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By Attorney Lisa Pierobon Mays

One of the most frustrating experiences an injured worker can face is having their workers’ compensation claim accepted – only to have benefits unnecessarily delayed for months.

Recently, Attorney Lisa Pierobon Mays of Mays Law Office successfully represented M.M., a health care employee, whose case demonstrates why injured workers often need experienced legal representation even after their claim has been conceded.
A Conceded Claim Shouldn’t Become a Battle
M.M. injured his left knee while…
Continue Reading Accepted But Still Unpaid: How Attorney Pierobon Mays Held an Insurance Carrier Accountable

If I were handed a stack of medical records and told that a disability insurance company denied this patient’s claim, I could often point to the exact appointment they relied on. More often than not, it would be the one that says: “Patient improving.”

This can be one of the most damaging phrases in a Long-Term Disability (LTD) claim. It might sound like a good thing, as everyone wants to improve. The problem is that disability insurance companies often…
Continue Reading How One Line in Your Medical Records Can Damage Your Long-Term Disability Claim

On April 8, 2026, Governor Evers signed 2025 Senate Bill 531, creating 2025 Wis. Act 230, which enacts a new provision of Wisconsin’s insurance statutes: § 632.11. Section 632.11 imposes new regulations on assignments of benefits obtained by contractors. While this new statute has provisions relevant to contractors, consumers, and insurers, the focus of this Legal Update is on the impact of this new statute on insurance companies.

But first, some context. An “assignment” is a contract where one…
Continue Reading Wisconsin Reins in Assignment of Benefits: What Property Insurers Need to Know Before Dec. 1, 2026

As the name suggests, long-term disability benefits are supposed to last for the long term. But what does that actually mean? If you’re facing a serious injury or illness, the length of time you can count on benefits is one of the first questions you’ll want answered.
First, Consult Your Policy
Every long-term disability (LTD) policy is a bit different. The “plan documents,” or full terms of the policy, will spell out your policy’s specific rules for how long…
Continue Reading How Long Do Long-Term Disability Benefits Last?

In Humana Inc. v. Teva Pharmaceuticals USA, Inc., the District Court for the Middle District of Florida (the “Court”) dismissed claims brought by Humana under the Racketeer Influenced and Corrupt Organizations Act (“RICO”) against Teva Pharmaceuticals USA and a few specialty pharmacies (collectively, “Teva”). The Court ruled that Humana lacked standing to sue due to the indirect purchaser rule. Despite the case’s dismissal, it’s important for hospitals and health care providers to focus on compliance with payors as…
Continue Reading FL District Court Extends the Indirect Purchaser Rule to Civil RICO Claims and Ultimately Dismisses Insurance Company’s RICO Claim Against Pharmaceutical Manufacturer

Amundsen Davis Transportation Alert

August 14, 2025

The introduction of artificial intelligence into commercial vehicles has revolutionized the insurance marketplace. Conventional thinking runs that this technology will be beneficial for insurers. For example, AI-enhanced dash cameras have the ability to spot distant vehicles and road obstructions far better than the naked eye. This allows for fleet operators to quickly deploy mitigation techniques, such as braking and gear-shifting, thus avoiding serious accidents. Additionally, predictive maintenance sensors exist to alert drivers

…
Continue Reading AI Issues in the Commercial Auto Policy: The Insurer’s Perspective

When it comes to long-term disability (LTD) claims, having a diagnosed medical condition is only part of the story. Many claimants are surprised to learn that simply proving you have a medical condition, and even having the support of a treating provider as well, does not guarantee an approval of a claim. What can make or break a case to insurers and courts is whether you can objectively prove how your condition limits your ability to work. This distinction…
Continue Reading More Than a Diagnosis: The Objective Evidence Gap That Sinks LTD Claims

Safety first.
Ümit Yıldırım, Unsplash

If you’re getting Long-Term Disability (LTD) benefits, you might wonder: can I work part-time when I’m on Long-Term Disability?  

The answer is usually yes! Long-Term Disability policies are all different and so it’s important to consult the terms of your specific policy (also called the “plan documents.”) If you don’t have a copy of the policy terms, you should be able to obtain them from either the Long-Term Disability insurance company or your employer. The plan documents are usually…
Continue Reading The Hidden Dangers of Working Part-Time While on Long-Term Disability

I devote a not-so-small portion of my practice to serving as a guardian ad litem in cases involving minor settlements. I scratched my head a number of times last year at anecdotes I heard and things I witnessed myself when it came to dealing with minor settlements.

