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Often Overlooked, but Effective, Provisions to Consider for your Benefit Plans

The Issue: When benefits under welfare plans – such as health plans and disability plans – are denied, litigation frequently results. In the context of “self-funded” plans (in contrast to “fully insured” plans, which are...more

The Unique Risks Of Investing In Out-Of-Network Providers

For several years, industry observers have been predicting the demise of out-of-network business models, yet they still survive. For some providers in certain specialties and certain geographies, a predominantly...more

Binding arbitration in managed care contracts - 6 tips to tailor your dispute resolution provisions

The Affordable Care Act is moving millions of previously uninsured patients into commercial managed care health plans. As the healthcare system grapples with complexity of this shift, the size of disputes between healthcare...more

Religious Institutions Update: December 2014

Every year, religious institutions spend millions purchasing insurance of various types from insurance companies. Many will never make claims on the policies remotely equal to their annual investment in premiums. In these...more

CFO’s Thirst for Wine Club Invitation Costs Hospital Millions

You can’t make this stuff up. Last Monday a federal court in Rhode Island ordered two insurance companies to pay a $30 million claim by hospital management company Lifespan Corp. Lifespan filed the claim after being ordered...more

California Court of Appeals Holds That the California Mental Parity Act Covers Residential Care for Anorexia Nervosa Even When the...

In Harlick v. Blue Shield of California (9th Cir. 2012) 686 F.3d 699, the Ninth Circuit interpreted the provisions of the California Mental Health Parity Act (Health and Safety Code § 1374.72) and its implementing regulation,...more

Employment Law Reporter – November 2014: The Impact of Burwell v. Hobby Lobby

Has the Supreme Court “ventured into a minefield,” by its “decision of startling breadth,” as Justice Ruth Bader Ginsburg wrote in her dissent to Burwell v. Hobby Lobby? In Hobby Lobby, the Court held that the contraceptive...more

Property Insurance May Mitigate Ebola-Related Losses

With cases of Ebola now in the U.S., concerns have been raised as to the safety of public places visited by a person infected with the virus. Despite assurances from health officials that it is nearly impossible to contract...more

Catch Me If You Can: Fake Doctor’s Application Voids Coverage for Himself But Not for Innocent Co-Insureds

Written like a blockbuster Hollywood film, the U.S. District Court in South Carolina, in Evanston Insurance Company v. Agape Senior Primary Care, et al., 2014 WL 5365679, issued a ruling October 21, 2014, in which it held...more

Ebola Exclusions from Commercial Insurance Policies

Last week we wrote about a new business interruption insurance policy that is being rolled out to healthcare providers which will provide specific coverage for various ebola-related losses. This week we note that some...more

Rating Agency Developments

On October 13, Moody’s released is rating methodology for U.S. Health Insurance Companies. On October 10, DBRS published its methodologies regarding the following...more

As Fear of Ebola Widens, Corporate Policyholders Seek To Prevent Loss While Insurers Seek To Exclude Loss

In response to the widespread fear of Ebola, at least one insurance company is seeking to protect itself from potentially significant financial loss in the event Ebola continues to spread beyond Africa by adding...more

Business Interruption Insurance for Ebola – Managing Risk for Hospitals and Healthcare Providers

William Gallagher Associates, a Boston-based insurance broker, has announced the rollout of a new policy to cover Ebola-related losses at hospitals and other healthcare providers involved in primary care emergency treatment. ...more

Ninth Circuit Holds That Provider Cannot Sue Nonsignatory Insurer for Breach of Contract

On October 10, 2014, the Ninth Circuit affirmed a grant of summary judgment in favor of Manatt client The MEGA Life and Health Insurance Company. In an unpublished memorandum opinion, the Ninth Circuit held that a health care...more

Arrival of Ebola Virus Prompts Policyholders to Assess Insurance Coverage

With news of the Ebola virus arriving in the United States, many companies are moving quickly to protect the health and safety of their employees and customers. At the same time, some insurance providers have already...more

Will your errors and omissions policy pay your defense costs?

The hypothetical - HealthPayPlus (HPP) designs custom record management systems for large hospital systems. HPP developed a system for Research Hospitals of America (RHA) that HPP promised would revolutionize RHA’s...more

Illinois Blues Won’t Let Hospitals Jointly Negotiate Unless They’re Married

Remember when Hollywood wouldn’t show an unmarried couple in bed together? Blue Cross-Blue Shield of Illinois is taking that approach to contract negotiations. If hospitals want to negotiate jointly with the insurer, they...more

A Cautionary Tale for Companies With Potential False Claims Act Exposure

A False Claims Act suit can be a company’s worst nightmare, as it may potentially result in large settlements and awards on account of the statute’s trebled damages provision. However, the nightmare for AmerisourceBergen was...more

Torts – Effect of The Howell Decision on Liens Brought Under The Hospital Lien Act

Dameron Hospital Association v. AAA Northern California, Nevada, and Utah Insurance Exchange et al. - California Court Of Appeal, Third Appellate District (September 4, 2014) - In Howell v. Hamilton Meats (...more

Insurers, Be Ready To Pay Twice In Texas

Often, an insurance carrier will issue a check to two joint payees — the named insured and either a public adjuster or a mortgagee. What happens when the one payee cashes the check without first obtaining a signature from the...more

New Jersey Court Turns the Screws on the Insured, Holding That “Your Product” Exclusion Bars Coverage For Defective Product Claim

In Titanium Industries, Inc. v. Federal Ins. Co., No. A-1922-12T1, 2014 WL 4428324 (N.J. Super. Ct. App. Div. Sept. 10, 2014), the court held that the commercial general liability policy issued by defendant Federal Insurance...more

Captive Insurance: Feds Promote Tax Benefits, but Pay Attention to the Details

Recent IRS rulings and a U.S. Tax Court decision continue to lay a solid foundation for captive insurance companies. However, the tax requirements must be strictly followed. Below we provide an update to assist captives in...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

Insurance Antitrust Legal News - July 2014 • Volume 3, Number 4

In This Issue: - COURT DENIES BLUES’ MOTION TO DISMISS IN RE BLUE CROSS BLUE SHIELD ANTITRUST LITIGATION (MDL 2406): On June 18, United States District Court Judge David Proctor (Northern District of Alabama)...more

Minnesota Federal District Court Explores Application of Corporate Practice of Medicine Doctrine to MRI Scans

On March 25, 2014, in State Farm Mutual Automobile Insurance Company v. Mobile Diagnostic Imaging, Inc., the U.S. District Court for the District of Minnesota held that a corporation not owned or controlled by physicians does...more

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