The Fifth District Appellate Court has reversed a Madison County judge's certification of a class action lawsuit against Met Life and St. Paul Fire and Marine Insurance Co.
In November 2010, then-Judge Dan Stack appointed Granite City chiropractor Lawrence Shipley to represent a class alleging breach of contract on insurance claims submitted in 15 states since 1993.
Shipley contends in his complaint that the defendants failed to pay reasonable medical expenses provided under his patient's insurance policy.
After Shipley's patient, Glen Harford, received treatment for injuries sustained in a car accident, he assigned his claim for medical payment under his MetLife policy to Shipley. The chiropractor then submitted his bill for Harford's treatment to the insurance company, which used a computer software program to reduce the bill.
On Friday, a panel of the appellate court reversed the class certification and remanded the case back to the Madison County Circuit Court, holding that "individualized issues regarding whether class members submitted reasonable bills for payment and whether medical providers possessed a valid assignment of their patients' causes of action would predominate over any common issues."
The appellate court decision was released in a five-page unpublished order pursuant to Supreme Court Rule 23. Justice Stephen Spomer delivered the judgment of the panel with Justices James Donovan and Bruce Stewart concurring.
SLC Chapman LLC, the Wood River law firm representing Shipley, intends to appeal the ruling to the Illinois Supreme Court, said firm assistant Lisa Shewmake. She said the firm's "position will be stated in the briefings" and that attorney Mark Brown is handling the case.
Attorneys at HeplerBroom LLC represented Met Life in its petition to appeal. A request for attorney information and comment was not immediately returned Wednesday.
Shipley filed a two-count complaint against the insurance companies in 2003. His first count accused the defendants of breach of contract in that they failed to pay the full amount of medical expenses incurred by one of his patients. The second count, which was not at issue in the appeal, alleged a cause of action for a violation of the state's Consumer Fraud and Deceptive Practices Act.
His amended motion for class certification sought to certify a class including all insured persons or medical providers in 15 states who 1) submitted a claim to the defendants for reasonable payment of medical expenses, 2) had their claim adjusted by MetLife and reviewed by its computer bill software program, 3) received partial payment in an amount less than the submitted medical expenses and 4) received an amount less than the state policy limits.
Aside from a few exclusions, the class approved by Stack covered insurance claims made from Feb. 21, 1993 to the date of the certification order and insured persons and providers in Alabama, Arizona, California, Colorado, Connecticut, Georgia, Illinois, Indiana, Louisiana, Missouri, North Carolina, Ohio, South Carolina, Tennessee and Wisconsin.
In the appellate court's analysis, Spomer wrote that "the allegations of the class action complaint and posture of this case are identical to" those discussed in Bemis v. Safeco Insurance Co., a 2011 ruling out of the Fifth District.
The Bemis court, Spomer wrote, held that "individualized issues regarding whether the bills submitted by a medical provider reflect reasonable charges for necessary medical services and whether medical providers possess valid assignments would predominate at trial, defeating the commonality requirement for a class action as set forth in section 2-801 of the Illinois Code of Civil Procedure."
Shipley previously argued that the court's reliance in Bemis on the Supreme Court's ruling in Avery v. State Farm and other cases dealing with the commonality requirements is misplaced because the state high court misconstrued and misquoted language in cases that predate Section 2-801.
"This court is bound by principles of stare decisis to follow Avery and its progeny unless and until they are overruled by the Illinois Supreme Court," Spomer reasoned. "For these reasons, we find that the circuit court erred when it granted plaintiff's motion for a class certification.
The citation for the unpublished order in this case is 2012 IL App (5th) 100619-U. The Madison County case number is 03-L-277.