Atherton v. CONNECTICUT GENERAL LIFE INS.
353 Ill. Dec. 189
| Ill. App. Ct. | 2011Background
- Plaintiffs seek damages and fees after a Pulaski County court ordered coverage for Brooke Atherton's medically necessary in-home nursing care under QCHP.
- Plaintiffs filed multiple complaints in Cook County alleging common law fraud and Consumer Fraud Act violations against plan administrators and providers.
- Trial court granted summary judgment, finding res judicata bars the claims and that plaintiffs failed to prove reliance for common law fraud.
- Appellate court reversed on res judicata issues, concluding genuine issues of material fact exist as to privity/scope of agency and possible reliance.
- Court recognized that the agency relationship and scope of authority are questions of fact appropriate for trial, not summary judgment.
- Dissenting and concurring opinions addressed privity scope and reliance, with split views on the proper resolution.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does res judicata bar the current claims? | Plaintiffs contend privity may connect defendants to QCHP's prior suit. | Defendants argue privity via agency with QCHP estops current claims. | No, triable issue exists on privity/scope of agency; remand on res judicata not dispositive |
| Is there privity between defendants and QCHP for res judicata purposes? | Plaintiffs assert agency relationship makes defendants adequately represent interests. | Defendants contend agency equates to privity for preclusion. | Genuine issue of material fact as to privity and agency scope exists |
| Did plaintiffs justifiably rely on defendants' statements to prove common law fraud? | Plaintiffs claim misrepresentations concealed medical necessity and induced action. | Defendants assert plaintiffs disagreed with coverage decisions, negating justifiable reliance. | Justifiable reliance issues survive summary judgment; factual dispute remains |
| Is proximate causation of damages a question for trial? | Damages tied to alleged fraudulent acts by plan administrators. | Proximate causation is a fact-intensive inquiry unsuitable for summary judgment. | Question of proximate cause must be decided at trial |
| Do the claims against the individual defendants remain viable after remand? | Claims of fraud and Consumer Fraud Act should proceed on remand. | Res judicata and lack of justifiable reliance foreclose at least some fraud theories. | Remand for further proceedings; do not affirm outright dismissal on all counts |
Key Cases Cited
- Outboard Marine Corp. v. Liberty Mutual Insurance Co., 154 Ill.2d 90 (1992) (summary judgment standards and record review)
- Kalcheim v. People, 394 Ill.App.3d 324 (2009) (elements of res judicata; identity of causes of action)
- Purmal v. Robert N. Wadington & Associates, 354 Ill.App.3d 715 (2004) (privity and judgments; Restatement considerations)
- Progressive Land Developers, Inc. v. American International Group, Inc., 151 Ill.2d 285 (1992) (privity and identity of interests; Restatement guidance)
- State Farm Fire & Casualty Co. v. John J. Rickhoff Sheet Metal Co., 394 Ill.App.3d 548 (2009) (Restatement Second of Judgments privity categories)
- Doe v. Dilling, 228 Ill.2d 324 (2008) (elements of fraudulent misrepresentation; justifiable reliance)
- Bagnola v. SmithKline Beecham Clinical Laboratories, 333 Ill.App.3d 711 (2002) (privity and res judicata in agency contexts)
- Career Concepts, Inc. v. Synergy, Inc., 372 Ill.App.3d 395 (2007) (scope of agency; material fact question)