{ "id": 5784483, "name": "KEVIN CAHILL, Plaintiff-Appellant, v. EASTERN BENEFIT SYSTEMS, INC., et al., Defendants-Appellees", "name_abbreviation": "Cahill v. Eastern Benefit Systems, Inc.", "decision_date": "1992-10-19", "docket_number": "No. 1\u201491\u20141460", "first_page": "517", "last_page": "522", "citations": [ { "type": "official", "cite": "236 Ill. App. 3d 517" } ], "court": { "name_abbreviation": "Ill. App. Ct.", "id": 8837, "name": "Illinois Appellate Court" }, "jurisdiction": { "id": 29, "name_long": "Illinois", "name": "Ill." }, "cites_to": [ { "cite": "96 S. Ct. 1411", "category": "reporters:federal", "reporter": "S. Ct.", "opinion_index": 0 }, { "cite": "47 L. Ed. 2d 349", "category": "reporters:federal", "reporter": "L. Ed. 2d", "opinion_index": 0 }, { "cite": "424 U.S. 943", "category": "reporters:federal", "reporter": "U.S.", "case_ids": [ 12043361, 12042979, 12042920, 12043307, 12043413, 12043095, 12042873, 12043034, 12043163, 12043228 ], "opinion_index": 0, "case_paths": [ "/us/424/0943-09", "/us/424/0943-03", "/us/424/0943-02", "/us/424/0943-08", "/us/424/0943-10", "/us/424/0943-05", "/us/424/0943-01", "/us/424/0943-04", "/us/424/0943-06", "/us/424/0943-07" ] }, { "cite": "301 N.E.2d 729", "category": "reporters:state_regional", "reporter": "N.E.2d", "year": 1976, "opinion_index": 0 }, { "cite": "54 Ill. 2d 511", "category": "reporters:state", "reporter": "Ill. 2d", "case_ids": [ 2932912 ], "year": 1976, "opinion_index": 0, "case_paths": [ "/ill-2d/54/0511-01" ] }, { "cite": "274 N.E.2d 507", "category": "reporters:state_regional", "reporter": "N.E.2d", "year": 1973, "opinion_index": 0 }, { "cite": "2 Ill. App. 3d 906", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 2746826 ], "year": 1973, "opinion_index": 0, "case_paths": [ "/ill-app-3d/2/0906-01" ] }, { "cite": "756 F. Supp. 1108", "category": "reporters:federal", "reporter": "F. Supp.", "case_ids": [ 7392533 ], "opinion_index": 0, "case_paths": [ "/f-supp/756/1108-01" ] }, { "cite": "546 N.E.2d 580", "category": "reporters:state_regional", "reporter": "N.E.2d", "year": 1991, "opinion_index": 0 }, { "cite": "131 Ill. 2d 428", "category": "reporters:state", "reporter": "Ill. 2d", "case_ids": [ 5569862 ], "year": 1991, "opinion_index": 0, "case_paths": [ "/ill-2d/131/0428-01" ] }, { "cite": "558 N.E.2d 195", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "200 Ill. App. 3d 447", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 2463024 ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/200/0447-01" ] }, { "cite": "515 N.E.2d 129", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "116 Ill. 2d 578", "category": "reporters:state", "reporter": "Ill. 2d", "opinion_index": 0 }, { "cite": "510 N.E.2d 409", "category": "reporters:state_regional", "reporter": "N.E.2d", "year": 1987, "opinion_index": 0 }, { "cite": "156 Ill. App. 3d 154", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3504673 ], "year": 1987, "opinion_index": 0, "case_paths": [ "/ill-app-3d/156/0154-01" ] }, { "cite": "400 N.E.2d 918", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "78 Ill. 2d 381", "category": "reporters:state", "reporter": "Ill. 2d", "case_ids": [ 3074720 ], "weight": 2, "pin_cites": [ { "page": "385" } ], "opinion_index": 0, "case_paths": [ "/ill-2d/78/0381-01" ] }, { "cite": "505 N.E.2d 1045", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "153 Ill. App. 3d 136", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 3607564 ], "weight": 2, "pin_cites": [ { "page": "140" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/153/0136-01" ] }, { "cite": "178 N.E. 498", "category": "reporters:state_regional", "reporter": "N.E.", "year": 1987, "opinion_index": 0 }, { "cite": "346 Ill. 252", "category": "reporters:state", "reporter": "Ill.", "case_ids": [ 5265823 ], "weight": 2, "year": 1987, "pin_cites": [ { "page": "257" } ], "opinion_index": 0, "case_paths": [ "/ill/346/0252-01" ] }, { "cite": "534 N.E.2d 1312", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "179 Ill. App. 3d 852", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 2609480 ], "weight": 2, "pin_cites": [ { "page": "856" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/179/0852-01" ] }, { "cite": "536 N.E.2d 