Two Main Legal Options for Insurance Disputes

Web Admin - Monday, March 21, 2016

legal options for insurance disputes, Illinois Insurance Dispute AttorneysPeople purchase insurance policies to put their minds at rest. However, countless valid claims are denied by insurance companies every year. Many individuals are upset when their insurance company disputes a claim and refuses to pay—insurance companies are in the business of making money, and paying out claims is not a part of their business plan. When you find yourself involved in an insurance dispute with your insurance company, an experienced Illinois insurance dispute lawyer can help you deal with the insurance company and your disputed claim. 

Settlement As a First Option 

The most common approach for handling insurance disputes is to enter into settlement negotiations. A majority of insurance disputes are successfully resolved via settlements. Settlement negotiations begin when your lawyer submits your claim to the insurance company. The insurance company is not interested in paying the full amount of the disputed claim, but may be persuaded into paying a reduced amount of the claim instead. The insurance company will most likely reject your settlement claim; however, it will likely pitch back to you a counter settlement offer. 

After discussing the counter offer with your lawyer, you and your lawyer can then determine if the counter offer is satisfactory or not. If not, you can reject the counter settlement offer and put forth another settlement offer of your own. This process repeats until you and the insurance company come to an agreement, or ultimately decide that a settlement is not going to work. When settlement negotiations fall apart and fail, the dispute must be brought before the courts to be resolved. 

Proceeding to Court As a Second Option

If all else fails, your lawyer can prepare your insurance dispute claim for court. As an initial matter, it is very likely that your insurance policy contains a clause directed to a statute of limitations for bringing an insurance dispute to court. Your lawyer should be able to review your policy and inform you of when you must file the action in court in order to prevent your claim from being time barred under the policy. 

Your case will most likely be based on contract law or the Illinois Insurance Code, both of which your insurance dispute lawyer is highly familiar with. Additionally, your cause of action will most likely be based on a breach of contract (i.e., the insurance company refusing to pay, as per the insurance contract), or a violation of the Illinois Insurance Code. Your insurance dispute lawyer will work closely with you to develop your strongest case against your insurance company so that you can get the claim payout that you need. 

If you are having difficulty with your insurance company refusing to payout a valid claim, please feel free to contact one of our experienced Illinois insurance dispute attorneys today. Our firm serves the communities of Rolling Meadows, Buffalo Grove, Barrington, Inverness, Palatine, Des Plaines, Schaumburg, and Arlington Heights. Call 847-934-6000 to speak to a member of our team. 

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.



What to Expect When Suing an Insurance Company

Web Admin - Thursday, September 11, 2014

insurance lawsuit, Palatine insurance lawyerPeople purchase insurance with the goal of protecting themselves in the event that something unfortunate happens. However, no matter how hard people try to understand their policies and the limitations on them, many people face situations where they feel that the insurance company should be compensating them, but the company refuses. When this happens, people have a variety of options.

First, they can enter into an internal appeals process. Most insurance companies have a function that allows other employees of the company to review refusals and determine if they were warranted. If that fails, then the Illinois Department of Insurance also investigates some insurance-related issues. Alternatively, people with issues that neither of those strategies can solve may need to sue their insurance company if they want to see the compensation that they have already paid for. It is important for people to understand the process of a lawsuit and the length of time that it may take. Insurance companies are expert litigators, and they may drag the process out.

Understanding a Lawsuit

The beginning part of the process for filing a lawsuit against your insurance company involves hiring a lawyer and filing a complaint against them. The complaint is a legal document that triggers a lawsuit, and lays out the general allegations against the insurance company. Once this happens, the insurance company is allowed to respond with a document called an answer. The answer takes each fact asserted by the complaint and either confirms or denies them, so that both parties understand what is in dispute. Once this happens your lawyer and the insurance company lawyers will engage in discovery.

Discovery is a legal process in which both sides ask the other side questions to better understand the facts. This is mainly done through requests for documents, written questions called interrogatories that the other side has to answer, and depositions, which are in-person interviews. The majority of lawsuits end at some point during this phase. As more information comes out, both sides begin to understand their chances of winning at trial, and they likely reach a settlement. In the event that there is no settlement, the case moves to trial where both sides' attorneys present their arguments to the judge, who eventually makes the final legal decision.

Your Part in the Process

Not every step in that process will require the client's involvement. Initial interviews will need to be done for the attorney to get a picture of the case, and there will also be periodic conferences as new facts appear or the case moves forward. The most intensive piece that the client will need to do is prepare for a deposition in case the insurance company wants to depose them. This may require working with the client's attorney to better understand the types of questions that they company may ask, so that the deposition goes smoothly.

