Woman sues insurance broker after heart attack hospitalization denied

Steve Gonzalez May 21, 2008, 6:23am

A woman denied insurance coverage filed suit against an insurance broker in Madison County Circuit Court May 15, alleging negligent misrepresentation, fraudulent misrepresentation and violations of the Consumer Fraud and Deceptive Business Practices Act.

Linda Medlin claims she approached defendant James Lynch to buy health insurance in January 2006.

She claims she filled out an information sheet and was concerned she would not get coverage as she had to disclose taking medications for high cholesterol and high blood pressure and consequently relayed those concerns to Lynch.

Medlin also claims that she disclosed an angioplasty procedure in 1997 and claims Lynch informed her she would be eligible for coverage despite her disclosed health problems in 1997 because the "look back period" for Federated Health Insurance was only five years.

According to Medlin, Lynch also informed her that the medications she was currently taking would not hinder her efforts to obtain coverage or deny her coverage in the event a claim was made.

"In reliance on these representations, the Plaintiff purchased a Federated health insurance policy from the Defendant Policy #5753 effective date February 1, 2006, no listed exclusions," the complaint states.

According to the complaint, Medlin had a heart attack in July 2006 and Federated Insurance Company denied coverage for the treatment of the heart attack stating that she was on medication for a pre-existing heart condition.

Medlin claims Lynch has a duty to exercise reasonable care in representing to her that the medication she was on would not be a cause of denial in coverage or policy benefits in the event she had to make a claim against her insurance policy.

She also claims at the time she purchased the policy Lynch knew or should have known that her medications would negatively affect her ability to make a claim against the insurance policy he advised her to purchase.

"Defendant James Lynch never informed the Plaintiff that her medications would be considered a pre-existing heart condition," the complaint states.

Medlin claims she reasonably relied upon Lynch's representations in her decision to purchase the insurance policy and had she known the medications would cause a claim denial she never would have purchased the policy in the first place.

"By negligently concealing the fact that the insurance policy would not cover the Plaintiff in the event of a heart attack or other serious injury or illnesses, Defendant James Lynch, made the equivalent of a false statement of material fact," the complaint states.

She also claims Lynch represented that the insurance would provide coverage in the event of a heart attack or other serious injury or illness, which violated the Illinois Consumer Fraud and Deceptive Business Practices Act.

According to Medlin, she has been injured in that she has incurred more than $80,000 in medical bills that have not been paid and has also incurred the expense of legal proceedings, attorney's fees and other associated costs.

Represented by Paul Evans and Trenton Galetti of the Evans Law Firm in O'Fallon, Medlin is seeking damages in excess of $150,000, plus costs of the suit.

The case has been assigned to Circuit Judge Barbara Crowder.

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