Attorneys Dell & Schaefer win benefits for client under a catastrophic illness policy
Author: Attorney Gregory Dell
Our client was diagnosed with renal cell carcinoma of his left kidney in June of 2007. Under the provisions of his catastrophic illness policy, he was paid the lump sum benefit of $50,000 under the policy shortly thereafter. The terms of his policy stated that if he received no treatment for this cancer for at least a year, he could receive additional lump sum benefits if he developed another critical illness, such as a different type of cancer, a heart attack, or a stroke.
Over a year later, in September 2008, our client was diagnosed with renal cell carcinoma of his right kidney. His doctor stated that this diagnosis was a new, separate, primary cancer unrelated to his previous diagnosis of cancer in his left kidney. Accordingly, our client filed for benefits under his critical illness policy due to his new cancer diagnosis.
The insurance company denied coverage for the new diagnosis of cancer in his right kidney. The insurer argued that because our client attended follow-up visits and underwent scans to make sure his left kidney cancer had not recurred following surgery, he was ineligible for additional benefits for renal cell carcinoma under the policy.
Attorneys Dell & Schaefer obtained a copy of the insurance company’s claim file and all of our client’s medical records. An extensive Appeal letter was prepared and the insurance company was given 30 days to reverse their previous denial or a lawsuit would be filed.
After reviewing the Appeal letter prepared by Attorneys Gregory Dell and Robert Kerr, the insurance company reversed their prior denial and agreed to pay the $50,000 policy benefit to our client under a confidential settlement. Additionally, the insurance company agreed to keep the policy in force for any future additional catastrophic illnesses except renal cell carcinoma of the kidneys.
The client retained Dell & Schaefer on a contingency fee basis and he received $30,000 after payment of attorney fees and cost.