Burton v. Government Employees Insurance

Citations: 135 Ill. App. 3d 723; 482 N.E.2d 233; 90 Ill. Dec. 526; 1985 Ill. App. LEXIS 2307Docket: No. 3—84—0598

Court: Appellate Court of Illinois; August 16, 1985; Illinois; State Appellate Court

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An appeal was made regarding a summary judgment in favor of Government Employees Insurance Company, which denied coverage under the excess personal injury protection of an automobile insurance policy held by Dawn Burton and her deceased husband, Bradley Burton. Bradley died in a 1982 automobile accident while intoxicated, as indicated by a blood alcohol level of 173 mg%. Dawn Burton filed a claim for $2,000 in funeral expenses and $39,000 in survivor's benefits under the policy's excess personal injury protection provisions. The insurer denied the claim, leading Dawn to seek legal recourse in the circuit court of Will County for a money judgment, a declaratory judgment on future benefits, and damages for the insurer's refusal to pay.

Dawn's motion for partial summary judgment regarding benefits accrued from the date of Bradley's death was denied, and the court interpreted this denial as effectively granting summary judgment to the insurer. The trial court found that excess personal injury protection benefits were contingent on the basic personal injury protection benefits being payable, which were not applicable here due to Bradley's intoxication at the time of the accident. The relevant policy provisions stipulate that basic personal injury protection does not cover injuries if the insured was under the influence of alcohol or drugs. Similarly, excess personal injury protection is contingent upon the depletion of corresponding basic coverage, which the court interpreted as a necessary condition for entitlement to excess benefits.

Dawn argued that the trial court misinterpreted the policy, asserting that the plain language suggests excess benefits are not contingent upon the basic benefits' liability. However, the court noted that the policy's wording indicates that excess protection is subject to the depletion of corresponding insurance under basic protection, which implies a dependency on the basic coverage rather than an outright additional coverage.

Two legal principles support the plaintiff's interpretation regarding the insurance policy. First, ambiguities in insurance policy provisions are interpreted against the insurer and in favor of the insured, as established in Dora Township v. Indiana Insurance Co. Second, exclusionary provisions must be narrowly construed to ensure the insured retains the benefits for which they have paid, unless the policy terms explicitly dictate otherwise, per Lenkutis v. New York Life Insurance Co. 

In this case, since the excess protection under the policy is not clearly contingent upon basic liability protection, it should be interpreted to allow survivor’s and funeral benefits to be paid to the plaintiff. These benefits are designated for the plaintiff as a named insured and, in the case of survivor's benefits, as the surviving spouse of the deceased. The insurer's argument that excess benefits are akin to secondary coverage dependent on primary coverage is not supported by the policy's language. Moreover, any ambiguities do not permit inferences against the insured, and thus the exclusion of benefits due to the intoxication of the injured insured applies only to benefits payable to the injured party, not to excess benefits for a surviving spouse.

Consequently, the trial court's denial of the plaintiff's motion for summary judgment and its ruling in favor of the insurance company were incorrect. The court's judgment is reversed and the case is remanded for the determination of the amount of benefits owed to the plaintiff. The issue of whether the plaintiff is entitled to damages for the insurer’s delay remains unresolved and is left for consideration upon remand. Judges HEIPLE and WOMBACHER concur.