Hale v. Country Mutual Insurance Co.

Case Date: 10/16/2002
Court: 5th District Appellate
Docket No: 5-01-0955 Rel

                    NOTICE
Decision filed 10/16/02.  The text of this decision may be changed or corrected prior to the filing of a Petition for Rehearing or the disposition of the same.

NO. 5-01-0955

IN THE

APPELLATE COURT OF ILLINOIS

FIFTH DISTRICT


MARK A. HALE, 

     Plaintiff-Appellant,

v.

COUNTRY MUTUAL INSURANCE
COMPANY,

     Defendant-Appellee.

)
)
)
)
)
)
)
)
)
)
Appeal from the
Circuit Court of
Washington County.

No. 01-MR-2


Honorable
Lloyd A. Karmeier,
Judge, presiding.


 

JUSTICE KUEHN delivered the opinion of the court:

The plaintiff, Mark A. Hale, appeals from the trial court's November 20, 2001, orderdismissing his amended complaint with prejudice on the basis that he had failed to complywith an arbitration provision contained within an insurance policy written by the defendant,Country Mutual Insurance Company. We reverse.

Country Mutual Insurance Company (Country Mutual) issued a policy to Mark A.Hale that, in addition to other coverages, provided $100,000 in underinsured-motoristcoverage. That policy was in effect on April 11, 1997, when Hale was in a motor vehicleaccident resulting from the negligence of a man named Earl Raymond. Earl Raymond wasinsured by Allstate Insurance Company with $50,000 in liability coverage. Country Mutual'spolicy provision at issue in this case is as follows:

"Legal Action Against Us: No suit, action[,] or arbitration proceedings for recoveryof any claim may be brought against us until the insured has fully complied with allthe terms of this policy. Further, any suit, action, or arbitration will be barred unlesscommenced within 2 years after the date of the accident. Arbitration proceedings willnot commence until we receive your written demand for arbitration."

On March 22, 1999, Hale's attorney sent a letter to Country Mutual stating thefollowing:

"I have been retained to represent your insured, Mark Hale, for injuries sustained ina motor vehicle accident on April 11, 1997. It appears that we have an underinsuredclaim. At this time I ask that you disclose the underinsured motorist and medicalpayments policy limits of Mr. Hale."

More than four months later, Country Mutual responded to this notification. In its August4, 1999, letter to Hale's attorney, Country Mutual assigned his claim an internal number andincluded an "Underinsured Motorist Notice of Claim" form. Country Mutual asked Hale'sattorney to complete and return this form. On August 13, 1999, Hale's attorney sent thecompleted form to Country Mutual.

Receipt of the claim form and its contents apparently triggered some sort of a reviewprocess at Country Mutual, because on August 27, 1999, a liability specialist employed byCountry Mutual wrote to Hale's attorney and stated that the file had been assigned to him. He advised that Country Mutual was denying coverage because arbitration had not beendemanded on or before April 11, 1999.

Hale filed a declaratory judgment action against Country Mutual. The action soughtto have the trial court determine that his underinsured-motorist claim was timely made. Country Mutual sought to dismiss the complaint on the basis that Mark Hale had notcomplied with the limitations clause of its policy by expressly demanding arbitration. Thetrial court eventually granted this motion but granted Hale leave to file an amendedcomplaint. The amended complaint contained a second count alleging damages for CountryMutual's breach of duty of good faith and fair dealing. Country Mutual again sought to havethe complaint dismissed, pursuant to sections 2-615 and 2-619 of the Code of CivilProcedure (735 ILCS 5/2-615, 2-619 (West 2000)). On November 20, 2001, the trial courtentered its order dismissing Hale's amended complaint with prejudice.

When the trial court is presented with a motion to dismiss a case for the failure tostate a cause of action pursuant to section 2-615 of the Code of Civil Procedure, the courtmust determine whether the complaint sets forth sufficient facts that, if established, couldentitle the plaintiff to relief. Bryson v. News America Publications, Inc., 174 Ill. 2d 77, 86,672 N.E.2d 1207, 1214 (1996). The trial court must accept all well-pleaded facts in thecomplaint as true and draw reasonable inferences from those facts that are favorable to theplaintiff. Bryson, 174 Ill. 2d at 86, 672 N.E.2d at 1213. On appeal from a trial court'sinvoluntary dismissal of a complaint pursuant to section 2-619 of the Code of CivilProcedure, we must determine "whether the existence of a genuine issue of material factshould have precluded the dismissal or, absent such an issue of fact, whether dismissal isproper as a matter of law." Doyle v. Holy Cross Hospital, 186 Ill. 2d 104, 109-10, 708N.E.2d 1140, 1144 (1999). In both situations, because the trial court was not called uponto judge any witness's credibility or weigh facts, we review the matter de novo on appeal. Jackson v. Michael Reese Hospital & Medical Center, 294 Ill. App. 3d 1, 9, 689 N.E.2d 205,211 (1997); In re Estate of Mayfield, 288 Ill. App. 3d 534, 542, 680 N.E.2d 784, 789 (1997).

