Turner v. Orthopedic and Shoulder Center, S.C.
2017 IL App (4th) 160552
| Ill. App. Ct. | 2017Background
- Turner (plaintiff) was treated by Orthopedic and Shoulder Center (defendant) after a July 2014 car accident; defendant had a Participating Provider Agreement with Blue Cross Blue Shield (Blue Cross).
- The Agreement required the provider to accept Blue Cross’s usual and customary allowance as full payment for covered services and barred the provider from seeking additional payment from covered persons (third‑party beneficiaries).
- Defendant billed Blue Cross $29,008.55; Blue Cross paid the agreed discounted allowance of $6,495.63. Defendant then returned those payments to Blue Cross without a request.
- Defendant filed multiple health‑care services liens against Turner’s personal‑injury settlement fund, asserting amounts substantially higher than the Blue Cross discounted payments; defendant also demanded $34,027.40 from plaintiff’s counsel and threatened litigation.
- Turner sued for consumer fraud and intentional infliction of emotional distress and filed a petition to adjudicate the lien to zero; the trial court granted summary judgment for defendant on both counts and upheld the lien. Turner appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether defendant’s conduct constituted consumer fraud under the Consumer Fraud Act | Turner: Defendant refused to bill/accept Blue Cross payments and fraudulently billed her for $34,027.40 despite contractually owing less | Defendant: Its lien and demands were permissible; legislative history shows no intent to force providers to accept reduced insurer rates | Court: Dismissed consumer fraud claim — conduct was a breach of contract (plaintiff an intended third‑party beneficiary) and not actionable under the Act |
| Whether plaintiff forfeited the intentional infliction of emotional distress claim | Turner: Alleged emotional harm from liens, threats, and withholding contract | Defendant: No severe emotional distress; conduct not extreme and outrageous | Court: Claim forfeited on appeal for failure to argue in opening brief; alternatively, insufficient evidence of extreme emotional distress |
| Whether the asserted health‑care services lien was valid | Turner: Agreement with Blue Cross waived provider’s right to seek more than the discounted payment; also asserted defective notice under the Lien Act | Defendant: Lien valid; legislative history shows no requirement that providers accept reduced insurer payments; lien not precluded because it asserted against settlement fund rather than directly suing plaintiff | Court: Reversed trial court on lien — because Agreement made Blue Cross payment full satisfaction, defendant had no debt owed by Turner and thus no valid lien; remanded/adjudicated lien to zero |
| Relevance of legislative history (House Bill amendment) to lien question | Turner: Not central; relies on contract language and precedent | Defendant: Points to deleted language as evidence legislature did not intend to force acceptance of reduced insurer payments | Held: Legislative history irrelevant where statute is unambiguous; resolution rests on contract terms, not the cited legislative history |
Key Cases Cited
- Avery v. State Farm Mut. Automobile Ins. Co., 216 Ill. 2d 100 (2005) (a simple breach of contract, without more, is not actionable under the Consumer Fraud Act)
- Rogalla v. Christie Clinic, P.C., 341 Ill. App. 3d 410 (2003) (reconciling contractual exemption and third‑party/subrogation clauses to determine a provider’s right to seek third‑party recovery)
- Cirrincione v. Johnson, 184 Ill. 2d 109 (1998) (discusses remedies and sanctions for unreasonably withholding funds)
- Public Finance Corp. v. Davis, 66 Ill. 2d 85 (1976) (standard for intentional infliction of emotional distress: must be extreme and outrageous and cause severe distress)