Civil Remedies, Insurance

ERISA Litigation Alert: Check Your Plan Subrogation and Reimbursement Language to Eliminate “Contractual Gaps”

by Richard Birmingham | Davis Wright Tremaine LLP on 5/21/2013

In U.S. Airways v. McCutchen, the U.S. Supreme Court upheld the ability of U.S. Airways’ health plan to recover medical expenses that it previously paid to the injured party from a third party settlement, but remanded the...more

Discoverability of Documents in Insurance Bad Faith Claims

by Pavlack Law, LLC on 5/17/2013

This week we take a look at the ability to discover documents from an insurance company's claim's file in an insurance bad faith claim through the recent Southern District of Indiana decision in Woodruff v. American Family...more

First Circuit Permits Insurer to Retain Policy Premiums Despite Rescission

by Aaron Mandel | Sedgwick LLP on 5/16/2013

Courts often require insurers to return premiums (or at least offer to return them) when rescinding an insurance policy. Some states may even require it under statute. The reason is that rescission is an equitable remedy...more

Sixth Circuit Applies Strict Precondition of Payment Requirement to Reverse $11.1 Million FCA Judgment

by Nicholas Linder, Kirsten Mayer, Arefa Shakeel | Ropes & Gray LLP on 5/15/2013

The U.S. Court of Appeals for the Sixth Circuit, in United States ex rel. Hobbs v. MedQuest Associates, Inc., 711 F.3d 707 (6th Cir. April 1, 2013), recently reversed an $11.1 million False Claims Act (“FCA”) judgment,...more

Estée Lauder v. OneBeacon Insurance Group – Expanding the Scope of Discovery in Bad Faith Cases

by Jennifer Clark, Stacey Farrell, Angelo Savino | Cozen O'Connor on 5/15/2013

On April 15, 2013, the Supreme Court of the State of New York, County of New York, granted the insured’s request for the production of certain claims file material and previously sealed discovery in Estée Lauder Inc. v....more

I have never been in so much pain. Why does my insurance company insist that I have suffered a “minor” injury?

by Marc A. Flisfeder | Lerners LLP on 5/14/2013

In September, 2010, the Statutory Accident Benefits Schedule (“SABS”) was amended to introduce the Minor Injury Guideline (“MIG”). Many people are surprised to hear that their injuries are being described as “minor”. In fact,...more

Court Adheres to Specific Definition of “Designated Premises”; Holds Policy Cancellation Does Not Preclude Rescission

by Daniel Bryer | Sedgwick LLP on 5/13/2013

In Seneca Ins. Co. v. Cimran Co., — N.Y.S.2d –, 2013 WL 1405231 (App. Div. 1st Dep’t 2013), the New York appeals court granted the insurer’s motion for summary judgment, declaring that it had no duty to defend and indemnify...more

California Supreme Court Hears Argument on Whether Insurance Code Limits UCL Lawsuits Against Insurers

by Larry Golub, Samuel Sorich | Barger & Wolen on 5/13/2013

On May 8, 2013, the California Supreme Court convened to hear oral argument in Zhang v. Superior Court. The case presents the issue of whether conduct of an insurer, which is related to conduct that would violate California’s...more

Use of Additional Insured Status to Reduce Attorneys' Fees

by Conrad Lazo | Fowler White Boggs P.A. on 5/8/2013

Although insurance requirements are typically addressed in most construction contracts, they are often given minimum attention. On the other hand, attorneys’ fees are always a major concern. Notwithstanding, requiring...more

Bad Faith Liability Exposure: an Anvil, a Feather or an Occasional Lever?

by Lynda A. Bennett | Lowenstein Sandler LLP on 5/8/2013

Any company faced with a coverage denial inevitably asks the question: Will the insurance company change its position if we sue them for bad faith? The short answer to the question is usually no. In general, insurance...more

Senate Bill 814 Proposes Sweeping and Retroactive Changes to Environmental Claims Handling in Oregon

by Molly Eckman | Cozen O'Connor on 5/8/2013

On March 13, 2013, the Oregon legislature introduced Senate Bill 814 to create sweeping reforms on environmental claims handling regulations and available remedies for insureds facing liability for cleanup of contaminated...more

CMS Proposes Increased Rewards for Reporting Fraud and Abuse

by Ameena Ashfaq, B. Scott McBride | BakerHostetler on 5/7/2013

The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule modifying certain provisions in their Incentive Reward Program (IRP) to sweeten the incentives for reporting sanctionable conduct....more

