Not All Deaths Are Covered by Life Insurance
Jun 29, 2018 | Blog | ShareIf you are the beneficiary of a life insurance policy — whether in Illinois or elsewhere — then you may find that the insurer unexpectedly denies your claim on the basis of an exclusion written into the policy (that you were not aware of). This can put you in a uniquely vulnerable position as a beneficiary. After all, if you were reliant on your loved one for resources, then the life insurance proceeds are critical to your ability to bounce back financially. Depending on the nature of the exclusion and the circumstances surrounding your loved one’s death, however, it is […]
Insurance Waiting Periods Are Sometimes Used to Deny Coverage
Jun 27, 2018 | Blog | ShareIn the private insurance context, the existence of a “waiting period” is to be expected, and in fact, waiting periods are nearly ubiquitous. Whether you are signed onto a health insurance policy, a disability insurance policy, or some other form of insurance, in all likelihood, there is a waiting period provision written into the insurance agreement. Insurers frequently use these waiting period provisions as the basis for a claim denial — even when the claim is otherwise legitimate. Fortunately, the waiting period restriction is not always applicable. Let’s take a brief look at some of the basics, first. Waiting Period […]
How Disability Benefits Are Affected By Other Forms of Recovery
Jun 22, 2018 | Blog | ShareAccidents that give rise to disabilities — whether in the workplace or elsewhere — may seem complicated by the presence of multiple sources of compensation. If you have been injured in a motor vehicle accident, for example, then you may receive a substantial award of damages from the defendant, and you might also be eligible to receive disability benefits in accordance with your private disability insurance policy. In the state of Illinois (and elsewhere), however, these varied sources of compensation do not necessarily interfere with one another, except in limited circumstances. Private Disability Benefits Are Not Affected Private disability insurance […]
Automatic Eligibility for Disability Benefits
Jun 20, 2018 | Blog | ShareIn the private disability insurance context — in Illinois and elsewhere — insurers will often deny legitimate disability claims on the basis that the policyholder’s condition is not actually disabling in accordance with the language of the insurance plan. There are no absolute rules that apply to all disability insurance policies — the definition of disability may differ significantly depending on policy. Generally speaking, plans with high premiums have broader definitions of disability than cheaper plans. For example, your plan may include a broad definition of disability that awards disability benefits in the event that your condition renders you incapable […]
Seventh Circuit: “Unfortunate Circumstances” Not Enough to Warrant Pension Payments to Deceased Worker’s Daughter
Jun 19, 2018 | Blog | ShareBy: Andrew B. Bryant Mother Died Three Days Before Pension Payments Would Have Vested With Daughter In a truly unfortunate set of circumstances, a woman who worked for 37 years at a Wisconsin children’s hospital passed away three days after her retirement date, with her pension payments set to begin another three days after he date of death. The woman’s daughter, the named beneficiary under the pension plan (“the Plan”), was denied payments under the Plan because the date of death preceded the beginning of pension payments. In upholding the denial of benefits, the Seventh Circuit noted that in order […]
Common Disputes in Short-Term Disability Insurance
May 31, 2018 | Blog | ShareShort-term disability insurance provides temporary wage replacement benefits in the event that you are suffering from a disabling condition, though the benefits apply for a very limited period of time — in most cases, short-term disability benefits are only paid out for six months to one year of proven disability. After sufficient time has passed that short-term disability benefits are no longer available, you may be eligible to receive long-term disability benefits (if you are still disabled and if you are a long-term disability policyholder). Unfortunately, despite having paid for short-term disability insurance coverage — and relying on such coverage […]
Illinois Law Prohibits Discretionary Clauses in Insurance Contracts
May 25, 2018 | Blog | ShareIf you’ve had a legitimate insurance claim denied in Illinois — whether a health insurance claim or a disability insurance claim — then you may find that the insurer justifies their denial on the basis of a discretionary clause written into the policy. Discretionary clauses can vary in function somewhat, but as a general rule, they give the insurer the ability to interpret (in accordance with their own standards) the terms of the contract. This type of “discretionary” power gives the insurer an enormous advantage when it comes time to determine whether or not to award health or disability benefits. […]
Hiding a Condition on Your Disability Insurance Application May Affect Your Benefits
May 18, 2018 | Blog | ShareIn Illinois, and elsewhere, it’s critical that disability insurance policyholders avoid misrepresenting the truth on their application. It’s worth noting that your application for disability insurance policy will typically require that you confirm the truth and accuracy of all statements made in the application. Failure to adequately and accurately represent the facts on one’s application may be used later on by the insurer as a justification to deny an otherwise legitimate disability benefits claim — the insurer will likely argue, for example, that they are entitled to rescind the insurance contract as a consequence of the misrepresentation at issue. You […]
Disability Claimants Must Make Reasonable Attempts to Recover
May 11, 2018 | Blog | ShareIn Illinois, policyholders may have their otherwise legitimate disability claims denied if they fail to exercise reasonable efforts in recovering from their disability (and otherwise mitigating their losses). As a general rule, policyholders must uphold their end of the contractual bargain, so to speak — the insurer is not an absolute guarantor of losses suffered by the policyholder. The insurer can only be held reasonable losses that arise due to the disabling condition at-issue. Confused? Let’s take a quick look at the duty to mitigate imposed on disability policyholders in Illinois. The General Duty to Mitigate Throughout the country, insurance […]
By: Jennifer Danish Courts infrequently award attorneys’ fees to defendants for having to defend themselves in ERISA disability benefit claims. Recently though, the Court, in James W. Hackney v. Allmed Healthcare Management, Inc., No. 3:15-CV-00075-GFVT, 2018 WL 1981902 (E.D. Ky. Apr. 27, 2018) ordered an unsuccessful plaintiff to pay the defendant attorneys’ fees and costs, because the plaintiff pursued a cause of action not generally recognized as available under ERISA. Hackney brought a state law negligence claim against Allmed for rendering an unlicensed medical opinion about him in connection with his long-term disability benefit claim under an ERISA-governed benefit plan […]