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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. The voices of the prophets are more on blogs than subway walls these days, Dawn. Here is the voice of one calling out in the wilderness ... against a corrupted judiciary ... that remains corrupt a decade and a half later ... due to, so sadly, the acquiescence of good judges unwilling to shake the forest ... for fear that is not faith .. http://www.ogdenonpolitics.com/2013/09/prof-alan-dershowitz-on-indiana.html

  2. So I purchased a vehicle cash from the lot on West Washington in Feb 2017. Since then I found it the vehicle had been declared a total loss and had sat in a salvage yard due to fire. My title does not show any of that. I also have had to put thousands of dollars into repairs because it was not a solid vehicle like they stated. I need to find out how to contact the lawyers on this lawsuit.

  3. It really doesn't matter what the law IS, if law enforcement refuses to take reports (or take them seriously), if courts refuse to allow unrepresented parties to speak (especially in Small Claims, which is supposedly "informal"). It doesn't matter what the law IS, if constituents are unable to make effective contact or receive any meaningful response from their representatives. Two of our pets were unnecessarily killed; court records reflect that I "abandoned" them. Not so; when I was denied one of them (and my possessions, which by court order I was supposed to be able to remove), I went directly to the court. And earlier, when I tried to have the DV PO extended (it expired while the subject was on probation for violating it), the court denied any extension. The result? Same problems, less than eight hours after expiration. Ironic that the county sheriff was charged (and later pleaded to) with intimidation, but none of his officers seemed interested or capable of taking such a report from a private citizen. When I learned from one officer what I needed to do, I forwarded audio and transcript of one occurrence and my call to law enforcement (before the statute of limitations expired) to the prosecutor's office. I didn't even receive an acknowledgement. Earlier, I'd gone in to the prosecutor's office and been told that the officer's (written) report didn't match what I said occurred. Since I had the audio, I can only say that I have very little faith in Indiana government or law enforcement.

  4. One can only wonder whether Mr. Kimmel was paid for his work by Mr. Burgh ... or whether that bill fell to the citizens of Indiana, many of whom cannot afford attorneys for important matters. It really doesn't take a judge(s) to know that "pavement" can be considered a deadly weapon. It only takes a brain and some education or thought. I'm glad to see the conviction was upheld although sorry to see that the asphalt could even be considered "an issue".

  5. In response to bryanjbrown: thank you for your comment. I am familiar with Paul Ogden (and applaud his assistance to Shirley Justice) and have read of Gary Welsh's (strange) death (and have visited his blog on many occasions). I am not familiar with you (yet). I lived in Kosciusko county, where the sheriff was just removed after pleading in what seems a very "sweetheart" deal. Unfortunately, something NEEDS to change since the attorneys won't (en masse) stand up for ethics (rather making a show to please the "rules" and apparently the judges). I read that many attorneys are underemployed. Seems wisdom would be to cull the herd and get rid of the rotting apples in practice and on the bench, for everyone's sake as well as justice. I'd like to file an attorney complaint, but I have little faith in anything (other than the most flagrant and obvious) resulting in action. My own belief is that if this was medicine, there'd be maimed and injured all over and the carnage caused by "the profession" would be difficult to hide. One can dream ... meanwhile, back to figuring out to file a pro se "motion to dismiss" as well as another court required paper that Indiana is so fond of providing NO resources for (unlike many other states, who don't automatically assume that citizens involved in the court process are scumbags) so that maybe I can get the family law attorney - whose work left me with no settlement, no possessions and resulted in the death of two pets (etc ad nauseum) - to stop abusing the proceedings supplemental and small claims rules and using it as a vehicle for harassment and apparently, amusement.

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