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Judges rule on pre-existing condition case

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Highlighting the highly controversial health care debate that’s played out during the past year, the 7th Circuit Court of Appeals today ruled on a pretty straightforward case about a pre-existing condition clause that denied a man’s claim for long-term disability benefits.

Judge Terry Evans wrote for the unanimous panel, affirming a decision from Judge Larry McKinney in the Southern District of Indiana that had rejected the man’s Employment Retirement Income Security Act suit and granted summary judgment in favor of the employer. The case is The Estate of Norman Blanco, by its personal representative Steven C. Blanco v. Prudential Insurance Company Of America, Pruvalue Insurance Benefits Trust, and Porsche Engineering Services Inc., No. 08-2074.

“The phrase ‘preexisting condition’ was frequently in the news as efforts to enact national health care reform were debated over the last year,” Judge Evans began in the ruling. “And although our case today involves a preexisting condition exclusion, there is a twist.”

Now deceased, Norman Blanco had started at the age of 45 as an engineer at Porsche Engineering Services in Michigan in April 2005. His company’s welfare benefit plan covered by ERISA kicked in a month later and was underwritten and administered by Prudential Insurance, providing long- and short-term disability benefits to those who couldn’t work. Blanco suffered a heart attack in July and was unable to work for several days while hospitalized, and he later submitted a disability benefit claim. The short-term benefits were approved, but the long-term benefits weren’t because Prudential determined he had a preexisting condition based on a history of worsening heart disease and prior heart attacks and treatment that he didn’t always adhere to.

At the District Court level, Judge McKinney granted a summary judgment motion by Prudential Insurance, which had upheld the claim denial during an internal review process. The trial judge had limited some of the evidence in that case, and the appellate panel affirmed his decision. Blanco died following that decision, and his estate carried on the appeal.

Analyzing Judge McKinney’s ruling, the 7th Circuit decided that Blanco did fall under the pre-existing exclusion sections of ERISA and couldn’t receive those long-term benefits.

“The purpose of the policy is to exclude from coverage a person who is aware of something – be it a sign or symptom – for which a reasonably prudent person should seek treatment,” Judge Evans wrote.
 

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  1. What is the one thing the Hoosier legal status quo hates more than a whistleblower? A lawyer whistleblower taking on the system man to man. That must never be rewarded, must always, always, always be punished, lest the whole rotten tree be felled.

  2. I want to post this to keep this tread alive and hope more of David's former clients might come forward. In my case, this coward of a man represented me from June 2014 for a couple of months before I fired him. I knew something was wrong when he blatantly lied about what he had advised me in my contentious and unfortunate divorce trial. His impact on the proceedings cast a very long shadow and continues to impact me after a lengthy 19 month divorce. I would join a class action suit.

  3. The dispute in LB Indiana regarding lake front property rights is typical of most beach communities along our Great Lakes. Simply put, communication to non owners when visiting the lakefront would be beneficial. The Great Lakes are designated navigational waters (including shorelines). The high-water mark signifies the area one is able to navigate. This means you can walk, run, skip, etc. along the shores. You can't however loiter, camp, sunbath in front of someones property. Informational signs may be helpful to owners and visitors. Our Great Lakes are a treasure that should be enjoyed by all. PS We should all be concerned that the Long Beach, Indiana community is on septic systems.

  4. Dear Fan, let me help you correct the title to your post. "ACLU is [Left] most of the time" will render it accurate. Just google it if you doubt that I am, err, "right" about this: "By the mid-1930s, Roger Nash Baldwin had carved out a well-established reputation as America’s foremost civil libertarian. He was, at the same time, one of the nation’s leading figures in left-of-center circles. Founder and long time director of the American Civil Liberties Union, Baldwin was a firm Popular Fronter who believed that forces on the left side of the political spectrum should unite to ward off the threat posed by right-wing aggressors and to advance progressive causes. Baldwin’s expansive civil liberties perspective, coupled with his determined belief in the need for sweeping socioeconomic change, sometimes resulted in contradictory and controversial pronouncements. That made him something of a lightning rod for those who painted the ACLU with a red brush." http://www.harvardsquarelibrary.org/biographies/roger-baldwin-2/ "[George Soros underwrites the ACLU' which It supports open borders, has rushed to the defense of suspected terrorists and their abettors, and appointed former New Left terrorist Bernardine Dohrn to its Advisory Board." http://www.discoverthenetworks.org/viewSubCategory.asp?id=1237 "The creation of non-profit law firms ushered in an era of progressive public interest firms modeled after already established like the National Association for the Advancement of Colored People ("NAACP") and the American Civil Liberties Union ("ACLU") to advance progressive causes from the environmental protection to consumer advocacy." https://en.wikipedia.org/wiki/Cause_lawyering

  5. Mr. Foltz: Your comment that the ACLU is "one of the most wicked and evil organizations in existence today" clearly shows you have no real understanding of what the ACLU does for Americans. The fact that the state is paying out so much in legal fees to the ACLU is clear evidence the ACLU is doing something right, defending all of us from laws that are unconstitutional. The ACLU is the single largest advocacy group for the US Constitution. Every single citizen of the United States owes some level of debt to the ACLU for defending our rights.

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