Articles Posted in Insurance Claims

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In 2006, Kipling Development Corp. was building a home in Will County, Ill. Kipling was the general contractor on the job.  The firm hired subcontractors to handle specific pieces of the job, including Speed-Drywall and United Floor Covering.

A service technician, Brian Harwell, entered the worksite to replace a furnace filter, using the stairs leading to the first floor to the basement. In the process, the stairs collapsed beneath Harwell, sending him falling into the basement. He sustained serious injuries and filed a lawsuit against Kipling as the general contractor of the building site.

In the lawsuit, it was alleged that Kipling was negligent in choosing not to properly supervise and direct construction and failing to furnish Harwell with a safe workplace and a safe stairway. In addition, Harwell also sued Speed-Drywall and United Floor Covering, claiming that they had modified or failed to secure the stairwell.

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The United States Court of Appeals for the Seventh Circuit in Chicago has affirmed in part and reversed in part the district court’s decision regarding a third-party lawsuit.

Sam Chee was driving with his wife, Toni Chee, in August 2010 when their car slammed into a tree. Toni was seriously injured and taken to a hospital where she died within a week. The estate of Toni Chee filed two lawsuits. One was against Sam Chee for negligent driving and another was against the hospital and the attending physicians claiming medical negligence was a cause of Toni’s death.

The defendants in the medical malpractice claim filed a third-party action against Sam Chee, seeking contribution or other compensation from him should the medical defendants be held liable to the estate.

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On April 7, 2010, Jeffrey and Stephanie Hadary were involved in an automobile crash with Carlos Velez. Velez was driving a car owned by Hertz Corp.  Both the Hadarys and Velez were insured; the Hadarys had insurance through Safeway Insurance Co. They paid a monthly premium of $57. The Hadarys’ policy included underinsured motorist coverage up to $100,000 per person or $300,000 per occurrence.

Velez did not carry insurance through Hertz, but was insured through American Access Casualty Co. for a maximum of $20,000 per person or $40,000 per occurrence.

In line with Illinois law, Hertz was required to insure the operator of its rented cars at a minimum of $50,000 per person or $100,000 per incident. The Hadarys recovered $40,000 from American Access as Velez’s insurer, but this amount did not cover their extensive injuries from this incident.

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The Illinois Supreme Court has overturned the Illinois Appellate Court decision regarding the cap on self-insured rental car companies. The Supreme Court reversed a $600,000 judgment against Enterprise Rent-A-Car’s Chicago area’s subsidiary.

The Supreme Court ruled that self-insured rental car companies are liable for a maximum of $100,000 toward all injured parties in a rental car crash.

The decision of the Supreme Court was unanimous. In 2007, a crash in which an Enterprise vehicle was involved, injured at least two individuals. Enterprise paid $75,000 to two of the people involved in the crash. Enterprise argued that it had responsibility  to pay only an additional $25,000 allowed under the cap to the plaintiff.

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Scot Vandenberg and his wife maintained that their allegations in an unfiled tort complaint triggered insurance coverage for an accident that injured Scot, paralyzing him during a party he attended on a 75-foot yacht.

Scot was severely injured when he fell off a bench at the edge of a top deck of the yacht to a lower deck. The original complaint he filed against the companies that owned and maintained the yacht (along with several corporate officers) alleged that the defendants were negligent because there was no railing on the upper level of the yacht.

Two of the defendants sued in this case were insured by Maryland Casualty under a policy that excluded coverage for bodily injury claims involving the ownership, maintenance or use of a watercraft.

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Daniel Orr died in a motorcycle accident in August 2012. His beneficiaries, who were his daughters, Hailey and Daniell, filed claims seeking benefits payable under a group life insurance policy governed by ERISA. The insurance policy was issued by Union Security Insurance Co. to Orr’s former employer.

The policy provided accidental death and dismemberment benefits to a participant and his or her beneficiaries, subject to certain exclusions, including exclusion on a loss resulting directly or indirectly from intoxication.

In December 2012, Union Security notified the Orr daughters that it had denied their claims on the ground that Orr’s death resulted from his intoxication. The notification explained that autopsy and toxicology reports showed that Orr’s blood alcohol level at the time of the accident was above the legal limit.

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The plaintiff Shrempf, Kelly, Napp & Darr, Ltd. was granted summary judgment by the Circuit Court of Madison County for attorney fees and costs they claimed were due pursuant to the Illinois Common Fund Doctrine. The defendants, the Carpenters’ Health and Welfare Trust Fund and the trustees of the Carpenters’ Health and Welfare Trust Fund of St. Louis, appealed.

On May 4, 2006, James Corey Miller was injured when he fell from a ladder. Miller was a participant in the defendants’ Plan. The Plan is a self-funded, multi-employer, Employee Welfare Benefit Plan subject to the provisions of the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. §1001, et seq. (ERISA).

The defendants became aware that Miller’s injuries were “sustained due to the act or omission of a third-party when Miller applied for disability benefits because he was no longer able to work.” As part of Miller’s benefit coverage, the Plan was “not obligated to pay any benefits” for an injury or sickness where “a third-party [was] legally liable to make payment or does make payment.”

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In August 2005, Trustgard Insurance Co. and G.A. Crandall & Co. came to an agreement that allowed Crandall to sell certain types of Trustgard insurance. The terms of the agreement specified that as a condition precedent to any lawsuit, the dispute must be first submitted to arbitration.

The parties’ agreement specified that the demand for arbitration must be made within one year of the dispute and that failure to make the demand on time, in writing and in a specified time period, would result in a waiver of any claim centered on the dispute.

In 2008, Richard Lombardi insured his 1995 Dodge with Trustgard automobile insurance purchased through Crandall. Lombardi’s policy had a limit of $100,000 in coverage for each accident.

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The Illinois Supreme Court has reversed the Illinois Appellate Court in a case centering on an application for legal malpractice insurance. In this case, one of the partners of the law firm of Tuzzolino and Terpinas (T&T) filled out a renewal form for legal malpractice with ISBA Mutual for himself and for the firm. In the application, he was asked whether there were any circumstances that would give rise to an unreported legal malpractice claim. The attorney who filled out the form answered “no.” In fact, a legal malpractice claim had already been brought against one of the firm’s attorneys, Mr. Tuzzolino, but was not yet reported to the firm’s

insurer.

The attorney who filled out the form, Mr. Terpinas, did not sign his name to the form. He claimed to have become aware of the claim against Mr. Tuzzolino about a month later and then reported the claim to ISBA Mutual.

As ISBA was then on notice of the claim and the errant application form, it filed a lawsuit for rescission of the insurance policy in March 2009. There were cross-motions for summary judgment filed and the trial court granted ISBA’s motion for summary judgment. The trial judge found that ISBA was entitled to rescission of the policy in its entirety and that it had no duty to defend Terpinas or the law firm because of the errantly completed form.

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The Illinois Appellate Court has affirmed a Cook County trial judge’s order regarding the effect of an attorney’s lien notice sent to a defendant’s attorneys rather than the defendant directly.

Randy Brown was the owner and operator of a Harold’s Chicken Shack in suburban Broadview, Ill., until Jan. 15, 2009. On that date, the building’s roof collapsed, and the restaurant was destroyed.

The building was leased to Brown by Tap Investment LLC. It was managed by Universal Realty Group. Tap and Universal were defendants in this case. Brown sued both companies and their principals. His lawsuit was filed on Aug. 2, 2010, and the complaint was signed by a lawyer with the law firm representing Brown. The law firm was based in Naperville, Ill.

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