Scudella v. Illinois Farmers Ins. Co.

• Decision Date: 09 August 1988
• Docket Number: No. 87-2934,87-2934
• Citation: 123 Ill.Dec. 673,528 N.E.2d 218,174 Ill.App.3d 245
• Parties: , 123 Ill.Dec. 673 Anthony J. SCUDELLA, Plaintiff-Appellant, v. ILLINOIS FARMERS INSURANCE COMPANY, Defendant-Appellee.
• Court: United States Appellate Court of Illinois

Page 218

528 N.E.2d 218

174 Ill.App.3d 245, 123 Ill.Dec. 673

Anthony J. SCUDELLA, Plaintiff-Appellant, v. ILLINOIS FARMERS INSURANCE COMPANY, Defendant-Appellee.

No. 87-2934.

Appellate Court of Illinois,

First District, Second Division.

Aug. 9, 1988.

Rehearing Denied Oct. 4, 1988.

Ambrose & Cushing, P.C., Chicago (John C. Ambrose, of counsel), for plaintiff-appellant.

Hinshaw, Culbertson, Moelmann, Hoban & Fuller, Chicago (D. Kendall Griffith, Katherine S. Dedrick and Gerald Haberkorn, of counsel), for defendant-appellee.

Presiding Justice HARTMAN delivered the opinion of the court:

Plaintiff appeals the dismissal of his declaratory judgment action in an automobile insurance case. He raises as issues for our review whether: (1) worker's compensation benefits and uninsured motorist payments may be set off against payments due under personal injury income continuation coverage; (2) underinsurance should have been offered and added to plaintiff's coverage; and (3) his vexatious and unreasonable delay count was properly dismissed.

On September 17, 1980, plaintiff, a refuse collector, was struck while walking across a street by a motorcycle and was permanently injured. He filed an action against the uninsured cyclist and was awarded $250,000 in a default judgment.

Plaintiff owned two assertedly identical automobile insurance policies issued by defendant, one for a 1975 Pontiac and the other for a 1975 Dodge Truck.

Plaintiff's Basic Personal Injury Protection ("PIP") policy covered reasonable and necessary medical expenses for medical services rendered within one year of an accident, with a limit of $2000 per person. It also contained income continuation provisions, replacing 85% of income lost within one year of an accident, resulting from total disability, with a payment limit of $150 per week per injured person. Basic PIP requirements also prohibited duplicate recovery based on multiple policies and limited total benefits from any one accident to the total Basic PIP benefits under the policy.

Excess PIP covered all reasonable and necessary medical expenses, as well as parallel income replacement provisions for 260 weeks, starting one year after the date of the accident. Both Basic and Excess PIP contained similar limits of liability clauses:

"Any amount payable to or for the benefit of an injured person under this insurance shall be reduced by:

"(1) any amount paid or payable to such injured person under the workmen's compensation laws of any state or the Federal Government;

"(2) any amount paid or payable to such injured person under Part I of the policy or under Uninsured Motorists Coverage which would result in a duplication of payment or reimbursement for any loss covered under this insurance."

Another provision of the insurance policy prohibited the "stacking" of defendant's policies.

Plaintiff received the following payments from defendant under the policy: (1) $15,000 for uninsured motorist benefits; (2) $7800 as income continuation under Basic PIP; and (3) $16,500 in income continuation under Excess PIP. As a result of the accident, plaintiff was awarded $83,500 in worker's compensation payments for 158 and two-sevenths weeks of disability from his employer's compensation carrier. Defendant ceased making payments to plaintiff because of the offset provision in his policy, quoted in "(1)" above.

Plaintiff filed actions against defendant for declaratory judgment, and on March 17, 1987, he filed his second amended complaint in five counts. In count I, he asserted that he received only $24,300 under Basic and Excess PIP, but should have received a total of $46,800, representing 312 weeks of compensation at $150 per week. Plaintiff urged that the limits on coverage relating to worker's compensation payments and uninsured motorist payments should be declared void and unenforceable because they were ambiguous and made PIP coverage illusory. In count II, he requested a $5000 penalty and attorney fees under section 155 of the Insurance Code (Ill.Rev.Stat.1979, ch. 73, par. 767) for defendant's unreasonable delay in making additional PIP payments. In the third count, plaintiff asked for relief in excess of $15,000 plus costs for defendant's failure to offer him underinsurance coverage as mandated by statute (Ill.Rev.Stat.1979 Supp., ch. 73, par. 755a-1 (repealed effective September 3, 1980 and replaced by Ill.Rev.Stat.1981, ch. 73, par. 755a-2(4))), which would have allowed him additional recovery. In count IV, he requested $15,000 in uninsured motorist coverage under his second policy and, in count V, he sought payment of $5000 as a penalty, plus attorney fees and costs, for defendant's unreasonable delay in paying the additional $15,000. Ill.Rev.Stat.1979, ch. 73, par. 767.

