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Petrovich v. Share Health Plan of Illinois, Inc.

719 N.E.2d 756 (1999)

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Petrovich v. Share Health Plan of Illinois, Inc.

Illinois Supreme Court

719 N.E.2d 756 (1999)

Facts

Petrovich’s (plaintiff) employer contracted with Share Health Plan of Illinois, Inc. (Share) (defendant) to provide healthcare coverage. Share was a health maintenance organization (HMO) that paid for medical care provided to enrollees within its own network of physicians. Share did not directly employ physicians or own healthcare facilities. Instead, it contracted with independent medical groups and physicians to provide treatment to Share’s enrollees. The physicians were paid under a capitation scheme, i.e., a fixed payment for each member that enrolled in Share. Share’s member handbook did not mention that the physicians were independent contractors, but described them as “Share physicians,” and “our staff.” Petrovich chose Dr. Marie Kowalski as her primary-care physician from a list supplied by Share. Petrovich thereafter sought medical treatment from Kowalski for mouth pain, which Kowalski and other Share physicians failed to timely diagnose as oral cancer. After Kowalski underwent surgery and radiation treatments, she brought suit against Kowalski and the other physicians for malpractice, and against Share claiming it was vicariously liable for the negligence committed by the physicians. Share filed a motion for summary judgment in the trial court arguing that it could not be liable for the physicians’ negligence because they were hired as independent contractors, not as Share’s agents. Although a subscriber certificate that set forth an enrollee’s rights and obligations stated the physicians hired by Share were, in fact, independent contractors, Petrovich did not recall receiving it. The trial court granted Share’s motion for summary judgment and Petrovich appealed. The appellate court reversed, holding that a genuine issue of material fact existed regard whether Petrovich’s treating physicians were Share’s apparent agents. Share appealed.

Rule of Law

Issue

Holding and Reasoning (Bilandic, J.)

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