194", "category": "reporters:state_regional", "reporter": "N.E.2d", "opinion_index": 0 }, { "cite": "180 Ill. App. 3d 539", "category": "reporters:state", "reporter": "Ill. App. 3d", "case_ids": [ 2616689 ], "weight": 2, "pin_cites": [ { "page": "546" } ], "opinion_index": 0, "case_paths": [ "/ill-app-3d/180/0539-01" ] } ], "analysis": { "cardinality": 630, "char_count": 11118, "ocr_confidence": 0.771, "pagerank": { "raw": 1.2910739305592674e-07, "percentile": 0.6197896093556033 }, "sha256": "9ea4804fd77a95cb4bd2097d85d84c18eca1df4b758db3f39a5f99d5904233cd", "simhash": "1:2f93dfd477033648", "word_count": 1788 }, "last_updated": "2023-07-14T15:50:05.842880+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [], "parties": [ "KEVIN CAHILL, Plaintiff-Appellant, v. EASTERN BENEFIT SYSTEMS, INC., et al., Defendants-Appellees." ], "opinions": [ { "text": "JUSTICE O\u2019CONNOR\ndelivered the opinion of the court:\nThis appeal questions the propriety of an order of the circuit court dismissing plaintiff Kevin Cahill\u2019s fourth amended complaint, which sought damages from defendants, Eastern Benefit Systems and Care America, for failure to pay all of an insurance claim submitted by Ca-hill.\nWe affirm.\nCahill\u2019s complaint, as amended, alleged that he was employed by Wieboldt Stores, Inc., and, as a result of his employment, was provided with health insurance for both himself and his family. The insurance claim at issue here concerns the November 11, 1986, admission of Cahill\u2019s son, Stephen, to Palos Community Hospital by his physician, Dr. Voltolina, and his subsequent 36-day stay at the hospital. The hospital ultimately submitted a bill for $13,615.40 to Wieboldt\u2019s for Stephen\u2019s stay. Wieboldt\u2019s, in turn, paid $4,720.05 of the bill, claiming that Stephen\u2019s hospitalization should have only been 14 days as opposed to 36 days.\nCahill further alleged that Eastern was the agent of Wieboldt\u2019s for \u201cthe purpose of approving, administering and paying all medical and hospitalization claims submitted by insureds of [Wieboldt\u2019s]\u201d and that Care America was the agent of both Eastern and Wieboldt\u2019s for the \u201cpurpose of investigating and making recommendations regarding medical and hospitalization claims submitted to both Eastern and Wieboldt\u2019s.\u201d Cahill stated that the contract between Wieboldt\u2019s, Eastern, and Care America was for the direct benefit of Cahill and his family, that is, to provide insurance coverage and payment of medical and hospitalization costs to Cahill and his family.\nIn count I of the complaint, Cahill charged defendants with breach of Cahill\u2019s insurance contract because only a portion of the hospital bill was paid. Count II alleged a violation of section 155 of the Illinois Insurance Code (Ill. Rev. Stat. 1989, ch. 73, par. 767.) In count III, Cahill charged that Care America had a duty to review the submitted insurance claims with reasonable care and that Care America breached that duty with regard to its determination that Stephen should have been hospitalized for only 14 days. Cahill further charged that Eastern negligently relied upon Care America\u2019s wrong determination, thereby breaching its duty to administer the submitted insurance claims with care.\nAttached to the complaint was a document entitled \u201cSpecial Benefit Addendum.\u201d This document states that the employee benefits plan \u201cincludes a Medical Utilization Review Program involving the services of Care America, an independent medical review organization. The Intent of the program is to eliminate inappropriate medical services while at the same time helping to contain the costs of your medical care.\u201d The document contained instructions that the insured must follow in order to receive \u201cmaximum benefits in the event you or a family member may require surgery or hospitalization.\u201d One such requirement was that the insured notify Care America before any hospital admission. The document also identified a \u201cnon compliance penalty\u201d which warned that \u201cthe fact that a physician or another provider has furnished, ordered or approved a service or supply does not, of itself, make the service medically necessary.