We start with the language utilized by Country Mutual in its policy. The languagehas been challenged over the years and has consistently been upheld. The language is notcontrary to public policy, and it is clear and unambiguous. See Buchalo v. Country MutualInsurance Co., 83 Ill. App. 3d 1040, 404 N.E.2d 473 (1980); Coyne v. Country MutualInsurance Co., 39 Ill. App. 3d 279, 349 N.E.2d 485 (1976); Shelton v. Country MutualInsurance Co., 161 Ill. App. 3d 652, 515 N.E.2d 235 (1987).

Whether or not Hale was "underinsured" could not be determined until the underlyingliability case was resolved by settlement or judgment. However, Country Mutual's policylanguage does not require a demand for arbitration within two years of the "loss," as wouldrequire a different construction. See McCray v. Merit Insurance Co., 233 Ill. App. 3d 36,598 N.E.2d 366 (1992); Whiting v. Prestige Casualty Co., 238 Ill. App. 3d 376, 606 N.E.2d397 (1992). Because Country Mutual's policy contained the word "accident" as the limitingoccurrence, we must determine whether Hale sought arbitration within two years of theaccident.

Did Hale's attorney's letter constitute an unequivocal demand for arbitration? If thetest requires precise verbiage, then his letter would surely fail. His attorney's letter merelyindicated that he had an underinsured-motorist claim. Hale's attorney could not possiblyknow for certain whether he had such a claim, because at the time of the writing theunderlying liability suit had not been concluded.

This contractual limitations period is not unlike a statutory limitations period in thattheir purposes are identical. A limitations period requires necessary litigation to be broughtwithin such time so that the facts of the case can still be established with the utmost certaintybefore that proof becomes stale or completely lost. Leitch v. New York Central R.R. Co.,388 Ill. 236, 245, 58 N.E.2d 16, 20 (1944). Similarly, the insurance company requiresnotification of a claim in a timely fashion. Its ability to defend the claim would be greatlydiminished if there was no time frame in which such claims had to be filed or be barred.

Keeping this notification purpose in mind, we address the facts of this case. In theabsence of a settlement agreement between Country Mutual and its insured, arbitration is theonly means by which the insured could collect underinsured-motorist benefits. The policyrequired arbitration proceedings to be commenced within two years of the accident date. The policy further stated that the arbitration process would begin when the insureddemanded arbitration in writing.

The language utilized by Hale's attorney was not perfect but served the purpose ofnotifying Country Mutual of the underinsured-motorist claim. Country Mutual obviouslyreceived this notification, because it acknowledged the letter by sending Hale's attorney anunderinsured-motorist claim form. By establishing a claim number, setting up its file, andsending out the claim form, Country Mutual invoked its claim-handling process. We do notmean to imply that Country Mutual's act of sending out the form resulted in an estoppel. The act of sending out the claim form does not fit the factual scenario seen in estoppel cases. However, Country Mutual's actions do acknowledge notification-the purpose of thecontractual limitations period at issue.

Because there is no way for an insured to make an underinsured-motorist claim absentan arbitration proceeding, we conclude that timely notification of a claim is sufficient. Because arbitration is the formal means by which the underinsured individual can recoverfrom his or her own company, notification of the claim serves as notice of an impendingarbitration. The purpose of the limitations clause is notification-not a trap for insuredsfailing to use the precise wording suggested by the insurer. To hold otherwise would meanthat with every minor claim, the attorney would need to formally request arbitration or fearmalpractice for failing to do so. The insurance industry could not desire that outcomebecause its companies would be inundated with premature arbitration demands. Use of theexact words should not dictate coverage or lack thereof. The form of filing an underinsured-motorist claim, which necessitates an arbitration demand, should not dictate the substanceof the request. To the extent that other cases are contrary to our holding, we disagree withthose cases.

Because of our holding on this issue, we do not reach the issues of estoppel andCountry Mutual's history of dealings with other insureds, also raised by Hale on appeal.

For the foregoing reasons, the judgment of the circuit court of Washington Countyis hereby reversed.

Reversed.

MAAG, P.J., and CHAPMAN, J., concur.