Administrative Agency Insurance

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Arizona Enacts Limited Privilege For Insurance Self-Audits

Arizona has enacted a privilege applicable to voluntary compliance audits conducted by insurance companies. This “self-evaluative” privilege protects audit documents and testimony in civil and some administrative proceedings....more

If A Tree Falls In The City, Is It Serving A Public Purpose?

Today’s posting has nothing to do with corporate law and everything to do with trees. On November 30 and December 1, 2011, the City of Pasadena experienced an unusually violent windstorm. Wind speeds in excess of 100 miles...more

Florida Court of Appeal Holds Insured’s Death Alone Does Not Trigger Unclaimed Property Law Obligations

In an opinion filed August 5, Florida’s First District Court of Appeal held that Florida’s unclaimed property law does not make life insurance proceeds due and payable at the time of the insured’s death and does not impose an...more

Highmark and UPMC Consent Decree

Highmark and UPMC took a major step toward resolving network participation issues June 27, 2014, by executing a Consent Decree with the Commonwealth of Pennsylvania Departments of Insurance and Health. The Consent...more

Favorable Ruling: Taxability of HMOs Under New York City General Corporation Tax

A New York City Tax Appeals Tribunal Administrative Law Judge (ALJ) recently ruled in favor of Aetna, Inc. (Aetna) on whether a health maintenance organization (HMO) was “doing an insurance business” in New York State,...more

New Washington Rule Clarifies Authority to Issue Penalties Against TPAs

The Washington State Department of Health has promulgated a new rule clarifying the Department's authority to issue civil penalties against health carriers and third-party administrators. This rule, which is outside the...more

The Future of Premium Subsidies under the Affordable Care Act: 'Halbig v. Burwell' and 'King v. Burwell'

Both decisions addressed whether tax credits are available for residents in states that have federally-facilitated health exchanges. The District of Columbia Court of Appeals said “no”; the Fourth Circuit Court of Appeals...more

How Big Is Halbig? The Viability of the ACA’s Employer Mandate Hangs in the Balance

For employers with employees in the 36 states with a federally facilitated exchange, the question arises how the Halbig decision impacts their decision and strategy to provide health coverage to their employees when the...more

A Tale of Two Circuits: D.C. Circuit, Fourth Circuit Split on ACA Subsidies

It was the best of times for ACA subsidies, it was the worst of times for ACA subsidies. On Tuesday, the Court of Appeals for the D.C. Circuit (“D.C. Circuit”) and the Court of Appeals for the Fourth Circuit (“Fourth...more

Harsh Justice

Concerned that its own decision might have "the potential to conflict" with that of the Pennsylvania Insurance Department, a Pennsylvania federal court relied on the primary jurisdiction doctrine to dismiss a putative class...more

High Court allows application for permission to bring judicial review proceedings relating to the jurisdiction of the Financial...

In this case report, Sarah Hitchins, an associate in Allen & Overy LLP’s Banking, Finance and Regulatory Litigation Group, considers the High Court’s decision to allow an application for permission to bring judicial review...more

Proposed Expansion of OIG’s Exclusion Authority

In May, the Office of Inspector General of the Department of Health and Human Services (OIG) proposed a new rule (Rule) that would implement changes included in the ACA. The Rule would expand OIG’s authority to exclude...more

I Can’t Get No SATISFACTION-- In the Eleventh Circuit, Is Discretionary Language Still "Satisfactory to Us"?

Ever since the United States Supreme Court addressed the question of whether a wholesale adoption of the "arbitrary and capricious" standard of review would be appropriate for judicial review of denial of benefit...more

Employee Benefit Plan is Governmental Plan, Even Though Employees are Not, says District Court in 11th Circuit.

It is a deceptively simple statement: Governmental employee benefit plans are exempt from ERISA. 29 U.S.C. § 1003(b)(1). But what about an employee benefit plan of an entity affiliated with a governmental entity, but whose...more

CMS Releases Proposed IPPS and LTCH Rule

On April 30, 2014, CMS released the much anticipated proposed Hospital Inpatient Prospective Payment System rule (“Proposed IPPS Rule”), which would apply to FY 2015 Medicare payments. For inpatient acute care hospitals, CMS...more

Unclaimed Property Round Up

The battle over unclaimed property continues to spawn increased litigation and regulatory activity. Litigation Highlights - In December 2013, a West Virginia court dismissed 63 lawsuits brought by the Treasurer...more

Securing Public Deposits Under Pennsylvania's Act 72

A governmental entity in Pennsylvania may deposit its moneys in a financial institution only if the financial institution pledges collateral for the deposit to the extent the deposit exceeds the FDIC insurance limits. This...more

New York Trial Court Holds that Administrative Orders Do Not Constitute "Final Adjudications"

New York Trial Court Holds that Administrative Orders Do Not Constitute “Final Adjudications” For Purposes of Applying Fraud/Dishonesty Exclusion in Professional Liability Policy - A recent New York trial court...more

Market Conduct Examinations: Are You Prepared?

Market analysis and market conduct examinations provide insurance regulators with information to assess how the insurance marketplace as a whole, and the individual insurance entities that make up that market, are in...more

Legal Alert: NCOIL Unclaimed Property Task Force Springs Into Action; Co-Chair Keiser Seeks Proposed Changes to Model Unclaimed...

On Friday, March 7, 2014, the National Conference of Insurance Legislators’ (NCOIL) Unclaimed Property Task Force (Task Force) met in-person at NCOIL’s spring meeting. Led by the Task Force’s Co-Chair George Keiser (ND), the...more

CFPB Initiates Administrative Proceeding Against Mortgage Lender

Subsequent to its denial of a mortgage lender’s petition to set aside a civil investigative demand in 2012, the CFPB publicly announced that it had served Notice of Charges, initiating an administrative proceeding against the...more

Capital Thinking: General Legislative

The Senate will convene today, Monday, January 27, at 2:00 pm. After any leader remarks, the Senate will resume consideration of the motion to proceed to S. 1926, the Homeowner Flood Insurance Affordability Act of 2014. At...more

Washington's Unprecedented Bid to Supplant State Insurance Regulators

In mid-October, Prudential Financial Inc. dropped its fight against being designated as a systemically important financial institution (SIFI) by the Treasury Department's Financial Stability Oversight Council. When the...more

Australia’s High Court Denies Employee Worker’s Compensation Claim For Sex Injury

Ruling in a 4-2 decision[1], the Australian High Court denied a government employee worker’s compensation claim for an injury the employee sustained while having sex in a motel room during a business trip. The female...more

NC Medicaid Providers, Are You Required to Seek an Informal Appeal Prior to Filing a Contested Case at OAH?

Recently, numerous clients have come to me asking whether they have the right to appeal straight to the Office of Administrative Appeals or whether they have to attend informal appeals first, whether the informal appeal is...more

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