\u201d The failure of an insured to contact Care America would \u201cresult in a fifty percent (50%) reduction of benefits otherwise payable for covered expenses which are medically necessary.\u201d\nBoth Eastern and Care America moved to dismiss the complaint, arguing that Cahill had failed to state a cause of action upon which relief could be granted. In a written decision, the circuit court ruled that Cahill failed to allege facts which showed that Care America and Eastern had a contractual duty owing to Cahill. The court also found that the Insurance Code was inapplicable to the facts presented in the complaint. Finally, the court held that Cahill had failed to allege any facts which would create any duty in tort owing to Cahill. As a result, the complaint was dismissed.\nGenerally, courts are to construe pleadings liberally, with the view to do substantial justice between the parties. (Keller v. State Farm Insurance Co. (1989), 180 Ill. App. 3d 539, 536 N.E.2d 194.) No pleading, therefore, is defective in substance if it contains facts which reasonably inform the opposite party of the nature of the charge to be answered. (Keller, 180 Ill. App. 3d at 546.) A motion to dismiss based upon section 2 \u2014 615 of the Code of Civil Procedure (Ill. Rev. Stat. 1989, ch. 110, par. 2 \u2014 615), however, challenges the sufficiency of the complaint and should be decided solely upon the allegations the complaint sets forth. (Perkins v. Collette (1989), 179 Ill. App. 3d 852, 534 N.E.2d 1312.) The motion is to be granted only if it is clear that plaintiff cannot prove any set of facts under the pleading which would entitle him to the relief requested. Perkins, 179 Ill. App. 3d at 856.\nCahill contends that his complaint adequately alleged facts which prove that he was a third-party beneficiary to the contracts between Wieboldt\u2019s and Care America and Eastern. We disagree.\nIn Illinois, an individual not a party to a contract may only enforce the contract\u2019s rights when that contract\u2019s original parties intentionally enter into the contract for the direct benefit of the individual. (Carson Pirie Scott & Co. v. Parrett (1931), 346 Ill. 252, 178 N.E. 498; Wheeling Trust & Savings Bank v. Tremco Inc. (1987), 153 Ill. App. 3d 136, 505 N.E.2d 1045.) Courts must determine whether the benefit to the third person is direct to him or is but an incidental benefit to him arising from the contract. (Carson Pirie Scott & Co., 346 Ill. at 257, Wheeling Trust & Savings Bank, 153 Ill. App. 3d at 140.) The critical inquiry centers on the intention of the parties, which is to be gleaned from the language of the contract and the circumstances surrounding the parties at the time of its execution. (People ex rel. Resnik v. Curtis & Davis, Architects & Planners, Inc. (1980), 78 Ill. 2d 381, 400 N.E.2d 918.) The promisor\u2019s intention must be shown by an express provision in the contract identifying the third-party beneficiary. People ex rel. Resnik v. Curtis & Davis, Architects & Planners, Inc., 78 Ill. 2d at 385.\nHere, the only contractual obligation which can be evinced from the complaint is that between Wieboldt\u2019s and Cahill. Cahill failed to attach to his complaint any contract between Wieboldt\u2019s and Care America and Eastern; therefore, we are unable to ascertain the intention of the parties with regard to Cahill. The attached \u201cSpecial Benefit Addendum\u201d does not satisfy the requirement for the original contract. Parenthetically, we note that it appears from the record that Cahill failed to follow the hospital preadmission instructions, which conceivably explains the reduction in the benefits received by Cahill. Accordingly, the circuit court did not err in finding that Cahill had failed to state a cause of action for breach of contract.\nCahill next claims that the circuit court erred in finding that Ca-hill failed to allege facts which raise any duty owing in tort to him.