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

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

Archive