Lower Leg Amputee Receives Greater Than Contract Value Payout
More than six years after a motorcycle accident and more than 16 surgeries later, our client had to undergo a lower leg amputation. In the wake of his amputation, the insurance company that he had dutifully paid his premiums for, denied his claim. Michael Horrow and the team of specialists at Donahue & Horrow LLP, were able to quickly secure a settlement for the client for a greater than that stipulated by the policy.
At the time of his accident, our client was insured under an Accidental Death and Disability (“AD&D”) policy that promised him a lump sum if he suffered certain bodily injuries as the result of an accident, including the loss of his leg below the knee.
Even though he no longer worked for the employer that provided the AD&D coverage at the time of the accident, after the amputation surgery, he filed a claim for benefits. However, relying on language in the ERISA plan that said the amputation must occur within 365 days of the accident, the insurance company denied his claim.
Donahue & Horrow LLP filed an ERISA Complaint in Federal Court in Los Angeles, California. The Complaint included allegations that under California’s “process of nature rule” time limitations, like those in the Plan, are disregarded if the insured can show that the loss was part of the natural disease process begun by the accidental injury. As it was clear that the amputation was the result of the accident, the insurance company’s claim decision was in violation of the law.
Once the Complaint was filed and the defendant’s insurance company analyzed Donahue & Horrow LLP’s arguments in favor of the client, the parties very quickly –a short four months after the filing of the lawsuit– reached the favorable settlement.
If you are facing a fight with your private disability insurance company, we are here to help. There are no out-of-pocket expenses for you whatsoever. Call our team today to learn more (877) 664-5407.