Health Cost Controls v. Sevilla

• Decision Date: 27 August 1999
• Docket Number: No. 1-98-1695.,1-98-1695.
• Parties: HEALTH COST CONTROLS, Plaintiff and Counterdefendant-Appellee, v. Richard SEVILLA and Edward M. Burnes, Defendants and Counterplaintiffs-Appellants and Third-Party Plaintiffs-Appellants (Health Cost Controls of America, Inc., and Continental Assurance Company, Third-Party Defendants-Appellees).
• Court: United States Appellate Court of Illinois

718 N.E.2d 558

307 Ill. App.3d 582

240 Ill.Dec. 925

HEALTH COST CONTROLS, Plaintiff and Counterdefendant-Appellee, v. Richard SEVILLA and Edward M. Burnes, Defendants and Counterplaintiffs-Appellants and Third-Party Plaintiffs-Appellants (Health Cost Controls of America, Inc., and Continental Assurance Company, Third-Party Defendants-Appellees).

No. 1-98-1695.

Appellate Court of Illinois, First District, Fifth Division.

August 27, 1999.

Clinton A. Krislov, Jonathan Nachsin of Krislov & Associates, Ltd., Edward M. Burnes, Chicago, for Defendants and Counterplaintiffs-Appellants and Third-Party Plaintiffs-Appellants Richard Sevilla and Edward M. Barnes.

David A. Belofsky, Douglas M. Belofsky, Lance R. Minor of Belofsky & Belofsky, P.C., Chicago, for Plaintiff and Counterdefendant-Appellee and Third-Party Defendants-Appellees Health Cost Controls, Health Cost Controls of America, Inc., and Continental Assurance company.

Justice GREIMAN delivered the opinion of the court:

Plaintiff Health Cost Controls (HCC) filed a complaint against defendants Richard Sevilla and Edward M. Burnes, the attorney for Sevilla, in the circuit court of Cook County, seeking to recover reimbursement and repayment of medical benefits paid to Sevilla from the settlement that Sevilla obtained from a third-party tortfeasor as a result of an automobile accident. In turn, defendants Sevilla and Burnes filed a class action counterclaim, asserting that the common fund doctrine required a reduction for attorney fees and expenses from the amount HCC claimed for all liens on class member recoveries. On April 3, 1998, the trial court dismissed HCC's complaint for lack of subject matter jurisdiction and dismissed defendants' counterclaim.

Defendants now appeal the April 3, 1998, order and other trial court rulings, asserting that the trial court improperly (1) dismissed HCC's complaint; (2) dismissed defendants' counterclaim; (3) denied sanctions against HCC; (4) struck Burnes' affidavit; and (5) denied leave to amend defendants' original class certification motion.

We find that the trial court had subject matter jurisdiction over both HCC's complaint and defendants' counterclaim. Thus, we reverse the trial court's order of April 3, 1998, and remand the matter to the circuit court. In addition, we affirm the denial of sanctions against HCC, finding that the trial court did not abuse its discretion. Based on these holdings, we need not consider the other contested rulings by the trial court.

The underlying, undisputed facts, as alleged in HCC's complaint and acknowledged by defendants, are quite straightforward and typical of the body of reimbursement cases. Sevilla was covered under a health insurance policy issued by Continental Assurance Company (CNA) through his employer, Central Can Company. Sevilla was in a car accident, suffered personal injuries and retained private counsel (Burnes) to sue the people allegedly responsible for the accident. In turn, HCC, on behalf of the health insurer (CNA), sent a notice of lien to Burnes for the amount of money the insurer had paid for Sevilla's medical care. Sevilla and the alleged tortfeasor ultimately entered into a settlement agreement. Thereafter, HCC sought to obtain reimbursement from Sevilla, as expressly authorized in the reimbursement provision of the health insurance policy. The settling tortfeasor's insurance carrier issued a check for the amount of HCC's claimed lien and made the check payable to Sevilla, Burnes and HCC. HCC was given possession of the check.

After HCC had possession of the check, the dispute began. Sevilla and Burnes decided not to endorse the check, claiming that HCC was not entitled to the full amount of the check. Rather, the amount of recovery was subject to the common fund doctrine and, therefore, must be reduced by one-third for attorney fees incurred in obtaining the settlement.

On April 28, 1994, HCC filed its complaint in the circuit court of Cook County, seeking to require Sevilla and Burnes to endorse the check in satisfaction of HCC's lien. The complaint stated that HCC was appointed and authorized to administer and prosecute CNA's rights to reimbursement and subrogation under the policy. The reimbursement provision stated:

"In no event will the amount of reimbursement to Us [the insurer] exceed the lesser of:

1. The amount actually paid under the policy; or

2. The amount actually recovered from that part of the judgment or settlement in excess of the amount necessary to fully reimburse the Covered Person for out-of-pocket expenses incurred, including attorney fees."

