Civil Remedies Insurance Administrative Agency

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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

Subrogation Claims are “Equitable Relief” Governed by ERISA

That subrogation claim you have might be governed by ERISA, at least in some circuits… Here’s the case of Thurber v. Aetna Life Insurance Company, __F.3d__ (2nd Cir. March 13, 2013) (Insurer’s counterclaim for return...more

Who Cares if I Give a COBRA Notice for My Dental Plan?

Employers are generally aware that medical plans are subject to continuation coverage under the federal law known as COBRA. They may forget that COBRA extends to all group health plans, including dental, vision and medical...more

Hospitals Win a Case Challenging CMS Policy to Include Part C Days in the SSI Fraction in the Medicare DSH Formula

On November 15, 2012, the United States District Court for the District of Columbia released a 33-page opinion ruling in favor of a group of hospitals that had challenged CMS’s policy of including Medicare Part C patient days...more

Missouri Court of Appeals Reverses and Renders Summary Judgment, Holding Insurer Not Liable For Indemnity Because TCPA Statutory...

Plaintiff insurance company appealed the trial court’s summary judgment order in favor of Defendants who had settled an underlying action involving the allegedly unsolicited transmission of more than 10,000 faxes in violation...more

Proposed Settlement Would Prevent Medicare Denials for Chronically Ill and Disabled Due to Lack of Improvement

A proposed settlement has been reached between CMS and the plaintiffs in a national class action involving the denial of benefits to chronically ill and disabled Medicare beneficiaries. Many of these patients have had skilled...more

Proposed Settlement of Medicare Class Action Could Impact Chronic Care Benefits

On October 16, 2012, representatives of the parties in the nationwide class action lawsuit styled, Glenda Jimmo, et. al vs. Kathleen Sebelius filed a proposed legal settlement with the chief judge of the Federal District...more

Medicare Therapy Coverage Policy to Be Revised

Proposed class action settlement disavows and discontinues use of the "Improvement Standard." Under a proposed settlement of Jimmo v. Sebelius, No. 5:11-cv-00017 (D. Vt. filed Oct. 16, 2012) filed with the U.S....more

Supreme Court Will Not Review Sixth Circuit Ruling That Government May Seek Full Reimbursement of Medicare Payments to Beneficiary...

On October 1, 2012, the United States Supreme Court said it would not review a decision by the U.S. Court of Appeals for the Sixth Circuit which ruled 2-1 that, upon settlement by a Medicare beneficiary with a third-party...more

Government Sanctioned for Destruction of Documents

U.S. district court decision may now allow defendants in False Claims Act cases to obtain sanctions where potentially relevant documents are lost or destroyed due to the government's failure to issue a timely litigation...more

Administrative Exemption To Overtime Compensation Requirements Did Not Apply To Insurance Claims Adjusters

A court of appeal recently rejected two insurance companies’ assertion that the administrative exemption to the overtime compensation requirements applied to their insurance claims adjusters in the adjusters’ lawsuit seeking...more

New Indemnity Law Protects Subcontractors

California Senate Bill 474 prohibits a contract provision requiring a subcontractor to indemnify a general contractor, construction manager, or other subcontractor for claims arising out of their "active negligence." This...more

McAfee & Taft AgLINC Agriculture & Equine Industry Newsletter - July 2012: The Equal Access to Justice Act - A valuable tool for...

Many farmers are all too familiar with the Risk Management Agency’s (RMA) role in administering the federal crop insurance program. In addition to promulgating regulations, drafting policies, and issuing bulletins affecting...more

Medicare Seeks to Safeguard Its Share of “Future Medicals” from Liability Settlements

The Centers for Medicare & Medicaid Services (“CMS”) has issued an advance notice of proposed rulemaking (“Notice”), soliciting comments on options for how beneficiaries and their attorneys can comply with Medicare Secondary...more

IP Buzz - June 2012

In this issue: - Using Injunctions to Gain Market Share: What’s the Harm - Business Method Patents and September 16, 2012 - News:ICANN Reveals List Of New gTLD Applications - New Insurance Helps Small...more

CMS Solicits Comments Regarding Options for Beneficiaries to Satisfy Their Obligations Under the MSP Statute for Settlements...

In an Advanced Notice of Proposed Rulemaking (ANPR) published in the Federal Register on June 15, 2012, CMS is soliciting public comments on proposed standardized options for Medicare beneficiaries to resolve their...more

Claimant Fired For Refusal To Sign Disciplinary Memo Was Not Entitled To Unemployment Benefits

A California court of appeal recently held that a claimant who was terminated by his employer because he refused to sign a disciplinary memorandum that dealt with a prior incident of misconduct was disqualified from receiving...more

Unemployment Benefits impact on a Social Security Disability Claim

It is not unusual for a disabled individual to apply for and receive unemployment benefits while they have a Social Security Disability application pending. As to whether this is advisable is another matter entirely.Receipt...more

Recent Developments in the Life Settlement Industry - June 2012

The Delaware General Assembly is considering new legislation to address a contentious issue in the life settlement industry. A new law proposed in May 2012, Delaware Senate Bill No. 220 (the Senate Bill), would require a life...more

Florida Supreme Court Hands Down Important Decision For First-Party Property Insurers

Just in time for hurricane season, the Florida Supreme Court has issued an opinion clarifying the state’s law on a number of important insurance issues, including whether Florida recognizes an implied warranty of good faith...more

FSA Bans Introducer Appointed Representative Following Upper Tribunal’s Decision

On 22 May 2012, the FSA published a final notice issued to appointed representative Derek William Wright. The notice prohibits Mr. Wright from performing any function in relation to any regulated activity on honesty,...more

Supreme Court Review of Provider Medicaid Challenge: Is a Remand Good News for Providers?

A recent United States Supreme Court decision suggested, in a remand back to the Ninth Circuit Court of Appeals, that once the Centers for Medicare and Medicaid Services (CMS) approve a Medicaid state plan amendment, a...more

Lawsuit Challenges ALJ Final Decision Authority in Medicaid Appeals

The first case to contest North Carolina’s move to Administrative Law Judge (ALJ) final decisions in contested cases challenging administrative agency actions, is limited in scope and theory. On February 8th, Piedmont...more

Commercial General Liability Insurance Covers FLSA Claims: Republic Franklin Insurance Company v. Albemarle County School Board

Who pays for the defense of FLSA claims against a local government entity, and who pays for the liquidated damages and attorneys’ fees if the local government entity loses?  The Fourth Circuit Court of...more

Payment Matters: Court Rules Dual Eligible Days Properly Included in Medicaid Fraction of Medicare DSH Calculation

The United States District Court for the District of Columbia Circuit recently handed providers a victory in Catholic Health Initiatives – Iowa v. Sebelius, No. 10-cv-411 (D.D.C. Jan. 30, 2012), ruling that CMS used...more

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