Appealing ERISA Life Insurance Claim Denial

Web Admin - Friday, August 21, 2015

Illinois insurance dispute lawyerThe Employee Retirement Income Security Act of 1974 (ERISA) governs certain life insurance plans offered by employers. Whether or not ERISA covers an insurance plan is important because it will impact the way in which a claim denial may be appealed. Additionally, claims governed by ERISA have more limited remedy options than under traditional state law.

What is ERISA?

Under ERISA, minimum standards are established for benefit plans offered by employers, including life insurance plans. However, ERISA is only applicable to private employers that offer employer-sponsored insurance (or other benefit plans) to employees. ERISA does not mandate that plans are offered by employers, but does set standards and rules that must be met for those employers that do offer plans. ERISA does not apply to individually purchased, private insurance plans.

Additionally, ERISA does not apply to the following plans:

  1. - A government plan;
  2. - A church plan with respect to which no election has been made under section 410(d) of title 26;
  3. - A plan maintained strictly for the purpose of complying with relevant workers’ compensation laws or unemployment compensation or disability insurance laws;
  4. - A plan maintained outside of the United States for the benefit of nonresident illegal immigrants; or
  5. - An excess benefit plan that is not funded.

Appealing a Claim Denial

The process for appeal begins with the insurance company sending a letter to the claimant explaining that the claim has been denied. A claimant has the right to receive all “relevant documents” to the case, but this must be requested. It is important to request the plan administrator to send these documents. After the claimant has all of the documents and is ready to state his or her case, the request for an administrative review should be made. However, a request for this review must be made within 180 days of the denial of the claim. It is important to note that, under ERISA-governed plans, a lawsuit is not available until an administrative review is conducted.

For the review, the insurance company will provide the reasons for denying the claim. The claimant should respond to these thoroughly and objectively. This is a critical step, because the information provided at this stage will be the information that the judge will review upon appeal in the event that the administrative review is not favorable to the claimant. Similarly, the administrative review is limited to the evidence and medical documents that have been provided to the company.

If the administrative review does not overturn the denial of the claim, the decision can be appealed by filing a federal lawsuit. ERISA does not allow for punitive damage awards or bad faith claims in these types of lawsuits. Additionally, the case is heard and ruled on by a judge, not a jury. As a result of these differences, quite often it can be beneficial to attempt to argue that ERISA does not cover the insurance plan.

Appealing denial of claims governed by ERISA can be complicated. For more information about the process and how an experienced Illinois insurance dispute attorney can help, contact us today. Drost, Gilbert, Andrew & Apicella, LLC proudly provides legal representation for communities such as Des Plaines, Crystal Lake, Palatine, Rolling Meadows, and Barrington.

Ken ApicellaAbout the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.

Insurance Claim After an Automobile Accident

Web Admin - Friday, July 31, 2015

insurance claim, Illinois car accident lawyer, insurance disputeIn a perfect world, we would not need insurance because we would never have any accidents. Unfortunately, we do not live in such a wonderful place. If you have never been involved in an automobile accident, you may not be familiar with the process of making an insurance claim. Though we hope you never have to go through this process, understanding what to expect if you do can be helpful.

Illinois Fault-Based Insurance

When it comes to automobile accidents, Illinois is a fault-based state. This means that whoever is legally at fault for the accident is responsible for paying those individuals injured by the accident. Usually, this means that the at-fault party’s insurance carrier will pay for the damages. An individual involved in an accident caused by another driver has three options:

  1. 1. File a claim with his or her own insurance company, which will then pursue a subrogation claim against the at-fault party’s insurance company;
  2. 2. Pursue a claim directly with the at-fault party’s insurance company; or
  3. 3. File a personal injury lawsuit against the at-fault driver.