And that got me thinking; maybe we should all think a bit more about how to most effectively and efficiently approach settlements offered to minors.

I am hopeful that anyone reading this…
Continue Reading Some Thoughts on Minor Settlements and GALs in Personal Injury Cases

Courtroom And Gavel
Interior of an empty courtroom with gavel and sounding block on the desk.

Cincinnati Insurance Company v. James Ropicky, et al., No. 2023AP588, 2024 WL 5220615 (Wis. Ct. App. Dec. 26, 2024)

On December 26, 2024, the Court of Appeals of Wisconsin issued is decision in Cincinnati Insurance Company v. James Ropicky, et al., No. 2023AP588, 2024 WL 5220615 (Wis. Ct. App. Dec. 26, 2024), addressing whether an ensuing cause of loss exception to a Construction Defect Exclusion, Fungi Exclusion, and Fungi Additional Coverage endorsement contained in a homeowner’s insurance policy issued…
Continue Reading Wisconsin Appellate Court Interprets Construction Defect Exclusion and Fungi Exclusion

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Policyholders nationwide are frustrated with the insurance industry in general. The recent murder of one of the nation’s largest healthcare insurers by a disgruntled policyholder is just one glaring example.[1] Or consider the 26.4% premium increase homeowners across the country experienced over the past three years on average.[2] Here in Wisconsin, homeowners saw their premiums jump 21.4% on average since 2018. While policyholder dissatisfaction is certainly expected in the wake of national headlines and skyrocketing premiums, it…
Continue Reading Climate Change: Are Insurers Really ‘Covering Less’?

Oftentimes, when an insured sues their insurance company for not providing benefits the insured believes they are entitled to under their policy, the insured alleges that the insurance company breached the applicable contract and did so in bad faith. Wisconsin law makes clear that breach of contract and bad faith are distinctly separate claims, with different elements that the insured must establish.

Wisconsin first recognized the tort of bad faith in the state Supreme Court’s seminal decision in the…
Continue Reading Standards for Insurance Bad Faith Under Wisconsin Law

Miller v. West Bend Mutual Insurance Company
No. 2023AP1697 (Wis. Ct. App. Oct. 22, 2024) (recommended for publication)

In Miller v. West Bend Mutual Insurance Company, the Wisconsin Court of Appeals considered whether Wisconsin law permits insurers to define “underinsured motor vehicle” to exclude government-owned vehicles in a UIM policy. No. 2023AP1697 (Wis. Ct. App. Oct. 22, 2024). The court answered in the affirmative and recommended the opinion for publication, thereby confirming that the 2011 amendments to Wisconsin’s auto…
Continue Reading Contractually Defining UIM Coverage

In last week’s post, we talked about the Connelly case before the U.S. Supreme Court, which involved a fight between an estate and the IRS about whether money from a Key Person Insurance policy (that a company takes out on the lives of its shareholders) should count toward the company’s fair-market valuation for the purposes of estate taxes for the shareholder’s estate. The link for last week’s post can be found here.

With the context and case last…
Continue Reading Connelly: How to Pull the Wrench from the Works

Posted on August 21,2024 in Insurance Coverage Litigation
Few of us enjoy paying our insurance premiums every month, yet we do so because we understand that catastrophes can happen and we may need a safety net to cover our health, home, and finances in an emergency.

When an insurance company tries to deny or reduce coverage for illegitimate reasons, this is called “bad faith insurance.” The law prohibits insurance companies from acting this way, and people who…
Continue Reading Can I Sue My Insurance Company for Denying Coverage? 

McLaughlin v. Gaslight Pointe Condominium Association, LTD
No. 2023AP1011 (Wis. Ct. App. Apr. 17, 2024)

In McLaughlin v. Gaslight Pointe Condominium Association, LTD, the Wisconsin Court of Appeals contributed to Wisconsin’s ever-growing body of caselaw examining when an insured’s intentional conduct may constitute an “occurrence” within the meaning of a CGL policy. No. 2023AP1011 (Wis. Ct. App. Apr. 17, 2024) (recommended for publication). The court also examined several exclusions commonly found in CGL policies. In brief, the facts of…
Continue Reading The Wisconsin Court of Appeals’ Provides Further Guidance on the Intersection Between Volitional Acts and Occurrences