Insurance Coverage – Attorney Fees

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7^th Circuit Court of Appeals

Case Name: Lee Ann Prather v. Sun Life and Health Insurance Company

Case No.: 16-1861

Officials: WOOD, Chief Judge, and POSNER and WILLIAMS, Circuit Judges

Focus: Insurance Coverage – Attorney Fees

The plaintiff’s decedent, Jeremy Prather, was employed by a company that had obtained a Group Insurance Policy from Sun Life which provided accidental death and dismemberment coverage for the company’s employees, in the amount of $92,000 for Prather. The policy limited coverage to “bodily injuries … that result directly from an accident and independently of all other causes.” The clause we’ve italicized was the focus of an appeal from the district court, which had granted summary judgment for Sun Life, which had invoked the clause to deny the payment of death and dismemberment coverage to Prather’s survivor on the ground that Prather’s death had not been the exclusive result of an accident—it had also been the result of “complications from surgical treatment.” Prather’s widow brought suit “to recover benefits due to [her]” under the plan. 29 U.S.C. § 1132(a)(1).

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Attorney Derek A. Hawkins is the managing partner at Hawkins Law Offices LLC, where he heads up the firm’s startup law practice. He specializes in business formation, corporate governance, intellectual property protection, private equity and venture capital funding and mergers & acquisitions. Check out the website at www.hawkins-lawoffices.com or contact them at 262-737-8825.