DGAA bLAWg

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


Tags

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

Archive