{ "id": 5167469, "name": "John Kosick, Appellee, v. Hospital Service Corp., An Illinois not-for-profit corporation, Appellant", "name_abbreviation": "Kosick v. Hospital Service Corp.", "decision_date": "1956-12-28", "docket_number": "Gen. No. 46,885", "first_page": "291", "last_page": "297", "citations": [ { "type": "official", "cite": "12 Ill. App. 2d 291" } ], "court": { "name_abbreviation": "Ill. App. Ct.", "id": 8837, "name": "Illinois Appellate Court" }, "jurisdiction": { "id": 29, "name_long": "Illinois", "name": "Ill." }, "cites_to": [ { "cite": "349 U. S. 963", "category": "reporters:federal", "reporter": "U.S.", "case_ids": [ 11370404, 11370468, 11370633, 11370185, 11370123, 11370700, 11370319, 11370546, 11370044 ], "opinion_index": 0, "case_paths": [ "/us/349/0963-05", "/us/349/0963-06", "/us/349/0963-08", "/us/349/0963-03", "/us/349/0963-02", "/us/349/0963-09", "/us/349/0963-04", "/us/349/0963-07", "/us/349/0963-01" ] }, { "cite": "5 Ill.2d 384", "category": "reporters:state", "reporter": "Ill. 2d", "case_ids": [ 2704003 ], "opinion_index": 0, "case_paths": [ "/ill-2d/5/0384-01" ] }, { "cite": "291 Ill. 561", "category": "reporters:state", "reporter": "Ill.", "case_ids": [ 2420698 ], "opinion_index": 0, "case_paths": [ "/ill/291/0561-01" ] } ], "analysis": { "cardinality": 480, "char_count": 9258, "ocr_confidence": 0.529, "pagerank": { "raw": 2.408682747792993e-07, "percentile": 0.7997085930492472 }, "sha256": "f1f2306d1b145f6a1d704146c7b34c90004321125404f06370f167d8c15ecf67", "simhash": "1:8f3fcaa708ea7f47", "word_count": 1503 }, "last_updated": "2023-07-14T20:54:16.519843+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [ "FEINBERG-, P. J. and KILEY, J., concur." ], "parties": [ "John Kosick, Appellee, v. Hospital Service Corp., An Illinois not-for-profit corporation, Appellant." ], "opinions": [ { "text": "JUDGE LEWE\ndelivered the opinion of the court.\nDefendant appeals from a judgment in favor of plaintiff in an action to recover certain hospital expenses under the terms of a certificate for hospital care known as \u201cBlue Cross\u201d issued by defendant. Defendant\u2019s motion at the close of the evidence for a finding in its favor was overruled.\nPlaintiff was employed in the shop of one Fritz Muhlhauser as a pattern, molding and cabinet maker. While doing some work at his employer\u2019s residence, plaintiff suffered a back injury. As a result of this injury, he required hospital care.\nPlaintiff filed a claim under the Illinois Workmen\u2019s Compensation Act. After a hearing the arbitrator found, inter alia, that Muhlhauser was operating under the provisions of the Illinois Workmen\u2019s Compensation Act; that the relationship of employee and employer existed between Kosick and Muhlhauser; and that Kosick sustained accidental injuries arising out of and in the course of the employment. Upon review the Industrial Commission reversed the decision of the arbitrator. On appeal, the Circuit Court of Cook County found that the decision on review by the Industrial Commission was erroneous and remanded the cause to the Commission with directions to confirm the decision of the arbitrator. There was no appeal from the order of the Circuit Court confirming the decision of the arbitrator.\nAfter plaintiff had successfully prosecuted his claim for monies due him under the provisions of the Workmen\u2019s Compensation Act, including the sum of $1470.24 for necessary first aid, medical, surgical and hospital services, he petitioned the Industrial Commission in the same proceeding for a lump sum settlement of $5000. In accordance with the prayer of plaintiff\u2019s petition an order was entered by the Commission reciting that \u201c. . . a proper showing having been made, it appears to the Commission to be to the best interest of the parties that compensation herein be paid in a lump sum.\u201d Plaintiff admits receiving the lump sum payment of $5000.\nIn the present case, the principal issue at the trial was whether plaintiff was barred from recovering his hospital expenses by an exclusionary clause in the certificate of insurance which reads,\n\u201c \u2018Hospital service\u2019 does not include the following:\n\u201cCare of injuries or diseases for which the Member is entitled to hospital care, or for which he receives any award or settlement in any proceeding filed, under workmen\u2019s compensation or occupational diseases law.\u201d (Italics ours.)\nThe record shows that the trial judge rested his decision on the ground that the defendant had failed \u201cto show that a portion of the settlement at least was in contemplation of the medical and hospital expenses.\u201d\nPlaintiff says that it is a question of fact whether his injury arose out of and in the course of employment since the evidence shows that (1) plaintiff, \u201ca pattern and model maker,\u201d was injured while helping his employer build his home, and (2) the \u201csettlement contract\u201d executed by defendant states as reasons for a lump sum settlement that\n\u201cthere are disputed questions of law and fact, and respondents specifically deny that petitioner sustained an accidental injury arising out of and in the course of his employment and deny that petitioner\u2019s disability is related to any accidental injury sustained while in respondent\u2019s employment.\u201d\nAn examination of the pleadings shows that the question whether plaintiff\u2019s injuries arose out of or in the course of his employment was not raised in the statement of claim or defendant\u2019s answer. In plaintiff\u2019s reply he avers that the \u201csettlement received pursuant to the Workmen\u2019s Compensation Act was solely for the purchase of peace, and did not entitle plaintiff to hospital care.\u201d (Italics ours.)\nThe denials in plaintiff\u2019s reply that hospital charges for which recovery is here sought were paid pursuant to the Workmen\u2019s Compensation Act and that the lump sum settlement was for the purchase of peace are legal conclusions.