$113,000 health insurance win. Blue Cross Blue Shield of Illinois denied coverage for client's back surgery--two level artificial disc implantation--as medically unnecessary. Obtained reversal of BCBS's denial decision through external review process. (February 2019).
$14 million settlement. Acted as co-counsel for plaintiff and provided insurance coverage advice in fraternity hazing death case that went to Illinois Supreme Court and eventually settled for $14 million. Bogenberger v. Pi Kappa Alpha, 2018 IL 120951. (November 2018).
ERISA case for health insurance benefits settled for 100% of the benefits owed by UnitedHealthcare, plus 100% of Mr. Nyeste's fee and a penalty for untimely production of the Plan document. (August 2018).
The Illinois Appellate Court, First District, affirmed our $87,160.80 judgment against Direct Auto. Read appellate decision at Robert Gregory v. Direct Auto Ins. Co., 2017 IL App (1st) 163302-U (December 19, 2017). On February 5, 2018, the appellate court tacked on another $11,325.00 against Direct Auto for our attorney's fees on appeal due to Direct Auto's bad faith. With interest, the total amount paid by Direct Auto on my client's claim (which could have been settled for less than $11,500) was $107,426.35.
$650,000 settlement (as jury was about to begin deliberations) for client in breach of contract trial against insurance producer Gerald S. Adelman for Adelman's failure to procure life insurance for client as promised. (October 2017).
$87,160.80 judgment against Direct Auto Insurance Company for failing to cover theft of client's car worth $11,500. Judgment included penalties and attorneys' fees under Illinois bad faith statute for Direct Auto's "vexatious and unreasonable conduct and delay." (November 2016). Read trial court's decision on Direct Auto's bad faith: 2016-10-20 13-M1-120296 Gregory v DAIC opinion and judgment.pdf
$36,410.37 full payment of cash value of annuity where elderly annuitant died six months after mistakenly choosing the life-only pay-out option of $445 per month. (March 2016).
$57,715.98 settlement of claim under legacy (pre-1992) Medicare Supplement policy providing extended coverage for skilled nursing facility care for the the 101st through 365th day of confinement. Settlement includes over $10,000 in attorney's fees. (February 2016).
$371,563.85 settlement with Cincinnati Insurance Company for woodworking company that suffered a computer system crash. Claim was for loss of business income, restoration of electronic data, and loss of accounts receivable. Cincinnati initially offered to pay only $126,255.46. (December 2015).
Court ordered $7,500 sanction against Direct Auto Insurance Company for its "deliberate and pronounced disregard for the discovery process."
$129,256 to life insurance beneficiary from Globe Life and Accident Insurance Co. (full policy proceeds plus interest plus court costs) where Globe represented to beneficiary that life insurance policy had not been issued until after the insured died and that policy never took effect. We filed suit on March 16, 2015, and Globe paid up on May 14, 2015. (May 2015).
For eighteen months United HealthCare refused to pay for client's two surgeries to remove mesh used in two prior hernia repair surgeries. We filed suit on September 17, 2014, and case settled on November 6, 2014 for full payment under the health plan. (November 2014).
Direct Auto Insurance Company denied coverage for client's auto that was totaled in a snow storm accident and falsely accused client of making misrepresentations on his insurance application. Through affidavits from disinterested parties, we showed that client had not made any misrepresentations on application. Direct Auto had to pay full value of client's vehicle plus the registration and license fees for his replacement vehicle.
Replaced client's prior attorney and got nearly two-year old property damage claim settled within a month. Hanover Insurance needed reminding that it was bad faith not to pay portion of claim that was not in dispute. When faced with clear bad faith exposure for penalties and fees, whole matter was soon resolved. (May 2014).
After denying coverage and filing a declaratory judgment action in federal court, Tower Insurance Company paid over $300,000 to resolve claim for property damage to a crane. We filed a counterclaim for bad faith, and Tower agreed to pay 100% of my attorney fees. (March 2014).
After denying coverage, The Medical Protective Company paid its policy limit, $1 million, to resolve a medical malpractice liability claim against my client, an anesthesiology group. (February 2014).
Settlement of claim under legacy (pre-1992) BlueCross BlueShield of Illinois Medicare Supplement policy providing extended coverage for skilled nursing facility care for the the 101st through 365th day of confinement. Such coverage has not been offered since the federal standardization of Medicare Supplement policies in 1992. BlueCross BlueShield issued misleading EOBs stating that the policy did not provide coverage after the patient's Medicare benefits ended (on the 100th day of confinement). Terms of settlement are confidential. (October 2013).