\nCahill\u2019s tort claim appears to be one of negligent misrepresentation. Negligent misrepresentation involves the breach of a duty to use care in obtaining and communicating information upon which others may reasonably be expected to rely in the conduct of their affairs. (Zimmerman v. Northfield Real Estate, Inc. (1986), 156 Ill. App. 3d 154, 510 N.E.2d 409, appeal denied (1987), 116 Ill. 2d 578, 515 N.E.2d 129.) The elements needed to sustain a cause of action for negligent misrepresentation include a duty owed by defendant to plaintiff, a breach of such duty, and injury proximately resulting from the breach. (Harkala v. Wildwood Realty, Inc. (1990), 200 Ill. App. 3d 447, 558 N.E.2d 195.) A misrepresentation can result from the failure to provide adequate information when there is a duty to provide such information as well as providing information which is false. (Board of Education v. A, C, & S, Inc. (1989), 131 Ill. 2d 428, 546 N.E.2d 580.) Claims for negligent misrepresentation require a showing of actual reliance. Morse v. Abbott Laboratories (N.D. Ill. 1991), 756 F. Supp. 1108.\nIn his complaint, Cahill alleges that Care America \u201cmade an improper, unreasonable and negligent determination regarding the terms of hospitalization required by Stephen Cahill.\u201d The foregoing is not adequate to state a claim upon which relief can be granted. Cahill did not allege in his complaint that he relied on the alleged negligent determination made by Care America. Rather, he alleges that Eastern negligently relied on Care America\u2019s determination. As noted above, the element of reliance is necessary for a cause of action in negligent misrepresentation. Moreover, the maker of a negligent misrepresentation is subject to liability to only those persons for whose guidance he knows the information is to be supplied and to them only for loss incurred in the kind of transaction in which the information is expected to influence them. (Restatement (Second) of Torts \u00a7552 (1977).) In this case, the information was supplied to Eastern and to Wieboldt\u2019s, not to Cahill. Based on the foregoing, Cahill\u2019s complaint cannot be said to adequately state a claim for negligent misrepresentation.\nCahill also asserts that Care America owed him a duty because it acted as an agent of both Wieboldt\u2019s and Eastern and that Eastern owed Cahill a duty because it, too, was an agent of Wieboldt\u2019s. An agent, however, is not liable for injuries to third persons resulting solely from a mere breach of duty which he owes his principal, unless, at the same time the agent owes a separate duty to the third party. (Adkins v. Chicago, Rock Island & Pacific R.R. Co. (1971), 2 Ill. App. 3d 906, 274 N.E.2d 507, rev\u2019d on other grounds (1973), 54 Ill. 2d 511, 301 N.E.2d 729, cert. denied (1976), 424 U.S. 943, 47 L. Ed. 2d 349, 96 S. Ct. 1411. See also Restatement (Second) of Agency \u00a7357 (1957) (\u201cAn agent who intentionally or negligently fails to perform duties to his principal is not thereby liable to a person whose economic interests are thereby harmed\u201d).) Cahill has not alleged any facts which establish that either Eastern or Care America owed an independent duty to Cahill. As a result, Cahill\u2019s complaint fails to allege a cause of action sounding in tort.\nThe judgment of the circuit court, therefore, is affirmed.\nAffirmed.\nBUCKLEY, P.J., and CAMPBELL, J., concur.\nDuring the pendency of the proceedings in the circuit court, Wieboldt\u2019s filed a bankruptcy petition in the United States District Court. This appeal concerns only defendants Care America and Eastern.", "type": "majority", "author": "JUSTICE O\u2019CONNOR" } ], "attorneys": [ "William R. Dunn, of Oak Lawn, for appellant.", "Beigel & Sandler, Ltd., of Chicago (Lance C. Martin, of counsel), for appellee Eastern Benefit Systems, Inc.", "Couri & Couri, of Winnetka (Phillip E. Couri, of counsel), for appellee Care America." ], "corrections": "", "head_matter": "KEVIN CAHILL, Plaintiff-Appellant, v. EASTERN BENEFIT SYSTEMS, INC., et al., Defendants-Appellees.\nFirst District (1st Division)\nNo. 1\u201491\u20141460\nOpinion filed October 19, 1992.\nWilliam R. Dunn, of Oak Lawn, for appellant.\nBeigel & Sandler, Ltd., of Chicago (Lance C. Martin, of counsel), for appellee Eastern Benefit Systems, Inc.\nCouri & Couri, of Winnetka (Phillip E. Couri, of counsel), for appellee Care America." }, "file_name": "0517-01", "first_page_order": 537, "last_page_order": 542 }