Costs and Attorney Fees Awarded In the Same Action in Idaho

by Christina Ahn | Sedgwick LLP on 5/7/2013

In Employers Mutual Casualty Co. v. Donnelly, No. — P.3d —-, 2013 WL 1693661 (Idaho Apr. 19, 2013), a majority of the Idaho Supreme Court affirmed a declaratory judgment action decision that an insurer was required to pay...more

Court of Appeal Applies Howell Rule to Future Medical Expenses and Noneconomic Damages

by Samuel Sorich | Barger & Wolen on 5/6/2013

In Howell v. Hamilton Meats & Provisions, Inc., the California Supreme Court ruled that where a plaintiff’s medical care provider, pursuant to a prior agreement with the plaintiff’s health care provider, accepted less than...more

Kaiser Opinion May Affect Ability to Stack Policies issued by Single Carrier

by Unnati Gandhi | Farella Braun + Martel LLP on 5/6/2013

Policyholders should continue to assert that limits can be stacked in situations where there is continuing damage, despite the California Court of Appeals’ latest decision in Kaiser Cement & Gypsum Corp. v. Insurance Company...more

Federal Courts Can Enjoin State Court Litigation Of Arbitrable Claims

by Liz Kramer | Leonard, Street and Deinard - Arbitration... on 5/3/2013

In a new case that reminds federal judges everywhere to sing “I’ve got the power!” like C&C Music Factory, the Fifth Circuit reiterates that federal courts can stay related state court actions if necessary to “protect or...more

Supreme Court Denies Certiorari in MAO’s Double Damages Case

by Edward Waller | Fowler White Boggs P.A. on 5/3/2013

On April 15, 2013, the United States Supreme Court denied a petition for certiorari brought by GlaxoSmithKline (“Glaxo”) seeking review of a Third Circuit decision in favor of Humana Medical Plan (“Humana”), as a Medicare...more

OIG Issues Revised Provider Self-Disclosure Protocol

by Cameron Ellis, Jay Hardcastle, Judd Harwood, Christopher Puri, Jack Selden | Bradley Arant Boult Cummings LLP on 5/2/2013

On April 17, 2013, the Office of Inspector General (OIG) of the United States Department of Health and Human Services (HHS) revised its Provider Self-Disclosure Protocol (SDP), originally published in 1998, and updated in...more

Monthly Benefits Update - April 2013

by Andrew Malahowski | Franczek Radelet P.C. on 5/1/2013

Health Care Reform: Guidance on Required Future Modifications to SBC, Other Issues - The Internal Revenue Service (IRS), Department of Labor (DOL), and Department of Health and Human Services (HHS) issued new guidance...more

New Whistleblower Bounty Law On The Horizon In NY?

by Steven J. Pearlman, Daniel Saperstein | Proskauer - Whistleblowing & Retaliation on 5/1/2013

On March 22, 2013, the New York State Senate introduced the S4362 Proposal which, through a “bounty,” gives financial awards to whistleblowers who provide original information to the Department of Financial Services (DFS)...more

CMS Aims to Grease the Reporting Wheels for Medicare Fraud and Abuse

by Daniele Capasso, Charles Cohen, Howard Young | Morgan Lewis on 4/30/2013

Proposed rule would substantially increase rewards for fraud tips and enhance billing revocation authority. On April 29, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule (Proposed Rule) that...more

Cross-Border Crashes: How Canadian Healthcare Can Affect Your Settlement

by Law Office of Dean Standish Perkins and... on 4/30/2013

Despite the efforts to prevent accidents, crashes with Canadian drivers are still an all too common occurrence in Washington State. To make matters worse, dealing with Canadian insurance companies can be confusing and...more

Landmark Florida Supreme Court Decision: Florida’s Economic Loss Rule

by Neha Dagley | Schecter Law on 4/29/2013

In Tiara Condominium Association, Inc. v. Marsh & McLennan Companies, Inc., the Florida Supreme Court held, in a five-to-two decision, that the economic loss rule is limited to products liability cases. Tiara Condominium...more

The 2013 Florida Auto Insurance PIP Reform Law

by Viles & Beckman, LLC on 4/24/2013

This past December, Valerie Marshal, a licensed massage therapist and the owner of Indian Rehabilitation Center, Inc., along with 18 others, was arrested after an investigation uncovered a series of staged accidents and...more

ERISA Legal News - 1st Quarter, 2013 • Volume 4, Number 1

by Kimberly Ruppel | Dickinson Wright on 4/23/2013

In This Issue: - Supreme Court Update: Where Plan Reimbursement Or Recovery Terms Are Ambiguous Or Silent,Equitable Doctrines May Fill The Gaps: US Airways, Inc. v. McCutchen, 569 U.S. ___ (2013). In an...more

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Civil Remedies › Insurance