$65,000 settlement from State Farm Fire and Casualty Company for storm damage caused to roof of home. State Farm had denied coverage, contending that this classic Chicago bungalow had been defectively designed and constructed, despite the fact that it withstood 90 years of Chicago weather) until the record storm of July 22, 2011. (September 2013).
Settlement of claim for Applied Behavior Analysis therapy for autistic child under ERISA health plan. Issues included number of hours of therapy and who could be the provider under the terms of the plan. (August 2013).
Auto insurance claim against Mendakota Insurance Company (a/k/a KAI Advantage Auto): Auto insurer denied client's claim for the theft of his auto without providing any reason apart from "certain inconsistencies." We were forced to file suit. On the eve of trial, this substandard company paid the claim in full rather than submitting its claims persons for cross-examination at trial.
Settlement of $959,000 life insurance interpleader action involving four claimants under contested beneficiary designations. (October 2012).
Successfully recovered disability benefits for parking garage car hiker after insurer refused coverage despite client's limited ability to walk or stand. Client suffered from post thrombotic syndrome in left leg, which caused swelling, stiffness, and pain. (October 2012).
$155,000 settlement of claim against insurance broker who failed to provide client with copy of property insurance policy or advise of exclusion for theft. Building under renovation by client was broken into, and copper piping was stolen. Property insurer denied coverage due to the theft exclusion, so client sued broker and recovered from the broker's E&O insurer. (March 2012).
Health insurance company refused coveragve for prostate cancery surgery based on pre-existing condition exclusion, contending that one elevated PSA result demonstrated pre-exising cancer. After we sued, the insurance company paid the full amount of coverage under its health insurance policy, plus a premium for attorney's fees. (September 2011).
Recovered $185,000 against former American Family insurance agent who failed to place insurance coverage on boat that was subsequently stripped.
Defended lawfirm sued for legal malpractice. On March 9, 2011, the plaintiff dismissed his action against our client without any recovery but continued to sue other attorneys involved in the case. (March 2011).
Successfully appealed Hartford's termination of disability benefits for HIV+ client, recovering all back benefits and obtaining reinstatement of full benefits going forward. (January 2011).
Defended manufacturer of roofing products and defeated warranty claim by roofing contractor. Trial court found that problems with roof were due to improper installation rather than product defects. (January 2011).
$545,000 and $80,000 settlements for injuries and loss of consortium under Uninsured Motorist coverage from risk pooling trust of an order of the Catholic Church. (June 2010).
-$4.25 million settlement in insurance coverage action on behalf of injured claimant against Hartford Insurance Company and Fireman’s Fund Insurance Company where the carriers had denied any insurance coverage for the accident. (March 2010).
$170,000 settlement for ERISA disability claimant against Unum Life Insurance Company of America. (October 2009).
$101,000 recovered in disputed life insurance case. (October 2009).
In a health insurance appeal, succeeded in getting coverage for client’s hiatal hernia repair and Roux-en-Y gastric bypass for gastroesophageal reflux disease. (August 2009).
In a health insurance appeal, succeeded in getting coverage for magnetic resonance-guided focused ultrasound ("MRgFUS") treatment of uterine fibroids, a procedure that the insurance companied had denied as experimental. (June 2009).
On behalf of factory owner, successfully sued property insurer for damage to building roof and contents caused by severe storm. (April 2009).
Defended slate roofing supplier and succeeded in getting complaint dismissed. (January 2009).
$374,000 settlement for ERISA disability claimant against Prudential, recovering 100% of client's back benefits plus interest, full attorney's fees, and reinstatement of benefits going forward. (June 2008)
ERISA disability settlement for three years of back disability benefits plus reinstatement of monthly payments for a guaranteed period going forward.
Successfully represented 10 members of a 79-member housing cooperative to dissolve the corporation and for the directors' and officers' illegal, fraudulent, and oppressive acts. Clients have received deeds to their homes and will receive a distribution of the corporate assets. Trial court’s decision affirmed by Illinois Appellate Court in 100-page decision. (January 2007).
Hired specially as appellate counsel and succeeded in getting the appellate court to reverse the dismissal of our client's claim and allow it to go to trial.
$110,000 settlement of residential construction defect claim. (January 2006).
$1.5 million settlement of insurance coverage dispute where insurance company had denied any liability. (2004).
$250,000 judgment on guaranty, affirmed on appeal; was both trial and appellate counsel. (July 2003)
-$625,000 auto accident settlement, partial vision loss. (March 2002).
$537,000 contract judgment for Mexican artist against Chicago gallery
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James T. Nyeste Attorney at Law CoverageLaw.com