIM) claim with Acuity, which was Groot's automobile insurance carrier. Acuity filed a declaratory judgment action against Decker and Groot, contending that it was entitled to a set off for the entire amount it paid to Decker on the workers' compensation claim, plus the entire amount that Decker received from USAA, and that certain elements of loss for which Decker had been compensated through workers' compensation were precluded under Groot's automobile insurance policy. The parties filed cross-motions for summary judgment. Acuity's motion was denied, but Decker's was granted. We affirm for the following reasons.
¶ 3 The facts are undisputed. While working as a truck driver on March 19, 2012, Decker was involved in a motor vehicle collision with Hunter. Hunter was responsible for the accident. Decker settled his claim with USAA for the full policy limit of $50,000.
¶ 4 On his workers' compensation claim, Acuity paid Decker $350,942. Decker paid Acuity $37,067.48 from the USAA settlement as satisfaction of the workers' compensation lien. See 820 ILCS 305/5(b) (West 2014). Decker then submitted a claim for UIM compensation under Groot's automobile insurance policy, which provided for $2 million in UIM coverage.
¶ 5 In its declaratory judgment complaint, Acuity sought a judgment that the UIM coverage from which Decker sought compensation precluded certain elements of loss for which Decker had already been compensated. Acuity contended that Decker was not allowed to make a claim for lost wages, past medical expenses, and future medical expenses on his UIM claim. Acuity also contended that it was entitled to a set off for the full settlement that Decker received from USAA, including the $37,067.48 Decker paid Acuity from the settlement, plus the full amount paid for the workers' compensation claim. Acuity sought a total set off of $400,942. Acuity moved for summary judgment.
¶ 6 In his cross-motion, Decker responded that Acuity should get a set off for the amount paid by USAA and for the amount paid by Acuity on the workers' compensation claim, less the amount it was paid back. Decker pointed out that Acuity paid $350,942 on the workers' compensation claim and that USAA paid $50,000. Decker argued that, if Acuity had not been reimbursed by Decker, then Acuity would receive a set off for the full amount paid on the workers' compensation claim and the full amount of the settlement with USAA. However, because Acuity was reimbursed $37,067.48, it should not be able to claim a set off for the full $50,000, as this would amount to a double set off. Under Decker's position, Acuity would be entitled to a set off for only $363,874.52 ($350,942 paid in workers' compensation benefits, plus the $50,000 settlement from USAA minus the $37,067.48 reimbursed to Acuity). Further, when the case went to arbitration on the UIM claim, Decker argued, he could seek damages for all elements of loss, subject to the set off.
¶ 7 The trial court denied Acuity's summary judgment motion and granted Decker's motion. The court found that (a) Decker was allowed to present all elements of loss in his UIM claim, even though he had already been compensated for certain elements through workers' compensation, and (b) Acuity was not entitled to a set off for the full settlement with USAA, because Decker was statutorily required to pay 75% of the settlement toward the workers' compensation lien. The trial court concluded that the total set off that Acuity was entitled to was $363,874.52. Acuity timely appeals from the denial of its motion for summary judgment and the granting of Decker's motion.
¶ 10 Summary judgment is appropriate when the pleadings, depositions, admissions, and affidavits show that there is no issue of material fact and that the moving party is entitled to judgment as a matter of law. 735 ILCS 5/2–1005(c) (West 2014); Outboard Marine Corp. v. Liberty Mutual Insurance Co., 154 Ill.2d 90, 102, 180 Ill.Dec. 691, 607 N.E.2d 1204 (1992). Our review of the trial court's grant of summary judgment is de novo. Also, the construction of an insurance policy is a question of law, which we review de novo. Burcham v. West Bend Mutual Insurance Co., 2011 IL App (2d) 101035, ¶ 10, 356 Ill.Dec. 357, 961 N.E.2d 453.