Pursuing Insurance Claims

Usually, automobile accidents involve claims with insurance companies. The requirements on automobile insurance are codified under the Illinois Insurance Code. After a claim is filed, a claims adjuster will be assigned to the case. The adjuster may contact the insured person to obtain more information about the accident. In addition, the adjuster may do the following:

  1. 1. Request a copy of the police report;
  2. 2. Contact the other driver involved in the accident;
  3. 3. Contact any known witnesses to the accident;
  4. 4. Inspect the car for damages (this may include the adjuster taking photographs of the vehicle); and
  5. 5. Contact healthcare providers for information in relation to any injury expenses.

If the accident resulted in no injuries, the only issue will be repair to the vehicle. Resolution of claims made for vehicle repairs usually involves one of the following options:

  1. 1. Use a body shop approved by the insurance company: these shops are already approved to perform automobile repair by the carrier; the claimant simply takes his or her car in for an estimate and the work is subsequently completed;
  2. 2. Obtain quotes: the adjuster may request that the claimant take the vehicle to several shops in order to obtain estimates to compare; or
  3. 3. Claimant uses their own shop: claimants may decide to use a shop of their choosing. But, this may result in the claimant having to pay the difference in cost between the shop he or she chooses and what the insurance company determines is the fair price of the work.

If injuries occur as a result of the accident, resolving the insurance claims becomes more complex. It will be necessary for the claims adjuster to receive evidence of all medical bills. This may require the claimant to sign a waiver granting the insurance company access to his or her medical records. Further, personal injury can add significant costs on top of the cost to repair the vehicle. This added cost may make coming to an agreement on who was at fault and for what amounts much more difficult and time-consuming.

Making claims against insurance companies can be difficult and frustrating. For assistance with your insurance claim, call an experienced Illinois insurance dispute attorney at 847-934-6000 today. Drost, Gilbert, Andrew & Apicella, LLC proudly provides representation for individuals throughout the northwest suburbs, in communities such as Crystal Lake, Barrington, Deer Park, Inverness, and Schaumburg.

Ken ApicellaAbout the Author: Attorney Ken Apicella is a founding partner of DGAA focusing in the areas of personal injury, employment, insurance coverage disputes, and civil litigation. Ken earned his J.D. from DePaul University College of Law in 1999. He has been named a SuperLawyers Rising Star and a Forty Illinois Attorneys Under Forty to Watch. Ken has written and lectured for the Illinois Institute for Continuing Legal Education and regularly serves as a moderator at Northwest Suburban Bar Association's Continuing Legal Education seminars.