In its complaint, HCC asked the circuit court to declare that HCC was entitled to the full amount CNA had paid for Sevilla's medical expenses ($2,483.71) and to enjoin defendants from refusing to execute the check.

In April 1995, defendants filed their answer and affirmative defenses. Defendants primarily disputed HCC's entitlement to the total amount of the check ($2,483.71). In their answer, defendants asserted "that the Plan is obligated to bear the expenses of Defendant Sevilla's attorneys incurred in obtaining a recovery for him." As an affirmative defense, defendants asserted that "[u]nder the equitable `fund doctrine,' the Plan and HCC must bear the proportionate share of the costs and expenses incurred by Defendant Sevilla's attorneys in obtaining a recovery, and therefore the `fund doctrine' bars all or part of the recovery sought in this action."

In their class action counterclaim, defendants named Health Cost Controls of Illinois, Inc., and Health Cost Controls of America, Inc. (hereinafter collectively referred to as HCC). Defendants alleged in pertinent part that, under the common fund doctrine, HCC and CNA are obligated to bear the fees and expenses Sevilla's attorney incurred in obtaining the subject recovery from the tortfeasor. HCC and CNA refused to acknowledge this obligation. Defendants further alleged that HCC still possessed the check for $2,483.71 and refused to afford Sevilla a credit of one-third ($817.90) for the attorney fees incurred by Sevilla. The common issue of law advanced in the class action counterclaim was the applicability of the fund doctrine to subrogation recoveries.

Sometime in 1995, HCC unsuccessfully attempted to remove its complaint to the federal district court claiming that defendants' counterclaim raised federal questions under the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq. (West 1994)). In response, defendants apparently filed a motion in the federal court to remand the action to state court and the federal court granted the motion to remand on October 13, 1995.

No activity by any party is apparent in the record from the date of remand (October 1995) until defendants attempted to initiate discovery in February 1997 by serving HCC with a set of interrogatories and request to produce documents. In response, on March 11, 1997, HCC filed a motion for protective order staying all discovery until the resolution of its motion to dismiss for lack of subject matter jurisdiction, i.e., a motion that HCC intended to file contemporaneously with the motion for a protective order but, in fact, did not file until November 13, 1997. During the interim, on March 14, 1997, defendants filed two motions, i.e., a motion for class certification and a motion for summary judgment. The trial court ruled that all discovery be held in abeyance until these three motions were resolved, i.e., motion to dismiss, motion for class certification and motion for summary judgment. Ultimately, however, the trial court ruled only upon HCC's motion to dismiss.

On April 3, 1998, the trial court granted HCC's motion to dismiss for lack of subject matter jurisdiction under section 2-619 of the Code of Civil Procedure (735 ILCS 5/2-619 (West 1996)) and dismissed all claims. Thereafter, the trial court denied defendants' motion for sanctions against HCC. This court applies a de novo standard of review to the dismissal of a claim under section 2-619 because the resolution of such motion involves only a question of law. E.g., Storm & Associates, Ltd. v. Cuculich, 298 Ill.App.3d 1040, 1047, 233 Ill.Dec. 101, 700 N.E.2d 202 (1998).

On appeal, defendants primarily assert that the trial court erred, as a matter of law, in dismissing HCC's complaint based on lack of subject matter jurisdiction. Defendants maintain that ERISA is not an issue at all because the application of the common fund doctrine is a question of state, not federal, law. Thus, defendants submit that the circuit court had subject matter jurisdiction over HCC's complaint.

HCC contends that federal courts have exclusive subject matter jurisdiction over its complaint because its complaint is based on a reimbursement provision in an ERISA-governed benefit plan and, therefore, ERISA, a federal law, preempts state law. HCC maintains that its decision to file its complaint in the circuit court was erroneous because it pleaded claims arising under ERISA.

Subject matter jurisdiction is the power of the court to hear and determine the general question involved and the power to grant the particular relief requested. In re M.M., 156 Ill.2d 53, 64, 189 Ill.Dec. 1, 619 N.E.2d 702 (1993); see also In re Estate of Steinfeld, 158 Ill.2d 1, 12, 196 Ill.Dec. 636, 630 N.E.2d 801 (1994), citing Faris v. Faris, 35 Ill.2d 305, 309, 220 N.E.2d 210 (1966); Lescher v. Barker, 57 Ill.App.3d 776, 779, 15 Ill.Dec. 535, 373 N.E.2d 1007 (1978) ("jurisdiction of the subject matter is the power of a particular court to hear the type of case that is then before it"). Subject matter jurisdiction "does not simply mean jurisdiction of the particular case before it, but the class of cases to which that case belongs." Kemling v. Country Mutual Insurance Co., 107 Ill.App.3d 516, 519-20, 63 Ill.Dec. 331, 437 N.E.2d 1253 (1982).

Subject matter jurisdiction is conferred on courts by the constitution or by statute....