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

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

Archive