Recent Posts


Inverness corporate attorney child safety driving traumatic brain injuries Crystal Lake traffic attorney Illinois workplace lawyer estate planning for college students Illinois traffic attorney Illinois workers compensation attorney life insurance Illinois speeding lawyer insurance claims Des Plaines personal injury attorney Mount Prospect real estate lawyer Illinois Transfer on Death Instrument Schaumburg medical malpractice lawyer Arlington Heights employment attorney insurance claim texting and driving problem employees elder abuse Illinois lawyer digital evidence severance agreements TBI revenge porn Illinois Probate Act of 1975 Arlington Heights accident attorney digital assets, digital fiduciary, estate planning, digital content, Long Grove estate planning lawyers denied insurance claim Arlington Heights personal injury attorney Crystal Lake pet attorney living trust benefits paid sick leave Rolling Meadows personal injury lawyer comp time contracts Chicago lawyer Federal Food Drug and Cosmetic Act Illinois registered agent estate tax sexual harassment Crystal Lake employment lawyer Palatine construction attorney employment contract, employment law, employment at-will, Deer Park employment law attorneys, contract, llinois Real Estate Lawyers Association Schaumburg civil litigation attorney Crystal Lake law firm Illinois construction accident attorney distracted driving accidents social media after death Affordable Care Act special needs trust business litigation Transfer on Death Instrument Illinois estate planning attorney clemency probate process insurance attorney Rolling Meadows estate planning attorney anesthesia errors Rolling Meadows Attorney Crystal Lake tax lawyer Riverwoods estate planning lawyer Illinois medical malpractice lawyers Schaumburg wrongful death attorney Barrington criminal lawyer Barrington estate planning lawyer civil litigation overtime pay trucking accident lawyers Rolling Meadows Traffic Lawyer Illinois bicycle safety Illinois estate planning Schaumburg corporate attorney Illinois Human Rights Act digital media accounts, estate planning, Arlington Heights estate planning attorney, IRELA employment attorney Illinois traffic ticket lawyer Chicago corporate attorney commercial leasing Schaumburg injury lawyer Illinois Wage Payment and Collection Act Schaumburg Attorney deed transfer products liability Barrington employment law attorney wrongful termination Palatine criminal defense lawyer Illinois defective products attorney Mount Prospect elder law attorney Rolling Meadows traffic attorney Palatine insurance lawyer Illinois motorcycle accident lawyer in terrorem provision hiring employees spinal cord injury Illinois injury lawyer Crystal Lake car accident attorney Des Plaines Traffic Lawyer whistleblower protections Rolling Meadows insurance dispute lawyers, insurance dispute Crystal Lake bike accident lawyer POA LLCs meal breaks underage DUI Barrington personal injury lawyer Chicago attorney Long Grove estate planning attorneys fatal car accidents Illinois employment law modern family estate planning real estate attorneys Inverness probate lawyer elder law insurance dispute Barrington boating accident attorney BUI pedestrian-automobile accident subcontractor Mt Prospect Attorney Palatine civil litigation lawyer traffic violations defense Des Plaines drug crimes lawyer Palatine real estate lawyer Arlington Heights injury attorney loss of consortium Palatine employment attorney civil rights violation minimum wage Inverness insurance attorney Home Sale Contingencies Class A misdemeanor privacy Illinois medical malpractice claim Illinois LLC creation Palatine law firm digital assets Crystal Lake medical malpractice law firm Illinois job attorney DUI attorney Des Plaines collections attorney mortgage investment property creditors denial of life insurance low-ball insurance settlement breach of contract Illinois Sales Representative Act Buffalo Grove personal injury lawyer personal injury lawyer Crystal Lake employment attorney drug crime Barrington criminal defense lawyer work unions home inspection lawyer Rolling Meadows marijuana attorney estate planning Jay Andrew Crystal Lake accident attorney FSLA living trust preventable medical errors Des Plaines real estate lawyer Arlington Heights wills and trusts lawyers field sobriety test medical marijuana Illinois driving without license natural gas explosion DUI Illinois mortgages expungement caretaker rights crossover accidents DMV pedestrian injuries, pedestrian fatality Inverness injury lawyer Rolling Meadows drug defense attorney Illinois employment laws Illinois Workers’ Compensation Commission fiduciary rule Illinois Smoke Detector Act