Surprise! Your Insurance Company is Not On Your Side

Web Admin - Tuesday, March 07, 2017

Rolling Meadow insurance dispute attorneysIf you are like most consumers, you have seen the feel-good insurance commercials. The insurance companies claim to have only your best interest at heart, and promise to be there when things go wrong. Of course you believe them. After all, you pay your premiums every month. What reason would they have to deny your claim? You might be surprised. 

The Ugly Truth About Insurance Companies

Insurance companies are for-profit businesses, and, like most for-profit companies, they are in the business of making money. They cannot reasonably make money if they are busy paying out claims. So they do everything they can to deny them. 

Some use intentionally confusing wording and obscure clauses that their customers could not reasonably interpret. Others offer rewards to their employees who have the lowest payout quotas. Some will even go so far as to use shady practices, such as locking claims in a safe to delay the process so significantly that the customer eventually gives up. 

Sound unfair? It is! Yet it is an everyday issue within the insurance industry. Thankfully, there are some things that consumers can do to mitigate the risks of having their claim denied. 

Never Handle a Claim Alone

First and foremost, consumers should avoid trying to file a personal injury claim on their own. Instead, they should seek the assistance of an experienced personal injury lawyer. Medical insurance claims are somewhat different since, typically, the doctor or office staff initially submit the claim to the insurance company. Those who need to file a claim against their homeowners insurance should seek guidance from someone other than their insurance company since some have been known to drop their customers for even inquiring about a possible claim. 

If Your Claim is Denied or Delayed

Should you experience a denial or delay of a claim, either because you already filed it without assistance, or because of the insurance company’s shady tactics, it is important that you seek experienced assistance before addressing the issue. 

At Drost, Gilbert, Andrew & Apicella, LLC , we have the knowledge, experience, and resources you need to navigate through an insurance claim denial. Dedicated to your best interest, we will fight to get you and your loved ones the fair settlement that you deserve. Learn more about how our Rolling Meadows insurance claim dispute lawyers can assist with your case. Call 847-934-6000 and schedule a consultation today.

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.



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.



Bad Faith Insurance Claims

Web Admin - Friday, October 23, 2015

denied insurance claim, Crystal Lake insurance dispute attorney, bad faith insurance claimsIn some instances when a claim is made on an insurance policy, an insured may believe that the insurer has acted in bad faith in settling that claim. Bad faith may occur through a delay in settling an insurance claim as well as the outright denial of the claim. An insurance company that acts in bad faith in the settlement of a claim may be forced to pay the insured for those actions. 

Claims under the Insurance Code 

Under the Illinois Insurance Code (§155), it is possible to recover a statutory penalty, attorney’s fees, and other costs if an insurer fails to fulfill its obligations in an unreasonable manner after a claim is made. 

Specifically, an insured must prove that there was a delay in settling the claim that is vexatious and unreasonable. Determining if the delay is vexatious and unreasonable requires an examination of the totality of the circumstances. Some of the factors that are considered include the attitude of the insurer, whether the insured had to file a lawsuit to recover, and whether the insured was deprived of his or her property for a period of time. 

The amount that may be recovered as a penalty under §155 violations cannot exceed any of the following: 

- Sixty percent of the amount which the court or jury finds the insured is entitled to recover against the insurance company;

- $60,000; and

- The excess of the amount that the court or jury finds the insured is entitled to recover, exclusive of costs, over the amount that the insurance company offered to pay to settle the claim before the action. 

The primary defense to a bad faith claim is that there is a bona fide dispute as to whether a policy provides coverage for the claim. If a bona fide dispute exists, denying or delaying in the handling of the claim is not considered a violation. Further, it has been held in Illinois that conduct of insurers is also vexatious and unreasonable when the insurer presents a legitimate policy defense, a genuine legal or factual issue as to coverage exists, or the insurer takes a reasonable legal position based on an area of law that is unsettled. 

Action that Results in a Violation of §155 

Conduct that leads to a violation of the duty of good faith and fair dealing includes, but is not limited to, the following: 

- Knowingly misrepresenting relevant facts or insurance policy provisions;Not maintaining prompt and regular communication with the insured;

- Refusing to pay a claim (either in whole or in part) that the insurer acknowledges as being due;

- Settling a claim for less than what it is actually worth; and

- Failing to properly investigate a claim. 

Insurance Dispute Attorneys 

If you believe that your insurance claim has been delayed or denied in bad faith, it is important to reach out to an experienced Crystal Lake insurance dispute attorney. Our firm represents individuals in communities such as Schaumburg, Crystal Lake, Palatine, Des Plaines, Buffalo Grove, Rolling Meadows, Barrington, Arlington Heights, Inverness, and Deer Park. 

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.



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.

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.

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