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.



How to Handle a Denied Insurance Claim in Illinois

Web Admin - Tuesday, May 13, 2014

illinois denied insurance attorneyPeople purchase insurance coverage to protect themselves when something goes wrong. Depending on the type of insurance, claims can be paid out for health issues, auto accidents, home repairs, or deaths in the family, among other things. These are already stressful events. A denied insurance claim merely serves to add more stress and difficulty to an already trying situation. The reasons for such a denial can be varied and depend on the type of insurance in question, but in these situations consumers have options available to them to contest the insurance denial.

Reasons for a Denial

The reasons for an insurance company to deny a claim on a policy vary greatly between different types of insurance. For instance, a company providing a life insurance policy may reject a policy claim based on a belief that the person’s death was actually a suicide, or a company providing health insurance could reject a claim made for a specific treatment by arguing that the treatment was not actually medically necessary. However, there are also some grounds for a denial that span across the insurance industry. One of the most common is a “material misrepresentation,” which means that the company believes that the policyholder lied or withheld important information during the application for a policy.

Exactly what qualifies as a material misrepresentation changes from industry to industry. Health or life insurance companies would argue that hiding a prior medical condition may be a material misrepresentation, while an auto insurance company would be more concerned with a past accident. Furthermore, any of these reasons could just be a pretext for a “bad faith” denial, which means that the insurance company privately believes that the policyholder has a valid claim, and simply does not want to part with its money.

Contesting a Denial

Policyholders facing a denied claim do have options available to them. The process will likely begin with the insurance company’s internal appeals process. This may involve letter writing, phone calls, or in-person interviews where the policyholder explains their position. It can be advantageous to consult a lawyer at this point for two reasons.

First, the insurance company may have lawyers involved at this stage, so it evens the playing field. Second, if the issue does proceed to a lawsuit, the lawyer will already know the case’s history and they may be able to prevent early missteps that would cause problems in litigation, which would be the next step if the internal appeals fail. The one exception to this is in the case of health insurance. Illinois recently passed a law allowing policyholders to apply for an independent external review in the case of a denied health insurance claim.

If you are dealing with a denied insurance claim, you do not need to do it alone. Reach out to a skilled Schaumburg insurance dispute attorney today. Our team represents clients across the northwest suburbs, including in towns such as Crystal Lake, Arlington Heights, and Buffalo Grove, Illinois.

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.

Unpaid Claims by Insurance Companies on the Rise

Web Admin - Saturday, November 09, 2013

In recent years, it has become more difficult for policyholders to get paid after submitting a claim to their insurance company. In fact, research done by the Los Angeles Times shows that the amount of money that insurance companies failed to pay on claims more than doubled in the past decade to $372 million.

This increase comes, in part, from insurance companies using aggressive tactics to avoid paying money to deserving people. These tactics include denying payment or cancelling coverage after people make claims, confusing customers until they give up trying to collect on their policies, and delaying payment on valid claims. For many consumers, the best option to protect their rights in the face of these insurance actions is to seek out an attorney experienced in handling unfair insurance claim denials.

Insurance Company Tactics        

One of the most common tricks that insurance companies use to avoid paying for valid claims involves denying their validity, or canceling coverage after the policyholder makes a claim. Insurers often do this by claiming that the policyholder failed to inform them of some piece of information, even if that information had no effect on the reason for filing the claim in the first place. Some companies dealing in health insurance go so far as to examine the medical records of claimants in an attempt to dig up some pre-existing conditions that they can use to cancel the coverage or deny the claim. There have even been cases of insurance companies revoking coverage based on conditions that the company never asked about, or that doctors never diagnosed.

Insurance companies also actively attempt to confuse customers about the extent of their coverage in order to escape paying on claims. The companies’ best tool for this is often their contract. Insurance companies write their contracts with an eye towards keeping them difficult to understand, that way they can fool customers into believing that their policy covers more than it actually does until they file a claim.

Another strategy insurers use involves simply delaying payment of the claim until they give up, or in some cases even pass away. Insurers have many tools to prolong the process of trying to collect on a claim. Some tricks amount to nothing more than a bureaucratic runaround, like sending the wrong paperwork for the policyholder to fill out, but others are more aggressive--like simply waiting to mail the payment until the beneficiary complains. Some insurers delay payments so severely that customers resorted to lawsuits just to get the money the company owed them.

Legal Help for Unpaid Insurance Claims in Illinois

If you have questions about an insurance dispute, contact an Illinois insurance attorney today. Call 847-934-6000 to speak with a member of our team. We work with residents in many communities on these issues, including Chicago, Crystal Lake, Schaumburg, Des Plaines, and more.

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