Cases Handled by my Practice

Some Cases For Example

Over the years, my litigation practice has centered on a few different subject matters, depending on my clients’ needs and the needs of firm clients:

• After I worked for the US Dept. of Health and Human Services on disability claims appeals, between 1986 and 1989, I developed a practice in insurance denial appeals, especially health care and disability payment denials.
• While with Whitfield & McGann, I worked on many union-management issues for their major clients; and,
• After working again for the federal government (the FDIC, a bank regulator), between 2010 and 2014, I took on cases having to do with bank issues.
• Overlaid on these cases were the “bread and butter” cases of employment discrimination, contract disputes of all types, inheritance disputes, and other common contract and tort civil issues (no criminal matters).

For this page, it is difficult to select from the hundreds of cases I have handled over forty years. Some of the most important and interesting were settled without a final order being entered; others were determined after trial, with or without a written decision. Probably the easiest to “post” are rulings on summary judgment motions (see the handbook!), which terminated the case prior to trial after argument pretty much on the merits of the case. Federal cases are easiest to find, since their web site is better and goes back farther than the Circuit Court of Cook County, though complete records are not available on before 1996.

That said, here are some excerpts from court opinions on a few of my cases over those years, that were either interesting, significant, or simply emotionally appealing given the stakes and the needs of my clients.

Arbitrary and Capricious: Denials of benefits for therapy benefits

The situation has improved, but originally many of the insurer’s decisions had to be shown to be, not merely wrong, but arbitrary and capricious, a particularly difficult standard to meet. Nevertheless, it could be met!

“We conclude that Aetna failed to acknowledge the actual language of the plan provisions and failed to analyze —-‘s speech problems, in light of the medical records, in accordance with those plan provisions. Aetna did not and does not explain why it rejected the opinions of —-‘s medical providers. Aetna also chose not to conduct an independent medical examination. Because Aetna failed to make a rational connection between the evidence, the plan language, and its conclusion to terminate speech therapy benefits, its termination of benefits was arbitrary and capricious.” (101 CV 6064)

This was a case where the insurer discontinued payment for what were plainly covered services. Despite the clarity, they fought the lawsuit to the point of trial, but their own evidence, as the Judge decided, was insufficient to get them to trial.

In a similar case also concerning speech therapy for a child, another Judge concluded:

“Defendants point to no evidence supporting that ——’ s speech training included teaching him or his family about healthful practices and habits. Even if it could be assumed, without any supporting evidence, that some of —’s speech therapy included such instruction, that would, at most, support denying coverage for an allocated portion of the expense. Defendants do not attempt to disallow only a portion and point to no basis in the record for making such an apportionment. Because it is inconsistent with any reasonable interpretation of the plain language of the Medical Plan, a denial of benefits for ——- based on the Educational services exclusion is arbitrary and capricious. …” (04 CV 4649)

In those years, insurance companies routinely stood on the “right” to make more or less unilateral decisions about benefits. (02 C 539) Sometimes bringing the lawsuit was enough (after a bit of struggling) to convince the insurer to reconsider. Now, in many states, a fairer standard than “arbitrary and capricious” prevails, due in part to an energetic plaintiff’s bar forcing the insurers to answer for their denials in court. For example, in Marich v ECA IBEW, 99 CV 1924, the insurer was persuaded to change its interpretation of its plan after we brought a successful challenge on behalf of one of many plan participants.

Stubborn defendants, who refuse to pay as agreed, has been a consistent theme through many areas: employers who refuse to pay according to contract (successful arbitration proceeding, Chicago Bais Din, 2020); banks who fail to honor wire transfers (Federal court, 2021); insurance companies who refuse to pay for water damage caused by water from frozen pipes (Federal court, 2020). But we have also been successful defending clients from unwarranted claims against them (Chicago Bais Din, 2020; Circuit Court of Cook County, 2020, 2021).

Take that problem off your desk, and put it on mine!