Inverness elder law lawyer Crystal Lake personal injury lawyer rumble strips Detainer Actions license reinstatement trustee Arlington Heights car crash attorneys hands free device workplace sexual harassment Illinois estate planning law firm insurance denials personal injury accidents Des Plaines injury law firm Illinois car accident attorney eluding a police officer guardianship attorney Crystal Lake civil litigation lawyer insurance claim dispute Deer Park motorcycle accident lawyer workers compensation benefits traffic tickets employee misclassification probate claims Illinois tax attorney distracted driving accident victims Barrington Traffic Lawyer Crystal Lake employment law attorney fault based insurance Arlington Heights wills and trusts attorney wage theft Illinois will lawyer Illinois workers compensation lawyer South Barrington real estate lawyer cell phone accidents Crystal Lake medical malpractice attorneys filing a medical malpractice claim estate attorney foreclosure cell phone Rolling Meadows employment law attorneys employees sexual images Barrington employment law firm Illinois traffic accident lawyer Buffalo Grove traffic lawyers Rolling Meadows tax attorney Palatine employment lawyer insurance denial appeals Rolling Meadows corporate lawyer Attorney Ken Apicella Buffalo Grove traffic attorney Schaumburg estate planning lawyer internet personal injury, auto accident injuries, delayed injuries, serious injuries, Des Plaines personal injury attorneys Buffalo Grove probate lawyer Policy Cancellation Schaumburg personal injury lawyers Schaumburg elder law lawyer spinal cord injuries food poisoning attorney fees Chicago insurance law firm fiduciary rule delay BAC condo Crystal Lake insurance lawyer rent to own real estate contracts Barrington real estate lawyer Rolling Meadows personal injury lawyers trench injuries Schaumburg criminal law attorney appealing an insurance claim Des Plaines insurance attorney personal injury law firm Chicago traffic lawyer car accident lawyer bicycle accidents motorcycle accident lawyer pet bites Buffalo Grove criminal defense lawyer Illinois elder law attorney construction accidents, personal injury, wrongful death, Arlington Heights personal injury attorneys, workers' compensation GM ignition switches estate plan Illinois civil litigation lawyer wills Illinois insurance claim dispute lawyers reckless homicide criminal record Des Plaines insurance dispute, insurance dispute lawyers, insurance claim denial, insurance claim delays, Rolling Meadows insurance dispute attorneys Des Plaines accident attorney uninsured motorist School Visitation Rights Act first degree murder Illinois jet ski accident lawyer probate automated cars Inverness real estate attorney blended families wrongful termination, employment law, whistleblower protections, Illinois employment laws, discrimination in the workplace estate planning lawyer Family Medical Leave Act Rolling Meadows medical malpractice lawyers Barrington Illinois estate planning lawyer gift taxes Schaumburg estate attorney Arlington Heights estate planning attorney jet ski medical research Crystal lake insurance dispute attorney college kids employment lawyer probate claims process Chicago biking tips commercial real estate traffic accidents homestead rights Do Not Resuscitate Buffalo Grove law firm dealing with problem employees life insurance lawyer drug crimes lawyer real estate leasing car crash Illinois insurance dispute lawyers power of attorney Inverness accident lawyer icy parking lots natural gas Schaumburg personal injury lawyer slip and fall Palatine business attorney employee rights Rolling Meadows litigation lawyer pay when paid contract Deer Park DUI lawyer Buffalo Grove corporate attorney privacy laws Barrington injury attorney Exclusions defective products swimming pools Thanksgiving BAIID pedestrian accidents Schaumburg Illinois trucking safety Arlington Heights pedestrian accidents involuntary manslaughter right to work criminal defense Palatine corporate attorney Illinois insurance claims lawyers brain injury Liquor Control Act Chicago estate planning lawyer life insurance policy Illinois employment law attorneys Illinois insurance claim attorney loopholes Illinois employee rights attorney. Rolling Meadows insurance lawyer insurance claim delay Super Mario Mount Prospect wills and trusts lawyers Buffalo Grove insurance claim dispute lawyers Self-Directed IRA Accounts Illinois rollover accident lawyers surgical mistakes living wills medical malpractice claims mass shooting Arlington Heights wills and trusts attorneys drunk driving statistics Illinois corporate lawyer installment contracts DGAA Schaumburg construction accident lawyer