Woman claims insurer wrongfully denied policy's disability benefits

Kelly Holleran May 14, 2009, 6:13am

An Illinois woman has filed suit against an insurance company, alleging the company wrongfully denied her claim for disability benefits.

Nancy Stachewicz says she purchased a group disability policy from National Union Fire Insurance Company of Pittsburgh in 2004.

Stachewicz became aware of the policy after a telemarketer called her in May 2004 and informed her the policy was available to Citicorp card holders, according to the complaint filed May 8 in Madison County Circuit Court.

After a 60-day premium-free trial period, Stachewicz decided to purchase the policy for $21.90 per month, the suit states.

Four years later, on May 9, 2008, Stachewicz was involved in an automobile accident and is permanently unable to perform duties of any occupation for which she is qualified, according to court documents.

Since the accident, Stachewicz claims she has been under the supervision of a physician and has reached her maximum point of recovery.

Believing she was eligible for disability benefits, Stachewicz notified National Union of her accident and submitted a proof of loss seeking disability benefits on July 28, the complaint says.

However, National Union sent Stachewicz a letter dated Oct. 20, denying her claim for disability, according to court records.

In the letter, National Union told Stachewicz she would only be qualified for disability benefits if she lost two of her four hands and feet, suffered a complete paralysis of two limbs or became completely blind.

But Stachewicz contends she is eligible for disability benefits under the description of coverage she was sent after she signed up for the policy.

Of three definitions of total disability, one reads that a person becomes disabled when "the Insured is under the supervision of a Physician unless the injured person has reached his or her maximum point of recovery."

The definition means that Stachewicz should receive disability benefits, she says.

"Grammatically, defining the term 'disabled/total permanent disability' with the use of the term 'any of the following' followed immediately by a colon followed immediately by a series of three consecutively-numbered options means that an insured who satisfies any one or more of the three consecutively-numbered options meets the disabled/total permanent disability," the suit states.

Stachewicz has asked National Union multiple times to send her a copy of the master policy, but the insurance company has failed to do so, according to the complaint.

National Union is guilty of breach of contract, a bad faith denial and consumer fraud, the complaint says.

In the four-count suit, Stachewicz is asking the court to declare that a loss of two of four hands and feet or complete paralysis of two limbs or complete blindness or permanent inability to perform the material and substantial duties of any occupation for which the insured is qualified is not a necessary condition to receiving total disability benefits and that National Union be stopped from imposing the conditions as necessary for disability benefits. She is also asking the court to declare her entitled to permanent disability because she is unable to perform duties of the occupation for which she is qualified and because she has been under the care of a physician.

In addition, Stachewicz is seeking unspecified compensatory and punitive damages, attorneys' fees, court costs, pre- and post-judgment interest and other relief to which she may be entitled.

She is represented by Kenneth J. Brennan and John Bruegger of The Kenneth Brennan Law Firm.

Madison County Circuit Court case number: 09-L-483.

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