Articles Posted in Insurance Claims

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In the wrongful death case for Lee Lindemann, filed on behalf of the Estate of Sue Ann Lindemann, the U.S. District Court ruled that estoppel blocked National Fire & Marine Insurance Co. from invoking a “declining balance” provision in its insurance policy. This was done to reduce its $1 million liability limit to $600,000, by subtracting the $400,000 National paid to the defense expenses during the two years of litigation.

National’s policy covered Dr. Erick Falconer in this wrongful death case and another defendant, Western Healthcare. In May 2013, the answer that Falconer’s attorney submitted to “Interrogatory 9,” said he was insured under a National policy that had a $1 million liability limit.

But when responding to her request for a copy of the insurance policy, Dr. Falconer’s attorneys reportedly took a shortcut: they referred back to this interrogatory answer. This maneuver meant the litigants didn’t see the policy provision that ordinarily would have reduced the liability limit by the amount of defense expenditures.

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Blinderman Construction Co. was hired by the Public Building Commission of Chicago to be the general contractor for a construction project at an elementary school. Blinderman hired JM Polcurr Inc. as a subcontractor to do the electrical work on the project.

Following the contract, Polcurr purchased an insurance policy that named Blinderman as the additional insured from Hastings Mutual Insurance Co.

On July 19, 2011, Robert Woods, an employee of Polcurr, fell from a ladder while working at the school. He was rushed to a hospital; unfortunately he did not regain consciousness until a month later. He has not been able to work since that time due to his injuries.

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The plaintiffs in this case filed a complaint against the defendant insurance company, United Equitable Insurance Co., alleging breach of contract in bad faith when United Equitable would not pay the plaintiffs’ claims from an auto accident involving an uninsured motorist.

The plaintiffs filed a motion for summary judgment, which the trial judge granted. On appeal, United Equitable argued that the court erred because the policy required plaintiffs to unequivocally demand arbitration and appoint an arbitrator within two years of the incident, which plaintiffs did not do.

The appeals panel stated that the court erred in granting plaintiffs’ motion. The arbitration provision in the insurance policy stated that disagreements concerning uninsured motorist coverage and damages “shall be submitted to arbitration” within two years. A party sufficiently commences arbitration if the request for arbitration is unequivocal and made according to the terms of the policy.

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Forrest Buchtel, 74, was riding his bike southbound on Sherman Avenue in Evanston, Ill.  He stopped for a stop sign at Greenleaf Street, which is a four-way stop intersection and then began peddling his bike into the intersection when he was hit by an eastbound car driven by the defendant, Jason Whitaker.

Buchtel testified that he saw the Whitaker SUV about one-half block away as he peddled through the intersection and observed that Whitaker was not looking at the road ahead while talking to a woman in the front passenger seat.  Whitaker ran the stop sign.

The impact between the SUV driven by Whitaker and Buchtel on his bike, knocked him onto the hood of the SUV and then onto the pavement of the street.

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In this case, the quarrel was over setoffs for settlements that totaled $395,000 paid by two under-insured motorists who were claimed to have caused a crash that seriously injured Erin Tufano. Tufano was insured under an Illinois Emcasco Insurance Co. policy that provided $500,000 in under-insured motorist coverage (UIM).  A Cook County judge agreed with the insurance company’s argument that it owed only $105,000 based on the policy’s plain language.

The two insurance companies that insured the tortfeasors offered their policy limits ($100,000 and $295,000).  The Emcasco policy said the limit of liability for the UIM coverage “shall be reduced by all sums paid because of the ‘bodily injury’ by or on behalf of persons or organizations who may be legally responsible.”

By arguing that “all sums paid” provision of the insurance policy, Emcasco persuaded the trial judge that Tufano was entitled to receive only $105,000 in UIM benefits (a single $500,000 – $395,000).

