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Partial Cause v. Sole Cause: Why your insurance company can’t shift the burden to you

January 9, 2017 by Levinson and Stefani Leave a Comment

Questionnaire

Imagine going out to play a game of basketball with your crew. In the heat of the game you tear your Achilles tendon. You’re in pain, but you can rest knowing that your insurance will cover the surgery.

Six days later you have a routine and “uneventful” surgery to repair the tendon and you’re discharged on the same day. However, a couple of weeks later, and after a follow-up with your doctor, you collapse at work, go into cardiopulmonary arrest, and die.

The representative, and beneficiary, of your estate files a claim with your insurance company that purports to provide accidental death and dismemberment coverage for the company’s employees, in the amount of $92,000. However, they deny the claim because your late spouse’s coverage is limited to “bodily injuries. . . that result directly from an accident and independently of all other causes.” The insurance company argues that the basketball player’s death was not the exclusive result of the accident, but additional complications at surgery caused the death. Your representative sues the insurance company on a causation theory—but if not for the Achilles tendon accident, that required surgery, your spouse would not have died.

In a recent case, the 7th U.S. Circuit Court of Appeals was faced with this exact scenario. The lower court ruled in favor of the insurance company, but the 7th Circuit panel was not convinced that that was the right outcome. Judge Posner, writing for the court, explained that the evidence suggesting that the basketball player’s death was caused by a blood clot was inconclusive—it did not show that the blood clot was an independent cause, but merely a partial cause of the ball players death. The court focused on the chain of events that led to the ball player’s death. It concluded that the blood clot was “partial because the accident had to have played a role; no accident, no surgery or immobilization, hence no deep vein thrombosis or pulmonary embolism (blood clot).”

The court struck down the insurer’s arguments that the beneficiary had to prove that no other events played a role, and that the company had the “discretion to decide what evidence was sufficient to demonstrate a disability.” The court wrote that such burden of proof and discretion is illusory because it would give the insurance company unchecked carte blanche to decide whether to honor its contract.

Because the insurance company failed to make any plausible showing that the surgery, rather than the accident that necessitated the surgery, caused the basketball players death, the 7th Circuit Court of Appeals held that the judgment should have been in favor of the plaintiff beneficiary.

Heeding the fine print: Belot v. LTF Club Operations Co., Inc

January 6, 2017 by Levinson and Stefani Leave a Comment

On January 1st, many anxious and determined individuals stepped into health clubs across Illinois to embark on one of the most common New Year’s Resolutions—lose weight and get in-shape. Several clubs will market the opportunity for business by giving away free day or week guest passes to a potential new comer and/or repeat customers. However, before you step-foot into one of these big-box sweat machines to redeem your free guest pass, take a moment to read the fine print; and do not deviate from its instruction(s).

Four months ago, a district court judge ruled that the plaintiff (gym guest) was legally a trespasser when he tripped over some cables and injured himself at Life Time Fitness Club in an Illinois Suburb and, therefore, could not hold the defendant-company liable. Mr. Belot, the plaintiff, went into a local Lifetime Fitness to check out the facility. He waited to be greeted at the front desk, but no one was there. He decided to take a self-guided tour and in doing so tripped over a few cords while trying to test an elliptical machine.

The court emphasized that one’s status as an invitee can changed if he or she fails to satisfy any condition set forth in the invitation. The court conceded that the “[p]laintiff was arguably an invitee when he entered the gym: he received a guest pass in the mail, which was an express invitation, and the purpose of that invitation was ultimately to enroll him as a gym member, which is directly related to Defendants’ business.” However, the court continued its analysis and explained that “invitees may nonetheless lose their status and become trespassers when, after being invited onto the premises, they go to an area beyond the scope of an invitation or otherwise deviate from conditions of that invitation.”

The court held that Mr. Belot went beyond the scope of the guest pass when he ignored a clause in the invitation that required all guests to present a photo ID and take a membership tour. Therefore, he could not hold Life Time Fitness liable for the injuries he sustained while on his exploration of the facility.

I’ve never been in a bike crash. What do I do?

October 4, 2016 by Levinson and Stefani Leave a Comment

Jay tells cyclists how to protect their rights in the event of a bike crash.

Video: Lawyer no-nos from Chicago judges

June 6, 2016 by Levinson and Stefani Leave a Comment

Ever wonder what not to do in the courtroom? We went straight to the source to find out.

Book Review: Mark Mandell’s Case Framing

May 24, 2016 by Levinson and Stefani Leave a Comment

Every case has its details. That part’s obvious. What’s not obvious is how we choose to frame them. In every instance there’s a new set of facts, data and jurors. For every piece of valuable information, there are a plethora of details that prove superfluous. The challenge for trial lawyers is to pinpoint what works and what doesn’t. Even then, there’s more work to be done, and it’s generally with the intention of one thing: getting the jury to see your side of the story.

Click here to read the full article

The story of crash victim Douglas Balder

April 28, 2016 by Levinson and Stefani Leave a Comment

The Huffington Post caught up with Balder as part of an investigation that chronicles how Congress is caving to trucking lobbyists, who want to deregulate safety laws. Here’s his story in under one minute.

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