The Edwardsville law firm of Goldenberg, Heller & Antognoli, P.C. recently obtained a $1.2 million judgment on behalf of a young woman paralyzed in a car accident.
The judgment is against an employer-sponsored health care plan known as the M Class Mining Health Protection Plan that was accused of refusing to pay for the injured woman’s medical treatment. David Antognoli was lead counsel for Goldenberg Heller & Antognoli, P.C.
Dennis R. Ruth, circuit judge in the 3rd Judicial Circuit in Madison County, presided over the case and awarded benefits due for medical expenses, prejudgment interest, court costs and attorney fees. In addition, the court ordered the plan to stop using an “illegal activity” coverage exclusion to deny benefits for future medical treatment related to the car accident.
The plaintiff, who at the time was a 17 year-old high school honors student in Franklin County, Ill., sustained serious injuries in the car accident that occurred while she was on her way to school in February 2016. The accident left her paralyzed from the waist down and she continues to suffer complications requiring additional treatment.
The plan was established in accordance with the Employee Retirement Income Security Act (ERISA), a federal law that sets minimum standards for pension and health plans in private industry to provide protection for individuals. The plaintiff is a beneficiary of the plan as a result of her father’s employment with the coal company that sponsors the plan.
Following the accident, the plan denied payment for any medical expenses, claiming the plaintiff did not have automobile liability insurance when the accident occurred. According to the plan, her alleged failure to carry this insurance coverage was an “illegal activity” that disqualified her from receiving any medical benefits. Under Illinois law, a driver is required to carry liability insurance coverage to compensate others if the driver causes injury to someone else.
The plaintiff argued, among other things, that the exclusion did not apply because the alleged “illegal activity” had nothing to do with the accident or the plaintiff’s injuries. The court agreed and ruled that the plan wrongfully denied claims submitted in connection with injuries sustained in the plaintiff’s car accident.
The ruling is being appealed.
“We are thankful that Judge Ruth reversed the denial of benefits. Our client and her family have suffered a tremendous tragedy and the plan’s refusal to pay the medical bills has not only added insult to injury but also impaired our client’s physical and emotional recovery,” said Antognoli, partner in the law firm of Goldenberg, Heller & Antognoli. “The way the plan tried to use the ‘illegal activity’ exclusion was absurd and amounted to nothing more than a pretext to avoid its obligations.”
Goldenberg Heller & Antognoli is based in Edwardsville and serves clients in Illinois and Missouri.