Achieved settlement in case involving denial of claim for life insurance benefits premised on misrepresentation and concealment of relevant medical testing. Case was settled following mediation and consideration by both sides of the risks associated with phraseological arguments about the plaintiff's representations.
Plaintiff sued after his medical insurer cancelled his guaranteed renewable individual medical insurance policy. Insurer asserted that the termination was approved by the Department of Insurance because the insurer was no longer in the business of selling medical insurance. Plaintiff claimed the insurance could only be cancelled due to non-payment of premium or death, and he was left without comparable insurance and was seriously ill.
Plaintiffs sued their homeowners insurance carrier for breach of contract, bad faith, and unfair business practices, alleging that their insurer failed to pay the full cost of demolition and restoration of the house to its original condition, after their home was contaminated with fiberglass that was dispersed throughout the house by the HVAC system. The insurance company contends that it paid to replace the HVAC system, remove and store the contents of the home, for plaintiffs' living expenses when they were out of their home and to clean the home multiple times. Plaintiffs assert that the cleanings were unsuccessful and that it was necessary to demolish the interior down to the studs in order to get rid of the fiberglass contamination and then rebuild the interior of the home. The insurer claims that was unnecessary and that the cleanings removed the fiberglass from the home.
Plaintiff's primary insurer and his excess insurer settled an underlying lawsuit in which Plaintiff was sued for allegedly negligently maintaining and operating and elder care facility. The primary insurer claimed that it paid itsd policy limits, and the exces insurer took the position that the primary policy limits were double the amount paid by the primary insurer and therefore the excess insurer was not required to contribute to the settlement. Both the excess insurer and the insured paid the same amount in excess of the amount paid by the primary insurer to settle the case. The insured then brought this lawsuit for breach of contract and bad faith to recover the amount paid by the insured in the underlying settlement and punitive damages and attorneys' fees. The excess insurer claimed that the primary policies were not exhausted and that it made a voluntary payment to resolve the lawsuit and did not act in bad faith.
Plaintiff sued her homeowner's insurer for reach of contract and bad faith, alleging that her insurer failed to properly investigate and adjust her claim for water damage from a broken pipe and failed to have her possessions packed out and stored so that remediation and repairs could be done. The insurer asserted that it had paid all benefits due and owing, that PLaintiff fired the company that was hired to pack out her possessions, and that she failed to mitigate her damages.
Insured widow of the named insured claimed per accident policy limits of $500,000 under under-insured motorist coverage provision of her husband's auto policy. The widow claimed loss of consorrtium as well as damages for wrongful death, lost earnings, and other unpaid expenses incurred as a result of the bodily injury to her husband. The insured was severely injured when struck by a vehicle driven by a minor who was under-insured. Insured was working on location as an Art Director at the time of the accident. The insurer claimed that the per person limit of $250,000 applies and that offsets for payments by the third-party driver's insurer and workers compensation offsets exceeded the $250,000 per person policy limit and that no benefits are payable. The insured later went back to work in a new job and died of a heart attack shortly thereafter.
This was a pre-lawsuit mediation regarding a claim for extra-contractual damages under a landlord protection policy. The insured property was severely damaged by fire, and the initial repair estimate was for a fraction of the actual cost of abatement, demolition, and repair of the premises. Although the insurer ultimately paid the policy limits for the property and for alternative living expense ( loss rent from the tenants), the insurer did not agree to pay the policy limits until more than 6 months after the fire. This delay alegedly resulted in substantial expense to the landlord, including engineering expenses, permit expenses, the cost of hiring a public adjuster, and lost rent beyond the term covered by the policy. The insurer asserted that the delay was due to a third party vendor who failed to perform its job in a timely manner.
Plaintiff sued his former health insurer to recover benefits for his son's stay at a residential care facility for treatment of his mental illness. Anthem and the Pan denied Plaintiff's claims on the grounds that the treatment was not medially necessary, and the proper level of treatment would have been an intensivre outpatient program or a partial hospitalization program.
Plaintiff sued his ERISA-governed employee benefit plan and the insurer that administered the plan to recover benefits and for breach of fiduciary duty as a result of the denial of Plaintiff's claim for residential treatment for mental illness for his 16 year-old son. The claim was denied for lack of medical necessity, and defendants contended that a lower level of treatment such as partial hospitalization was the appropriate treatment for the son.
Plaintiff sued her disability insurer for wrongfully terminating her disability benefits after paying her one year of short term disability and 14 months of long term disability benefits. Plaintiff claimed her back condition had worsened and she was totally disabled from performing her own occupation or any occupation for which she was reasonably suited by education, training, and experience because she can only sit or stand for brief periods of time and is in constant pain. Her treating physicians stated that she was totally disabled, but several consultants retained by defendant insurer said the objective findings did not support her claim that she was totally disabled and tthat she was able to perform the material duties of her occupation.