Des Plaines personal injury lawyers Illinois wills and trusts attorneys Barrington personal injury attorney car collision advance healthcare directive Crystal Lake pedestrian accident lawyer Crystal Lake personal injury attorney operating agreements healthcare traumatic brain injury Buffalo Grove car accident lawyer car crash injuries rest breaks Schaumburg traffic lawyer Barrington attorney Buffalo Grove medical malpractice lawyers Crystal Lake estate planning lawyer insurance dispute attorney license suspension Des Plaines motorcycle accident attorney Illinois business law atorneys Palatine workers compensation lawyer income distribution deducation Crystal Lake will lawyer dog bites Palatine employment law lawyer taxes corporate law Buffalo Grove injury lawyer compensatory time job lawyers DNR insurance claim dispute attorney Des Plaines claims law firm CAM Rolling Meadows real estate attorney owner responsibility insurance adjusters Illinois probate lawyer rollover accidents defective products lawyer ken apicella ACA vacation home fines forming a corporation in Illinois Schaumburg estate planning attorney Des Plaines tax law firm Schaumburg probate attorney traffic violations Crystal Lake traffic lawyer Palatine punch death Illinois personal injury lawyer Schaumburg personal injury attorney liability criminal law jet ski accidents institutional trustee FMLA agent bike accident Illinois employment law attorney Rolling Meadows car accident lawyers Rolling Meadows boating crash lawyer gift tax exemption, estate planning, estate planning strategies, Illinois estate planning, South Barrington estate planning attorneys premises liability Illinois criminal defense attorney Illinois red light cameras real estate contract Inverness real estate lawyer Arlington Heights trucking lawyer capital gains tax Illinois workplace discrimination attorney pizza emoji no contest clauses Rolling Meadows insurance dispute lawyers unpaid assessment Landlord Tenant Ordinance Palatine probate lawyer car accident insurance disputes caregiver bicycle dooring accidents Arlington Heights real estate lawyer Arlington Heights personal injury lawyer boating under the influence Arlington Heights Traffic Lawyer estate planning, death tax, succession plans, business estate plans, Barrington estate planning lawyers Rolling Meadows criminal attorney Palatine traffic accidents unpaid overtime Schaumburg insurance lawyers Deer Park traffic lawyer employee discrimination Des Plaines criminal attorney PTSD digital information unauthorized overtime Illinois insurance attorney Barrington business law firm foreclosed rental property Whistleblower Claims trusts cell phone tower data Illinois law Chicago insurance claim attorneys medical malpractice, missed diagnosis, delayed diagnosis, medical mistake, Deer Creek medical malpractice lawyers Rolling Meadows probate lawyer Illinois business lawyer real estate zoning life insurance claims estate planning attorney Chicago trucking accident attorney living trust vs will Barrington medical malpractice lawyers changes to mortgage law insurance agents Arlington Heights insurance attorney dynasty trusts Kenilworth estate planning attorneys employment law disability benefits deadly crashes insurance agent negligence real estate closing marijuana crimes attorney accidental death benefits Illinois employment attorneys IRA benefits Illinois traffic laws landlord tenant law car accidents Des Plaines DUI attorney Arlington Heights Attorney Food and Drug Administration's Food Safety Modernization Act Arlington Heights criminal lawyer golf accidents Illinois real estate license Deer Park medical malpractice attorney Rolling Meadows DUI lawyer Home Remodeling Repair Act Barrington litigation attorney comparative negligence Deer Park traffic accident attorney Crystal Lake car accident lawyer Arlington Heights traffic attorney Illinois personal injury lawyers estate planning trusts Crystal Lake criminal defense attorney probate fees personal injury claim Colin H. Gilbert manufacturing financial advisors Des Plaines real estate attorney employment contract Palatine trusts lawyer Deer Park employment law attorney trauma after an accident Illinois employment law firm Illinois insurance lawyer Arlington Heights car accident lawyer Illinois boating accident lawyer landlord Illinois trusts attorney drugs senior citizens Rolling Meadows Rolling Meadows criminal lawyer liability claims Illinois small business traffic laws Chicago will attorney pet law Illinois DUI attorney healthcare claims health insurance dispute Crystal Lake business law attorneys Deer Park real estate law firm Palatine traffic lawyer texting while driving Rolling Meadows traffic law