STERLING WINTERS v. THE STATE OF ILLINOIS (2001)

OPINION

This matter comes before the Court on the claim of Sterling Winters to enforce a settlement entered in a worker's compensation claim filed in the Industrial Commission.

The factual background for Claimant's complaint against the State of Illinois, Central Management Services, is based on a contract arising out of a lump sum settlement approved by the Industrial Commission. The Claimant had filed a worker's compensation claim against his employer, State of Illinois, arising out of an accidental injury occurring on February 2, 1989. On January 27, 1990, the Industrial Commission (Case No. 89 WC 14357), entered a Memorandum of Decision of Arbitrator which made an award of $32,001.59 for the purpose of paying Claimant's medical bills. Thereafter, on August 29, 1990, Claimant and the State of Illinois entered into a settlement contract which would pay Claimant $54,864.25. That settlement also indicated that the State was still responsible for paying the medical bills as indicated in the decision of January 27, 1990. The Memorandum of Decision of the Arbitrator specifically states that if the medical bills had been paid by some other source, Sterling Winters is given a hold harmless.

Claimant has acknowledged that he received the settlement amount of $54,864.25 and he also acknowledges receipt of $2,133.27 for payment of his medical bills.

The essence of this claim is that Claimant alleges that the State has failed to pay to him the balance of the medical bills in the amount of $29,868.32.

At the trial in this case, Mr. Winters testified that to his knowledge, the remaining medical bills, i.e. $29,868.32, have not been paid. Claimant testified he did not pay the medical bills. Respondent contends that a review of Claimant's medical records indicated no balances were due.

Claimant contends that it is the law that Respondent has the burden to prove that medical payments were made. In Hill Freight Lines, Inc., 35 Ill.2d 419, the Illinois Supreme Court stated

...we feel that the burden is upon the employer to establish the fact that it is entitled to credits under Section 8(j) of the Workmen's Compensation Act. It is therefore incumbent upon the employer to see that sufficient evidence of the insurance contract itself was introduced in order to determine if it fell within the provisions of Section 8(j).

Claimant's contention is that Respondent has the burden to introduce evidence satisfactorily indicating that medical payments have been made either by the employer (State of Illinois) or by some insurance plan. Claimant argues that in this instance, there is no proof that any medical payments were made.

Respondent contends that a thorough review of the records suggests that no medical bills are due and outstanding. Further, Respondent also argues that at no point were the monies for medical bills to be paid directly to Claimant. Indeed, the settlement contract between Sterling Winters and the State of Illinois, No. 89 WC 14357, states as follows:

This settlement, however, does not relieve the Respondent of fully meeting its obligations under the 19(b-1) decision earlier entered in this cause. Respondent is to pay all related medical and rehabilitation expenses incurred by Petitioner through the date of settlement.

The Claimant presented no evidence that any medical bills were unpaid at the time of trial.

At oral arguments, Claimant's counsel, with refreshing candor, advised the Court for the first time that Claimant had filed a bankruptcy and was discharged from paying any of the medical bills. The bankruptcy was not proven at trial nor were the specific debts discharged entered into evidence. In fact, the bankruptcy was not mentioned at trial. Claimant's counsel also indicated it was most likely that Claimant did not list the potential workman's compensation award for medical payments as an asset in his bankruptcy, although he was not sure.

The Law

In contract actions in the Court of Claims, the Claimant has the burden of proof. Black v. State of Illinois, (1996), 49 Ill.Ct.Cl. 143; Thiems Construction Co. v. State of Illinois, (1993), 45 Ill.Ct.Cl. 267. The claimant also has the obligation to prove his damages by a preponderance of the evidence. Joint Venture v. State of Illinois, (1996), 50 Ill.Ct.Cl. 50. This case should have been a very simple matter. Claimant should have brought in specific bills, testified they were unpaid, and the Court would have ordered payment to the specific medical providers in the specific amounts due. Instead, Claimant presented no evidence as to the status of the bills except to testify without specifics that to his knowledge, the remaining medical bills had not been paid. However, with the new information received by the Court at the oral arguments, it is clear to the Court that the medical bills of Claimant were either paid by Claimant's State medical insurance or were discharged in bankruptcy.

Claimant's lack of candor on the status of the claims is akin to fraud. The Court believes Claimant fully intended to obtain an award from this Court and keep the money. Fraud in itself is an absolute defense which can be asserted by the State in this Court. 705 ILCS 505/14. First of America Bank v. State of Illinois, (1992), 48 Ill.Ct.Cl. 191. The Court, however, can determine this case without making a finding of fraud at this time. The Claimant had the burden of proof. This Court finds that Claimant has failed to prove by a preponderance of the evidence that any medical bills are currently due and owing. This is the Court of Claims, not the Industrial Commission. When Claimant presented unpaid bills to the Respondent totaling $2,133.27, that amount was paid. No other bills were presented to the Respondent for payment. It was incumbent upon Claimant to prove he needed to be held harmless for debts paid by other sources or which were unpaid. Claimant has failed to meet his burden of proof in this Court.

For the foregoing reasons, it is the Order of the Court that Claimant's claim be and hereby is denied.

FREDERICK, J.