News & Resources

By: Stephen A. Jackson Hennen v. Metro. Life Ins. Co., 17-3080, 2018 WL 4376994 (7th Cir. Sept. 14, 2018). Hennen worked as a sales specialist for NCR when she sought treatment for a back injury.  She was covered under her employer’s long-term disability plan insured by MetLife.  When physical therapy and surgery failed to resolve her injury Hennen applied for LTD benefits under the plan. Acting as the administrator, MetLife agreed Hennen was disabled and paid benefits for two years.  However, the plan had a two-year limit for neuromusculoskeletal disorders subject to several exceptions, one applies to radiculopathy.  Hennen argued […]

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By: Andrew B. Bryant The scenario is familiar: an insurance carrier denies a disability claim based, at least in part, on covert video surveillance of the claimant.   A recent decision by the District Court of the Western District of Tennessee displays how video surveillance can be used by a Court not only as substantive evidence to evaluate degree of disability, but also as a n important tool in assessing the credibility of the entire claim. In the case, Plaintiff Gregory Eaton had been receiving Long-Term Disability (LTD) benefits from Defendant Reliance Standard Life Insurance Company due to a back condition […]

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If you are the beneficiary of a life insurance policy — whether in Illinois or elsewhere — then you may find that the insurer unexpectedly denies your claim on the basis of an exclusion written into the policy (that you were not aware of).  This can put you in a uniquely vulnerable position as a beneficiary.  After all, if you were reliant on your loved one for resources, then the life insurance proceeds are critical to your ability to bounce back financially. Depending on the nature of the exclusion and the circumstances surrounding your loved one’s death, however, it is […]

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In the private insurance context, the existence of a “waiting period” is to be expected, and in fact, waiting periods are nearly ubiquitous. Whether you are signed onto a health insurance policy, a disability insurance policy, or some other form of insurance, in all likelihood, there is a waiting period provision written into the insurance agreement.  Insurers frequently use these waiting period provisions as the basis for a claim denial — even when the claim is otherwise legitimate. Fortunately, the waiting period restriction is not always applicable.  Let’s take a brief look at some of the basics, first. Waiting Period […]

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Accidents that give rise to disabilities — whether in the workplace or elsewhere — may seem complicated by the presence of multiple sources of compensation.  If you have been injured in a motor vehicle accident, for example, then you may receive a substantial award of damages from the defendant, and you might also be eligible to receive disability benefits in accordance with your private disability insurance policy.  In the state of Illinois (and elsewhere), however, these varied sources of compensation do not necessarily interfere with one another, except in limited circumstances. Private Disability Benefits Are Not Affected Private disability insurance […]

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In the private disability insurance context — in Illinois and elsewhere — insurers will often deny legitimate disability claims on the basis that the policyholder’s condition is not actually disabling in accordance with the language of the insurance plan. There are no absolute rules that apply to all disability insurance policies — the definition of disability may differ significantly depending on policy.  Generally speaking, plans with high premiums have broader definitions of disability than cheaper plans. For example, your plan may include a broad definition of disability that awards disability benefits in the event that your condition renders you incapable […]

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By: Andrew B. Bryant Mother Died Three Days Before Pension Payments Would Have Vested With Daughter In a truly unfortunate set of circumstances, a woman who worked for 37 years at a Wisconsin children’s hospital passed away three days after her retirement date, with her pension payments set to begin another three days after he date of death.   The woman’s daughter, the named beneficiary under the pension plan (“the Plan”), was denied payments under the Plan because the date of death preceded the beginning of pension payments.   In upholding the denial of benefits, the Seventh Circuit noted that in order […]

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Short-term disability insurance provides temporary wage replacement benefits in the event that you are suffering from a disabling condition, though the benefits apply for a very limited period of time — in most cases, short-term disability benefits are only paid out for six months to one year of proven disability.  After sufficient time has passed that short-term disability benefits are no longer available, you may be eligible to receive long-term disability benefits (if you are still disabled and if you are a long-term disability policyholder). Unfortunately, despite having paid for short-term disability insurance coverage — and relying on such coverage […]

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If you’ve had a legitimate insurance claim denied in Illinois — whether a health insurance claim or a disability insurance claim — then you may find that the insurer justifies their denial on the basis of a discretionary clause written into the policy. Discretionary clauses can vary in function somewhat, but as a general rule, they give the insurer the ability to interpret (in accordance with their own standards) the terms of the contract.  This type of “discretionary” power gives the insurer an enormous advantage when it comes time to determine whether or not to award health or disability benefits. […]

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In Illinois, and elsewhere, it’s critical that disability insurance policyholders avoid misrepresenting the truth on their application.  It’s worth noting that your application for disability insurance policy will typically require that you confirm the truth and accuracy of all statements made in the application. Failure to adequately and accurately represent the facts on one’s application may be used later on by the insurer as a justification to deny an otherwise legitimate disability benefits claim — the insurer will likely argue, for example, that they are entitled to rescind the insurance contract as a consequence of the misrepresentation at issue. You […]

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