If you are currently having an issue with an insurance company and would like to file a lawsuit against them, contact a dedicated Illinois insurance dispute attorney today. At Drost, Gilbert, Andrew & Apicella, LLC, we represent clients in many northwest suburban towns including Inverness, Palatine, and Schaumburg.

About 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.

Appealing a Denial of Accidental Death Benefits

Web Admin - Tuesday, February 18, 2014

illinois denied insurance benefitsMany people carry life insurance or accidental death and dismemberment (AD&D) policies. These policies, which people can acquire through their employer or on the open market, may pay benefits in cases of accidental death. Unfortunately, life insurance policies comprise an industry worth hundreds of billions of dollars, according to a report by the U.S. Treasury, and insurance companies have strong incentives to pay out as little as they can in benefits.

Often, that means denying legitimate life insurance claims on the basis of a “policy exclusion.” Policy exclusions are exceptions that insurance companies place into contracts that exempt certain situations from qualifying for payment. Common policy exemptions include suicides and deaths occurring within one year of the policy’s start. Companies can use these sorts of exemptions as pretexts for denying the payment of benefits.

Contesting a Denial

Even after the insurance company denies the claim, beneficiaries do have tools to appeal the decision. However, depending on the law governing the insurance policy, the tools may be expansive, or more limited in nature. For instance, plans through a person’s employer are often covered by the Employee Retirement Income Security Act (ERISA). ERISA places strict limits on how appeals take place.

Beneficiaries must appeal the decision through a special ERISA administrator before they can move into the regular court system. Beneficiaries with denied claims would do well to seek out a lawyer before filing their ERISA appeal because the actions that take place at that appeal can have strong impacts on a court case. Courts handling ERISA litigation often use evidence from the appeal when making their decisions. That means that if something is left unmentioned at that stage, it can be very difficult to convince the court to consider it later.

Plans purchased by an individual, rather than provided by an employer, will likely be governed by state law instead of ERISA. While this law is usually less restrictive, individuals should still be cautious when dealing with insurance companies. In state law cases, the beneficiary will likely sue the insurance company in an attempt to prove that their cases does not actually fall into the policy exclusion that the company is claiming.

If you have been the victim of a wrongful denial of a life insurance claim, get a written statement of the reasons for the denial, and seek help from an Illinois insurance attorney. Our firm serves clients across the northwest suburban area, including Schaumburg, Palatine, and Crystal Lake.

About 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.

What to Do if Your Life Insurance Claim is Denied

Web Admin - Tuesday, February 04, 2014

illinois life insurance claim lawyer

The law provides insurance companies with a variety of methods to protect themselves against fraud. Unfortunately, insurance companies may attempt to use these tools to withhold payment on legitimate claims. Two of the common ways that life insurance companies may try to stop beneficiaries from collecting on their claims are by rescission of the policy and denial of the insurance claims
A policy rescission occurs when the insurance company alleges that the person who took out the policy misrepresented material facts about themselves. If successful, this allows the insurance company to withdraw the person’s coverage. Conversely, if an insurance company denies a claim, they do not contest the validity of the whole policy. Instead, they are simply saying that the person’s death fell into an exception in the insurance. While both of these tactics result in a non-payment of the claim, they require different strategies to handle them.

Dealing with Rescission

When an insurance company rescinds a contract, they declare that the entire policy is invalid. One of the most common reasons that an insurance company will give for such a rescission is a “material misrepresentation.” This means that the company claims that the deceased wrongfully answered questions on the application related to things such as their age or medical history. To fight a rescission of this sort, your insurance attorney must prove that the deceased either did not make such a misrepresentation, or that any misrepresentation was not material. 

Fortunately, Illinois law does provide some protection in these circumstances. First, the law requires that the alleged misrepresentation occurred on the actual policy application, and not simply in a conversation with the insurance company. Second, the law forbids insurance companies from rescinding policies more than two years after issuance, except in cases of non-payment of premiums.

Dealing with Denial

An insurance company can deny a claim for several reasons, often because they believe the death falls into a policy exception, or because they believe the person filing the claim is not the proper beneficiary. One common fight over policy exceptions occurs when the insurance company asserts that a person’s wrongful death was actually a suicide, as suicides are ordinarily not covered by life insurance. Overcoming this sort of denial often requires bringing forth evidence to prove that the death truly was an accident.

If you believe that your life insurance policy was improperly revoked or if you had a life insurance claim denied recently, then consider contacting an Illinois insurance attorney today. Our firm handles cases across the northwest suburbs, including in Arlington Heights, Rolling Meadows, and Des Plaines.

About 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.

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