firm head on collisions car crashes boating accidents overtime violations Illinois real estate lawyer IRS personal injury traffic offenses Palatine injury attorney Schaumburg employment attorney criminal Inverness traffic law firm Des Plaines drug lawyer Chicago estate planning real estate lawyer pedestrian accident Des Plaines personal injury lawyer truck collisions medical malpractice workers comp medical malpractice compensation workers compensation new real estate form Illinois traffic attorneys Illinois insurance claim dispute lawyer Buffalo Grove employment lawyer federal regulations for LLCs preventing accidents controlled substance suspended license Legal Info speeding condo association pain and suffering Arlington Heights wills and trusts lawyer Barrington estate planning attorney blood alcohol content Inverness personal injury attorney holiday statistics car accident lawyers irrevocable trust liens Barrington civil litigation attorney Illinois wrongful termination lawyer personal injury attorney insurance negligence Fair Labor Standards Act Long Grove real estate attorney consent to a search Schaumburg employment law attorneys Arlington Heights TBI attorney real estate attorney Illinois personal injury attorney federal crimes Inverness civil lawyer Buffalo Grove real estate attorney Palatine civil attorney Illinois attorney Colin Gilbert probate lawyer wrongful death Kenilworth estate planning attorney civil litigation attorney ObamaCare Long Grove estate planning tax attorney Deer Park accident attorney Schaumburg drug defense lawyer drunk driving drug crimes Arlington Heights employment law attorneys Schaumburg car accident attorney employment law, meal breaks, rest breaks, hotel employees, Des Plaines employment law attorneys sole proprietorship back injuries license revocation wills and trusts independent contractor Illinois medical malpractice case personal injury claims pregnant women marijuana DUI penalities slip and fall accidents nursing home negligence Long Grove estate planning attorney Barrington drug crime attorney Inverness DUI lawyer Chicago employment lawyer estate planning, digital assets, Revised Uniform Fiduciary Access to Digital Assets Act, Illinois digital assets, Illinois estate planning, Illinois collections attorney Palatine drug lawyer startup company IRA trust transfer real estate bad faith insurance claims Long Grove real estate lawyer denied insurance claims Employment Discrimination Law insurance claim denials Illinois pet lawyer Joliet general practice lawyers drug possession Inverness estate planning lawyer residential real estate Rolling Meadows business lawyer insurance disputes, Illinois insurance disputes, Illinois insurance dispute attorneys, denied insurance claims, Arlington Heights insurance dispute attorneys trust payments Chicago will attorney, social media platforms, Illinois estate planning lawyer, medication errors traffic deaths Rolling Meadows accident lawyer Barrington employment attorney Forcible Entry unfunded trust murder traffic crimes Arlington Heights lawyer Des Plaines pet law attorney Schaumburg criminal attorney rollover car crashes Kenilworth estate planning lawyer Long Grove wills and trusts attorneys Palatine personal injury lawyer Deer Park personal injury lawyer employment law, Illinois employment laws Crystal Lake injury attorney Fourth of July Illinois home inspection Rolling Meadows personal injury attorney Palatine estate planning lawyer Arlington Heights medical malpractice lawyer boating DUI Schaumburg real estate lawyer Chicago employment attorney commercial leases murder charges Deer Park criminal attorney Deer Park workers compensation lawyer South Barrington real estate attorney Illinois underfunded trust murder defense Crystal Lake medical malpractice lawyer Barrington workers compensation attorney construction accidents product liability motorcycle accident Buffalo Grove personal injury attorney Retaliatory Discharge Illinois wills and trusts DUI defense Des Plaines civil attorney auto accidents Illinois pedestrian accident attorney Palatine elder law attorney power of attorney for healthcare Rolling Meadows employment attorney Des Plaines medical malpractice attorney Chicago car accident lawyer dram shop law Illinois insurance disputes Rolling Meadows insurance attorney underinsured motorist Illinois employment lawyer Arlington Heights tax lawyer Illinois medical malpractice attorney trucking accidents Rolling Meadows employment law attorney Palatine Attorney breathalyzer test hit and run accident construction contracts vacation home Palatine corporate law attorneys insurance claim denial Illinois living will Illinois personal injury small business