Lawrence Leff v. State of Illinois

ORDER

BURNS, J. This cause coming before the Court on Respondent’s Combined Motion to Dismiss pursuant to 74 Ill. Admin. Code §790.90 and 735 ILCS 5/2-619.1. The Claimant filed a Response. The Court having read the pleadings and being fully advised, finds as follows:

Background

The Claimant, a faculty member at Western Illinois University (WIU), has filed a complaint with this Court alleging that Respondent owes $6,335 to Montefiore Medical Institute (Montefiore) for certain non-precertified sleep study services that Montefiore provided to him in December 2018.

According to the Complaint, Claimant receives health insurance from Aetna via his employment at WIU. In December 2018, he participated in a sleep study organized by Montefiore. Claimant states that when Montefiore submitted the claim related to the sleep study service, Aetna denied it on the basis that Montefiore had failed to obtain pre-authorization for the services.

Claimant alleges that he appealed Aetna’s decision, on behalf of Montefiore, to both Aetna and Respondent, but to no avail. Claimant admits that Montefiore has never charged him for the services. Indeed, the Complaint states that Claimant spoke to a Montefiore employee in the billing department who told him “Montefiore had written off the charge as it was ‘their error’.” Nonetheless, Claimant considers this to be “not acceptable” and “too draconian” and asks this Court to compel Respondent to pay the $6,335 on the basis that it is required by the terms of his employee benefits/insurance plan with the Respondent.

Respondent has filed a motion to dismiss on numerous grounds, including failure to state a claim upon which relief may be granted, lack of standing, failure to exhaust remedies, and that Claimant, a non-attorney, cannot litigate a claim on behalf of Montefiore.

Analysis

When analyzing a section of 2-615 motion to dismiss, the Court must determine whether the allegations contained in the claimant’s complaint, taken as true and construed in the light most favorable to the claimant, are sufficient to state a cause of action upon which relief may be granted. Fillmore v. Taylor, 2019 IL 122626, ¶35. The Court should dismiss an action pursuant [*224] to section 2-615 of the Code only where no set of facts can be proven that would entitle the claimant to the relief he or she seeks. Id.

Here, Claimant alleges that Respondent, or Aetna, owes payment to Montefiore for its non-preccritified sleep study services. However, Claimant does not plead that he incurred any damages or injury from this event. Indeed, he admits that Montefiore has written off the charges and that he is only bringing this action to enforce his own rights as an employee covered by the State’s health insurance plan.

Our Supreme Court recently reiterated the well-settled rule that a wrongful or negligent act by a defendant, by itself, gives no right of action to anyone. Berry v. City of Chicago, 2020 IL 124999 ¶35. Until the defendant’s wrongful or negligent act produces injury to the plaintiff’s interest by loss or damage, no cause of action accrues. Id. Thus, to the extent Claimant seeks to state a cause of action based on tort, he has failed to do so, and any such claim would require dismissal.

Claimant appears to acknowledge in his response brief that he cannot sustain a claim sounding in tort. Instead, he points to Section 305 of the Restatement (Second) of Contracts, which states that “a promisee has the same right to performance in a contract for the benefit of a third party as any other contract promisee.” Restatement (Second) of Contracts § 305(1981). In essence, Claimant argues, Respondent has breached its contract with Claimant, and thus, he has standing to bring suit on behalf of Montefiore, a third-party beneficiary.

The problem with Claimant’s theory is that even if he could establish 1) the existence of a contract with Respondent for the benefit of Montefiore and 2) a specific promise in that contract by the Respondent to actually pay funds for the services provided, as opposed to merely covering the costs, both of which appear to this Court to present significant challenges, the sole remedy for such a breach in this case would be specific performance. As the comment to Section 305 of the Restatement (Second) of Contracts notes, “If the promisee has no economic interest in the performance...the ordinary remedy of damages for breach of contract is an inadequate remedy, since only nominal damages can be recovered. In such cases, specific performance is commonly appropriate.” This Court, however, has long held that it lacks jurisdiction to provide such equitable forms of relief. Garimella v. Board of Trustees of the University of Illinois, 50 Ill. Ct.

Cl. 350, 354 (1996) (dismissing count for specific performance from student claimant seeking to compel University to award her degree based on alleged breach of contract).

The Court of Claims is a legislative court, with limited jurisdiction that extends only to that granted to it by the General Assembly. Id. at 357. In Garimella, the Court engaged in a lengthy analysis of its jurisdiction to hear equitable claims and provide equitable relief. In a concurring opinion, Justice Epstein summed up our adjudicatory jurisdiction to be the following: (1) making monetary awards from appropriated funds; (2) recommending payment and appropriation (or other relief) to the General Assembly; and (3) issuing declarations of rights (declaratory judgments). Id. at 362. Nowhere in the Court of Claims Act does it state that this Court has the authority to compel a state agency to perform its part of a contract. Instead, we exist as a tribunal to hear claims against the State based on tort or breach of contract, among other things, and to provide money damages to those who can prove they suffered an injury as a result of the State’s violation of law and there is no other available remedy or alternate source of recovery for the person.

Here, we see nothing in the pleadings or exhibits that would have prevented Montefiore from bringing a claim in this court as a third-party beneficiary if it felt that it was entitled to [*225] payment under Illinois contract law. It chose not to do so. The claimant may not agree with Montefiore's decision, but that is Montefiore's decision to make.

For our purposes here, the Claimant has admitted that he has suffered no injury from the alleged breach of contract in this case, and, therefore, there is not relief for this Court to grant Claimant.

Because we find the Complaint fails to state a claim upon which relief can be granted, we make no findings as to the Respondent's other bases for dismissal.

IT IS HEREBY ORDERED that the Respondent's Motion to Dismiss is GRANTED and the Complaint is dismissed with prejudice.