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. […]
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 […]
In Illinois, policyholders may have their otherwise legitimate disability claims denied if they fail to exercise reasonable efforts in recovering from their disability (and otherwise mitigating their losses). As a general rule, policyholders must uphold their end of the contractual bargain, so to speak — the insurer is not an absolute guarantor of losses suffered by the policyholder. The insurer can only be held reasonable losses that arise due to the disabling condition at-issue. Confused? Let’s take a quick look at the duty to mitigate imposed on disability policyholders in Illinois. The General Duty to Mitigate Throughout the country, insurance […]
By: Jennifer Danish Courts infrequently award attorneys’ fees to defendants for having to defend themselves in ERISA disability benefit claims. Recently though, the Court, in James W. Hackney v. Allmed Healthcare Management, Inc., No. 3:15-CV-00075-GFVT, 2018 WL 1981902 (E.D. Ky. Apr. 27, 2018) ordered an unsuccessful plaintiff to pay the defendant attorneys’ fees and costs, because the plaintiff pursued a cause of action not generally recognized as available under ERISA. Hackney brought a state law negligence claim against Allmed for rendering an unlicensed medical opinion about him in connection with his long-term disability benefit claim under an ERISA-governed benefit plan […]
As a general rule, insurers do everything possible to minimize their liabilities. In the disability insurance context, this may involve the denial of an otherwise legitimate benefits claim on the basis of an exclusion written into the insurance policy. Exclusions are often written in a particularly ambiguous way, however, so as to encourage prospective policyholders to enter the insurance agreement — the policyholder may interpret the exclusion in a broad and more favorable manner, when the insurer actually intends to interpret the exclusion more strictly. Once you have become disabled, the insurer’s interpretation of the exclusion may come as something […]
Andrew Bryant & Jennifer Danish On April 4, 2018, the Seventh Circuit Court of Appeals issued an opinion vacating the denial of a Supplemental Security Income disability claim brought by 47-year-old Rebecca Ann Akin, who suffered from fibromyalgia, back and neck pain, and headaches. Akin v. Berryhill, 887 F.3d 314 (7th Cir. 2018). On appeal, Akin argued that the administrative law judge wrongly discounted her allegations of back pain, improperly credited the opinions of agency doctors who had not reviewed all the medical records (including MRI scans) and disregarded her history of headaches. In its opinion, the Seventh Circuit described […]
Roy Alan Cohen, The Tort Trial and Insurance Practice (TIPS) Section 2018-2019 Chair, appointed Jennifer Danish to serve as a Immediate Past Chair of the Health and Disability Insurance Law General Committee for 2018-2019 on April 25, 2018. Jennifer has served as the Chair of the Committee 2017-2018 and has accepted the appointment. Mr. Cohen also appointed Jennifer to serve as a Member of the Solo and Small Firm Task Force, the Diversity and Inclusion Standing Committee, and the Plaintiffs Practice Standing Committee for 2018-2019 on April 26, 2018. These leadership appointments are a clear recognition of her competence and experience, commitment to TIPS, and […]
James F. McCluskey, ISBA President-Elect, appointed Jennifer Danish to serve as a Member of the ISBA Standing Committee on Law Office Management & Economics for 2018-2019 on April 24, 2018. Jennifer has accepted the appointment and is honored to serve in the coming year.
James F. McCluskey, ISBA President-Elect, appointed Jennifer Danish to serve as a Member of the ISBA Standing Committee on Disability Law for 2018-2019 on April 24, 2018. Jennifer has accepted the appointment and is honored to serve in the coming year.
James F. McCluskey, ISBA President-Elect, appointed David A. Bryant to serve as a Member of the ISBA Insurance Law Section Council for 2018-2019 on April 24, 2018. David has accepted the appointment and is honored to serve in the coming year.