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

Archive