On April 10, 1987, defendant moved to dismiss counts I and IV under section 2-619 of the Code of Civil Procedure (Ill.Rev.Stat.1987, ch. 110, par. 2-619), asserting that the worker's compensation benefits plaintiff received precluded any additional payments under the policy and the anti-stacking provision barred the second $15,000 payment sought. Defendant further contended plaintiff actually had been overpaid. In a separate motion, defendant moved under section 2-615 of the Code of Civil Procedure (Ill.Rev.Stat.1987, ch. 110, par. 2-615) to dismiss counts II, III and V on the grounds that: the allegations of vexatious delay under counts II and V lacked a factual basis and the cyclist who injured plaintiff was uninsured not underinsured; therefore, count III failed to state a cause of action.

On June 29, 1987, the circuit court dismissed counts I, II, III and V with prejudice but denied dismissal of count IV. Defendant moved to reconsider count IV and, in an order entered August 20, 1987, count IV was dismissed with prejudice as well. Plaintiff appeals.

I.

Plaintiff first alleges that defendant should not be allowed to reduce its PIP payments by the worker's compensation award and the uninsured motorist benefits, despite the wording of the insurance policies, because the worker's compensation carrier has no right of subrogation against the insurance company, since subrogation is statutory under the compensation act and limited to a right against a tortfeasor. Plaintiff asserts that the PIP benefits are otherwise illusory, since defendant failed to mention such an exclusion in the title of the coverage. Additionally, plaintiff contends that the $15,000 paid him as uninsured motorist benefits should not reduce his PIP payments since no duplication is involved, as the loss from his injuries exceeds any amount that would be due him.

Clear and unambiguous insurance policy provisions will be applied as written and policy language will be given its plain and ordinary meaning (United States Fire Insurance Co. v. Schnackenberg (1981), 88 Ill.2d 1, 4-5, 57 Ill.Dec. 840, 429 N.E.2d 1203; Giardino v. American Family Insurance (1987), 164 Ill.App.3d 389, 391, 115 Ill.Dec. 501, 517 N.E.2d 1187; Allstate Insurance Co. v. Panzica (1987), 162 Ill.App.3d 589, 591, 114 Ill.Dec. 28, 515 N.E.2d 1299), unless it contravenes public policy (Menke v. Country Mutual Insurance Co. (1980), 78 Ill.2d 420, 423, 36 Ill.Dec. 698 401 N.E.2d 539; Becker v. Country Mutual Insurance Co. (1987), 158 Ill.App.3d 63, 68, 110 Ill.Dec. 285, 510 N.E.2d 1316, appeal denied (1987), 116 Ill.2d 548, 113 Ill.Dec. 292, 515 N.E.2d 101). Setoff provisions requiring that uninsured motorist payments be reduced by the amount of worker's compensation awarded a claimant have been upheld by our supreme court when challenged on public policy grounds. Stryker v. State Farm Mutual Automobile Insurance Co. (1978), 74 Ill.2d 507, 512-13, 24 Ill.Dec. 832, 386 N.E.2d 36; Ullman v. Wolverine Insurance Co. (1970), 48 Ill.2d 1, 7-8, 269 N.E.2d 295.

The uninsured motorist statute (Ill.Rev.Stat.1979, ch. 73, par. 755a) is intended to place a claimant in the same position as if the tortfeasor causing the injuries had been insured. Since the compensation carrier would then have the right to reimbursement, a setoff provision for worker's compensation payments against unemployed motorist proceeds does not treat that claimant unfairly. In neither case is the employee compensated for identical damages from both his employer and the tortfeasor. ( Stryker, 74 Ill.2d at 512, 24 Ill.Dec. 832, 386 N.E.2d 36; Ullman, 48 Ill.2d at 7, 269 N.E.2d 295.) More specifically, a provision reducing payment under an automobile insurance policy by the value of any worker's compensation award was upheld as being clear and unambiguous as applied to uninsured motorist benefits. (Niekamp v. Allstate Insurance Co. (1964), 52 Ill.App.2d 364, 365-67, 202 N.E.2d 126.) At bar, the policy setoff provision is equally clear and unambiguous and must be construed as written.

Setting off worker's compensation payments against the PIP payments here also prevents double recovery. The underlying purpose of worker's compensation is to furnish financial protection, including restoring lost wages, for workers whose earning ability is adversely affected by employment-related injuries. (Board of Education v. Industrial Comm'n (1972), 53 Ill.2d 167, 171, 290 N.E.2d 247.) Worker's compensation provides income replacement similar to income continuation under PIP. The award of $83,500 in worker's compensation to plaintiff precludes any additional PIP payments.

Plaintiff argues that the basis for setting off uninsurance coverage is purely statutory, based on an employer's right of subrogation against tortfeasors. (Ill.Rev.Stat.1979, ch. 48, par. 138.5(b); see Chicago Transit Authority v. Yellow Cab Co. (1982), 110 Ill.App.3d 379, 381, 66 Ill.Dec. 120, 442 N.E.2d 546.) Our supreme court, however, has asserted that simply treating an employee similarly, whether the tortfeasor was insured or uninsured, is the vital consideration, not whether an employer has the right to reimbursement from uninsured motorist proceeds by either...