Plaintiffs sued their property insurance carrier after the home they purchased was vandalized. When they purchased the property, it was occupied by a tenant who did not allow them access. They relied on a visual inspection report by the seller's agent and waived any other conditions. When the tenant refused to vacate the premises, they filed an unlawful detainer action, which was delayed for almost 2 years due to COVID and various cross-claims by the tenant. When the tenant finally did vacate the premises, they entered the home and found that windows, doors, tubs, sinks, plumbing, and electrical wiring had been removed or vandalized. Defendant insurer paid the amount the insurer determined was covered but denied the remaining claims on the ground that the damages were present at the inception of the policy or were due to normal wear and tear. Because the Plaintiff's determined that the property was uninhabitable, they had it demolished and built two new townhomes on the property. Defendant insurer moved to discuss the action based on spoliation of evidence due to the destruction of the original dwelling that they had insured.
Plaintiffs sued defendant insurer for breach of contract and bad faith after the insurer denied plaintiffs' claim for accidental death benefits. Plaintiffs were the beneficiaries of an accidental death policy insuring their grandmother. The insured grandmother died, and plaintiffs claimed that she may have choked. Defendant insurer asserted that the medical records, death certificate, and paramedic reports indicated that death was due to natural causes and various underlying sicknesses, and not an accident. The insurer claimed there was no evidence of choking.
Plaintiff’s wife purchased a $500,000 life insurance policy and represented on the application that she had not smoked cigarettes during the 24 months before the application. She did not disclose that she had been treated for gestational diabetes. She died suddenly at the age of 38, leaving behind her husband (the beneficiary) and two young children. The insurance company denied her husband’s claim for the life insurance benefits and rescinded the policy, claiming that the insured misrepresented her smoking history and her medical history in her application. Plaintiff sued for breach of contract and bad faith.
Plaintiffs sued their former homeowner's insurance company seeking coverage for claims against them by the buyer of their home for negligence, negligent non-disclosure, and breach of contract for failure to disclose numerous water leaks and unsuccessful attempts to repair the leaks. The insurer denied coverage, and the buyer obtained an arbitration award against the sellers. The sellers sued their former insurer for breach of the duty to defend, breach of the duty to indemnify, and bad faith.
Plaintiff Estate sued for fraud, conspiracy to defraud, financial elder abuse, violation of Insurance Code section 785, and violation of Business and Professions Code section 17200, in connection with an alleged schedule to sell annuities to a senior, and assist him in transferring assets to a trust in order to become eligible for Veterans Aid and Attendance benefits. The Veterans Administration later determined that the decedent was ineligible for the benefits and filed a claim against the estate for all benefits paid.
Plaintiff sued to recover benefits under an accidental death policy insuring her daughter. Her daughter died of a pulmonary embolism shortly after she collapsed while getting off a plane in Taipei after a 14-hour flight. Plaintiff claimed that her death was a covered accident. Defendant insurance company denied the claim on the basis that there was no accident and the death resulted from a sickness or disease, which was excluded from coverage. Plaintiff also sued bad faith and financial elder abuse.
Outpatient surgical center sued health insurer for alleged underpayment of claims under ERISA. Insurer asserted various defenses, including statue of limitations, failure to exhaust administrative remedies under ERISA, lack of standing due to anti-assignment provisions in health plans, and that all benefits due under the contracts were paid.
Insurance bad faith lawsuit for denial of long term disability benefits, failure to reasonably accommodate plaintiff employee in a new position, and wrongful termination.
Insurance bad faith termination of long term disability benefits based on the mental illness limitation in a long term disability policy and dispute over whether the disability was a mental or physical illness.
Bad faith lawsuit for improper offsets of Social Security benefits against long term disability benefits and denial of short term disability benefits.
Insurance coverage dispute over claim for water intrusion that allegedly occurred during high winds and a rain storm at a sound stage and post production studio including whether policy exclusions for defective maintenance, age-related deterioration, wear and tear, and failure to mitigate damages barred coverage under the Policy.
Claim for bad faith denial of long term care benefits and financial elder abuse arising from the denial of a claim for benefits under a long term care policy where the issue was whether the claimant satisfied the policy definition of a “Chronically Ill Individual.”
Insurance bad faith action for denial of claim for property damage to rental property from vandalism.
Interpleader action regarding a dispute between the insured’s children and the insured’s spouse (the children’s stepfather) over entitlement to life insurance benefits.
Suit to recover additional retirement benefits under a retiree supplemental health plan.