\nA lump sum settlement merely provides for a different method of payment. It is a commutation of periodical payments into one single, all inclusive payment, thus enabling an employee to obtain the entire amount of compensation due at one and the same time as distinguished from weekly payments. The governing rules relating to lump sum petitions are stated in Volume 2 of Angerstein, Illinois Workmen\u2019s Compensation \u00a7 1754 (Rev. ed. 1952), at pages 357-58. There it is said,\n\u201c [A] hearing on a lump sum petition and the jurisdiction of the commission on such petition, is solely to determine if compensation should be paid in a lump sum and not to determine any other disputed questions. After the parties have agreed upon the amount of compensation payable, or in case of a dispute, after an award is entered by the arbitrator, or a decision on review by the commission, and the time for any review under the provisions of the Act has expired, or in eases in which there has been a final judgment, then either the employee or the employer may petition the commission to commute or order paid in a lump sum all compensation payments yet unpaid under such agreement or award.\u201d\nOn the hearing of the petition for a lump sum the commission did not have jurisdiction to determine any disputed questions of law or fact with respect to liability for compensation. (Clark Co. v. Industrial Commission, 291 Ill. 561.) Therefore, reasons stated in the settlement contract as grounds for a lump sum settlement have no legal significance in that proceeding nor in the case at bar.\nIt should be noted that the arbitrator in his decision, which was subsequently affirmed by the Circuit Court, expressly found that plaintiff as petitioner in that proceeding \u201cis now entitled to have and receive from the respondents [Muhlhauser] . . . the further sum of $1470.24 for necessary first aid, medical, surgical and hospital services . . .\u201d\nThese items, though not segregated, are referred to in the \u201csettlement contract.\u201d The petition for settlement filed by plaintiff with the Industrial Commission recites that \u201cthe lump sum desired is $5,000 as a lump sum of all compensation provided in the settlement contract which, by reference, is made part hereof ??\nFrom the undisputed facts, we think the inference can be justifiably drawn that the lump sum payment to plaintiff necessarily included his hospital expenses and we so hold.\nPlaintiff insists that the exclusionary clause is ambiguous and that the word \u201cor\u201d in the clause should be construed to mean \u201cand,\u201d thus making only a single exclusion. Plaintiff admits that if the word \u201cor\u201d is so construed as a conjunctive, the effect would be to narrow the scope of the exclusionary clause. We think the mischief resulting from such a construction is clearly demonstrated in the illustration given by defendant of a case where the holder of a certificate for hospital care would be entitled to benefits under the Workmen\u2019s Compensation Act. Obviously the insurer would have no defense to an action, against it upon the certificate unless there had been an award or settlement in the Workmen\u2019s Compensation proceedings \u2014 prior to the trial of the action upon the certificate. There could then result the anomolous situation of payment of a judgment against the insurer prior to the final decision in the Workmen\u2019s Compensation case, which in turn would require a subsequent action by the insurer to recover the payment to the certificate holder after the conclusion of the Compensation case.\nIn a recent case, People v. Vraniak, 5 Ill.2d 384, (cert. denied, 349 U. S. 963), involving the construction of the word \u201cor,\u201d the Court said at page 389,\n\u201cIt is to be noted that the statute consists of a series of three separate clauses each joined by the disjunctive conjunction \u2018or.\u2019 As used in its ordinary sense, the word \u2018or\u2019 marks an alternative indicating that the various members of the sentence which it connects are to be taken separately.\u201d\nAnd so in the case at bar, we think the disjunctive conjunction \u201cor\u201d was clearly intended to mark an alternative designating both parts of the exclusionary clause to be read separately.\nPlaintiff was entitled to hospital care for the injuries he sustained while employed by Muhlhauser; and since the arbitrator also determined, as confirmed by the Circuit Court, that plaintiff was to be awarded a specific sum for hospital and other services, either part or both parts of the exclusionary clause are applicable. Plaintiff is therefore precluded from recovering. And the trial court erred in denying defendant\u2019s motion at the close of the evidence for a finding in defendant\u2019s favor.\nWe have not discussed the authorities cited in the briefs since none are precisely similar to the present case.\nFor the reasons stated the judgment is reversed.\nReversed.\nFEINBERG-, P. J. and KILEY, J., concur.", "type": "majority", "author": "JUDGE LEWE" } ], "attorneys": [ "Miller, Gorham, Wescott & Adams, all of Chicago, for appellant; Bobert T. Sherman and Joseph C. Lamy, of counsel.", "Hugh J. McCarthy, of Chicago, for appellee; Bobert Murphy, of counsel." ], "corrections": "", "head_matter": "John Kosick, Appellee, v. Hospital Service Corp., An Illinois not-for-profit corporation, Appellant.\nGen. No. 46,885.\nFirst District, Third Division.\nDecember 28, 1956.\nReleased for publication February 6, 1957.\nMiller, Gorham, Wescott & Adams, all of Chicago, for appellant; Bobert T. Sherman and Joseph C. Lamy, of counsel.\nHugh J. McCarthy, of Chicago, for appellee; Bobert Murphy, of counsel." }, "file_name": "0291-01", "first_page_order": 303, "last_page_order": 309 }