Category: Insurers

Seventh Circuit Awards Accidental Death Benefits

Jan 3, 2017 | Blog |

The United States Court of Appeals for the Seventh Circuit issued a decision in Prather v. Sun Life and Health Insurance Company on December 13, 2016. On July 16, 2013, Jeremy Prather had torn his left Achilles tendon playing basketball and after consulting with an orthopedic surgeon he scheduled surgery for July 22, 2013.  The day before surgery Prather called the surgeon’s office to complain of swelling in the lower part of his leg and he reported that an area of the calf was both sensitive and warm to the touch.  The surgeon told Prather to elevate the leg. Surgery the […]

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District Court Upholds LINA’s Denial of LTD Benefits Due To Lack of Objective Findings of Mental, Cognitive, or Behavioral Impairment

Nov 14, 2016 | Blog |

District court upholds insurer’s denial of LTD benefits agreeing with the insurer’s file reviewer that there are no objective findings from a psychiatric standpoint that indicates the Claimant is mentally, cognitively and/or behaviorally impaired. In Gailey v Life Insurance Company of North America, 2016 WL 6082112 ( M.D. Penn. October 17, 2016), the Claimant was a 48 year old office manager for many years with a history of anxiety and depression.  On July 15, 2013 she reported having an emotional breakdown at work and left the office crying, shaking, and suffering a panic attack.  She was unable to return to […]

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Insurer Required to Defend Insured

Jul 28, 2016 | Blog |

The Seventh Circuit Court of Appeals affirmed in part and reversed in part the district court’s decision regarding insurer’s duty to defend. Cincinnati Insurance Company brought action seeking declaration that its policy did not apply to the underlying claims against insured, arising out of automobile accident which resulted in death of insured’s wife. The United States District Court for the Central District of Illinois, Richard Mills, J., 2015 WL 4978711, granted in part and denied in part Cincinnati’s motion for summary judgment and granted in part and denied in part insured’s motion for summary judgment. Cincinnati appealed. In August 2010, […]

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