¶ 11 We construe an insurance policy by ascertaining and giving effect to the parties' intent, as expressed in the policy language. West American Insurance Co. v. Yorkville National Bank, 238 Ill.2d 177, 184, 345 Ill.Dec. 445, 939 N.E.2d 288 (2010). We give unambiguous words in the policy their plain, ordinary, and popular meanings. Id. We will read narrowly a policy provision purporting to exclude or limit coverage and apply it only where its terms are clear, definite, and specific. Gillen v. State Farm Mutual Automobile Insurance Co., 215 Ill.2d 381, 393, 294 Ill.Dec. 163, 830 N.E.2d 575 (2005). Where such a provision is ambiguous, it will be construed liberally in favor of coverage. Founders Insurance Co. v. Munoz, 237 Ill.2d 424, 433, 341 Ill.Dec. 485, 930 N.E.2d 999 (2010).
¶ 12 Groot's automobile insurance policy contains an “Illinois Uninsured and Underinsured Motorists Coverage” endorsement. Pertinent to the present case is paragraph 4b of the endorsement, which pertains to the UIM coverage limit for bodily injury. Paragraph 4b(5) states: “No one will be entitled to receive duplicate payments for the same elements of loss under this Coverage Form or any Liability Coverage Form.” (Emphasis in original.) Paragraph 4b(3) provides:
¶ 14 Acuity first argues that the trial court erred in reducing the UIM set off by the $37,067.48 that Decker paid Acuity for the workers' compensation lien. Acuity argues that the set off should include the entire $50,000 paid by USAA, notwithstanding Decker's payment to Acuity.
¶ 15 Section 143a–2(4) of the Illinois Insurance Code provides: “The limits of liability for an insurer providing underinsured motorist coverage shall be the limits of such coverage, less those amounts actually recovered under the applicable bodily injury insurance policies, bonds or other security maintained on the underinsured motor vehicle.” (Emphasis added.) 215 ILCS 5/143a–2(4) (West 2014). The Illinois Supreme Court has noted that the underlying purpose of UIM coverage is to “ ‘place the insured in the same position he would have occupied if the tortfeasor had carried adequate insurance.’ ” Phoenix Insurance Co. v. Rosen, 242 Ill.2d 48, 69, 350 Ill.Dec. 847, 949 N.E.2d 639 (2011) (quoting Sulser v. Country Mutual Insurance Co., 147 Ill.2d 548, 555–58, 169 Ill.Dec. 254, 591 N.E.2d 427 (1992) ). Thus, it is evident that UIM coverage was not designed to give either the injured party or the insurer a windfall.
¶ 16 Here, if we were to adopt Acuity's position, Acuity would be allowed to count the $37,067.48 twice as part of the “sums paid” under Acuity's UIM policy or the “amounts actually recovered” under the statute. When the $37,067.48 was paid for the workers' compensation lien, that amount was no longer part of Decker's workers' compensation award, i.e., it was no longer a sum paid on the workers' compensation claim, or an amount Decker actually recovered.
¶ 17 This holding is supported by the reasoning in Berrey v. Travelers Indemnity Co. of America, 770 F.3d 591 (7th Cir.2014), and Roberts v. Northland Insurance Co., 291 Ill.App.3d 727, 226 Ill.Dec. 268, 685 N.E.2d 371 (1997) rev'd on other grounds, 185 Ill.2d 262, 235 Ill.Dec. 579, 705 N.E.2d 762 (1998). In Berrey, the plaintiff was injured in a car accident at work. The at-fault driver carried liability insurance, but the cost of the plaintiff's injuries exceeded the $100,000 insurance policy limit. The plaintiff received partial compensation under her employer's workers' compensation scheme but, because her employer was not legally responsible for the accident, the workers' compensation carrier had a lien on any recovery the plaintiff received from the at-fault driver. The at-fault driver's insurance carrier paid the policy limit directly to the workers' compensation carrier to satisfy the workers' compensation lien. At arbitration, the arbitrator found that the plaintiff's case had a total value of $310,000. Berrey, 770 F.3d at 593.
¶ 18 The defendant-insurer provided UIM coverage to the plaintiff's employer. The defendant paid the plaintiff $210,000, the difference between her total calculated...
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