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Vanity Mack was injured in 2010 and submitted an under-insured motorist claim to Allstate Insurance Co. In addition to the claim, Mack filed a demand for arbitration under the rules of the Federal Arbitration Act.

In December 2010, Allstate informed Mack that she was required to execute the Health Insurance Portability and Accountability Act (HIPAA) authorizations as well as appear for an oral examination under oath.

These requirements were covered under Allstate’s insurance policy. Mack did not complete the HIPAA authorizations, and she did not appear for her oral examination despite multiple requests for her to do so. Continue reading

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The Illinois Appellate Court for the Third District has held that persons with claims against a corporation dissolved for more than 5 years could not recover against the corporation’s liability insurers.

In this case, defendant insurers included Employers Insurance Co. of Wausau, TIG Insurance Co. and Travelers Casualty and Surety Co.  The claimants were numerous individuals who were former employees of Sprinkmann Sons Corp. of Illinois who were diagnosed with mesothelioma and lung cancer.  The claimants brought a lawsuit against the former Sprinkmann company, its previous owners and its liability insurers in 2011.

The former Sprinkmann company, however, had been dissolved in 2003 with certain of its assets having been sold to a new corporation, Sprinkmann Insulation Inc.  The new Sprinkmann company did not acquire any liabilities or insurance policies of the older dissolved Sprinkmann company.

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Toni Dugan was insured by Nationwide Insurance Co. She was involved in an automobile accident with Chelsea Rainey who was insured by American Family Insurance Co. Rainey’s policy had a $100,000 limit, which American Family paid to Dugan and her husband, James.

The Dugans’ damages exceeded $200,000, and they made a claim under their own underinsurance motorist coverage through Nationwide. The Dugans’ claim against Nationwide sought $400,000 less American Family’s $100,000 payment. Based on the underinsured motorist coverage (UIM), the Dugans claimed coverage for 4 automobiles. The premium was charged on each of the four cars for UIM coverage of $100,000 per person and $300,000 per occurrence.

Nationwide denied coverage, contending its policy prohibited stacking of UIM coverage and filed a complaint for declaratory judgment. The parties filed cross-motions for summary judgment and the U.S. District Court judge of the Southern District of Illinois granted Nationwide’s motion finding that stacking was prohibited.

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The Illinois Appellate Court for the First District has held that an insurer had a duty to defend an additional insured who was entitled under the policy of insurance to coverage because of vicarious liability even though the underlying complaint against it included no allegations of vicarious liability. CSR Roofing Contractors was the general roofing contractor for a construction project in Lisle, Ill. It hired a subcontractor, Zamastil Exteriors, to perform a portion of the work in accordance with a master subcontract agreement.

The subcontract agreement required Zamastil to obtain additional insurance coverage for CSR that was not limited to vicarious liability. Vicarious liability is a term based on the principles of agency. In accident cases like this, the negligence of an employee or independent contractor can be imputed to the person’s employer when acting within the scope of employment. The legal doctrine of vicarious liability would make an employer liable for the acts of its employee. In other words, if the person is acting on behalf of the employer or master, the employer or the master can be held responsible for negligence caused by that employee.

The agreement between Zamastil and CSR provided that both CSR and Zamastil were responsible for complying with all federal safety regulations.

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On July 26, 2011, Lashaunda Carter was driving her car when she was involved in a crash with an uninsured motorist, Cortez Williams. Jasmine Carter was in Carter’s car and was injured as a result of the collision. Lashaunda was insured by American Access Insurance Co. Lashaunda’s insurance policy covered any compensatory damages Lashaunda would have to pay arising from bodily injury caused by her in an auto accident.

Under the terms of the insurance policy, American Access “shall defend any civil suit alleging such bodily injury.” The auto policy also required Lashaunda to give American Access written notice of any accident or loss as well as any filings in a lawsuit brought against her.

The policy stated that American Access would “not be obligated to pay . . . unless [American Access] received actual notice of a lawsuit before judgment had been entered in said suit.”

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