Metuchen, NJ (PRWEB) June 16, 2011
Vlasac & Shmaruk, LLC, a Metuchen-based law firm, was successful in its argument to the three Judge panel for the 3rd Circuit Court of Appeals, who reversed the Trial Judge's decision and remanded the matter back for further proceedings in the matter of VIERA v. LIFE INSURANCE COMPANY OF NORTH AMERICA.
According to the lawsuit filed, Mr. Viera was in a very serious and fatal motorcycle accident in 2008. Mr. Viera collided with a car and was ejected from his motorcycle. He had extensive injuries, which included, but were not limited to, severe pelvic fractures, lower extremity fractures and lacerations. He indicated that he had no feeling from the waist down. After being rushed to the hospital via ambulance, Mr. Viera ultimately passed away approximately 3 hours after the accident.
According to the court documents, Mrs. Viera submitted a claim for coverage of her accidental death and dismemberment insurance to the Life Insurance Company of North America (LINA). LINA denied the claim because Mr. Viera was on Coumadin. LINA cited to an exclusion in the policy which stated that "benefits will not be paid for any covered injury or covered loss which, directly or indirectly, in whole or in part is caused by or results from... Sickness, disease, bodily or mental infirmity, bacterial or viral infection or medical or surgical treatment thereof..."
As noted in the court documents, attorney Jamie Sutton argued that Ms. Viera's Accidental Death and Dismemberment claim should not have been denied by LINA. Mr. Viera accurately disclosed on his insurance application that he suffered from an atria fibrillation condition and that he was taking Coumadin to help control this condition. With this knowledge, LINA accepted Mr. Viera's application, accepted his premium payments for years, and then when Mr. Viera was in a serious and fatal motorcycle accident, LINA denied coverage stating that the Coumadin that he was taking was a significant contributing factor in bringing about his death.
Oral arguments were recently heard by the three Judge panel for the 3rd Circuit Court of Appeals (overseeing Pennsylvania, Delaware and New Jersey). The 3rd Circuit Court of Appeals Reversed the Trial Judge's decision and remanded the matter back for further proceedings and held that the Trial Court Judge erred and should have used the "de novo" standard of review.
“This is a monumental decision because of the impact this matter will have throughout the country on what standard of review will apply to insurance policies under ERISA. This was a matter of first impression for the 3rd Circuit, who wrote a 26 page published decision in our favor,” said Sutton.
“I am optimistic that now this matter has been remanded back to the District Court to be reviewed under the lower standard of review this case will survive summary judgment and we will be successful at trial. This decision will be very important going forward and will be very helpful to individuals throughout the country who have had similar ERISA-based insurance claims unfairly denied.”
Vlasac & Shmaruk is a full service personal injury law firm serving New Jersey, Pennsylvania and New York, providing representation in the areas of medical malpractice, product liability, automobile accidents, construction accidents, slip and falls, workers compensation and general negligence cases. Vlasac & Shmaruk has offices in Metuchen, Hamilton, Fair Lawn, New Jersey as well as Feasterville, PA.