Insurance | JD Supra

DOL Releases Exchange Notice Guidance and Model Notices

by Dennis R. Bonessa, John D. Martini, Rachel Cutler Shim, Allison Warden Sizemore | Reed Smith on 5/17/2013

On May 8, the Department of Labor ("DOL") issued guidance regarding the requirement that employers provide notice to employees describing the coverage options available under Health Insurance Marketplaces (formerly known as...more

Health Law Alert: OIG Issues Updated Special Advisory Bulletin On The Effect Of Exclusion From Participation In Federal Health...

by Jessica Kracl, Sheva J. Sanders | Leonard, Street and Deinard on 5/17/2013

On May 8, 2013, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) issued an updated Special Advisory Bulletin on the effect of exclusion from participating in federal health care programs....more

Model Notices Issued To Meet Affordable Care Act Requirements – Notices Must Be Issued By October 1, 2013

by Andrew E. Graw | Lowenstein Sandler LLP on 5/17/2013

On May 8, 2013, the U.S. Department of Labor (DOL) issued guidance and model forms to assist employers in fulfilling their obligations under the Affordable Care Act (ACA) to notify employees of the availability of health care...more

Insurance Recovery Law -- May 16, 2013

by Manatt, Phelps & Phillips, LLP on 5/17/2013

In This Issue: Prepare For A Storm of Lawsuits; To Ensure Coverage, Read Policy Carefully; and Ticketmaster Wins Reversal, Possible Coverage For Class Action Over Ticket Fees ...more

6th Circuit: Plan Administrators are NOT Necessarily Required to Obtain Vocational Evidence or an IME Before Making their LTD...

by Gabriel Baker, Steve Jensen, D. Michael Reilly | Lane Powell PC - ERISA Law on 5/17/2013

In Judge v. Metropolitan Life Insurance Company [PDF], 710 F.3d 651 (6th Cir. 2013), the Sixth Circuit rejected plaintiff’s proposed bright-line rule requiring plan administrators to obtain vocational evidence and an IME...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

Missouri Court Holds Prejudice Requirement Inapplicable to Claims Made Policy

by Traub Lieberman Straus & Shrewsberry LLP on 5/17/2013

In its recent decision in Secure Energy v. Phila. Indem. Ins. Co., 2013 U.S. Dist. LEXIS 69320 (E.D.Mo. May 15, 2013), the United States District Court for the Eastern District of Missouri had occasion to consider whether...more

CMS Proposes New Standard for Hospital Inpatient Admissions

by Leslie Demaree Goldsmith | Ober|Kaler on 5/17/2013

As part of its proposed inpatient prospective payment systems (IPPS) rule for FY 2014, CMS introduced a new standard for determining whether an inpatient admission to an acute care hospital is appropriate. Specifically, CMS...more

California Leads Country in Number and Amount of Dog Bite Insurance Claims in 2012

by Demas Law Group on 5/17/2013

Much has been made recently regarding the reaction of the insurance industry to the high number of claims being filed in response to dog bite attacks. Some insurance companies are limiting the types of breeds that they will...more

Bringing Sunlight to Healthcare Pricing: The CMS Release of Hospital Charge Data

by Robert Wolin | BakerHostetler on 5/17/2013

Former U.S. Supreme Court Justice Louis D. Brandeis once said that "Sunlight is the best disinfectant." The release of charges billed by some 3,337 Medicare hospitals for 100 of the most common inpatient diagnosis related...more

2013 Tennessee Property Subrogation Cheat Sheet v2.0

by Michael Durr on 5/17/2013

A handy reference to property subrogation in Tennessee. ...more

Indemnity Prohibition

by Peter Bauman - Senior Associate at Tharpe &... on 5/17/2013

On January 1, 2013, new rules governing indemnification in construction contracts went into effect under SB 474 in California. The new law impacts commercial real estate, and public and residential projects. The big picture...more

IRS, Treasury Department Issue Proposed Rules Governing Minimum Value, Affordability, and Wellness Programs

by Alden J. Bianchi | Mintz Levin - Employment, Labor & Benefits on 5/17/2013

A key policy goal of the Patient Protection and Affordable Care Act (the “Act”) is the expansion of health insurance coverage to all Americans. The concepts of “minimum value” and its correlate “actuarial value” speak to the...more

Revisit Surveys To Slow Down Due To Budget Sequestration

by Jason Lundy | Polsinelli on 5/17/2013

As of April 5, 2013 and in response to budget sequestration, the Centers for Medicare & Medicaid Services (CMS) warns that revisit surveys for skilled nursing facilities will be delayed and approval requirements for...more

DOL (Finally) Issues Model Exchange Notice

by Jewelie Grape | Leonard, Street and Deinard - Employee... on 5/16/2013

On May 8, 2013, the Department of Labor (DOL) issued long-awaited temporary guidance and a model notice to be provided to employees about upcoming coverage options through the health care exchange, known as the Marketplace,...more

Raising the Stakes of Worker Misclassification Yet Again

by Morgan Lewis on 5/16/2013

New requirements under the Patient Protection and Affordable Care Act are set to intensify state and federal governments' crackdown on worker misclassification....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

How to Recognize Insurance Bad Faith

by Lewis and Pokora on 5/16/2013

When you purchase an insurance policy and pay your monthly premiums, you expect your insurer to honor claims when you suffer a loss. One of insurance’s greatest benefits is supposed to be the peace of mind it purchases — the...more

Business Interruption Insurance

by Peter Bauman - Senior Associate at Tharpe &... on 5/16/2013

Business Interruption Insurance Business Interruption Insurance (“BII”) is a form of commercial insurance coverage that provides limited but useful protection when a business is unable to continue normal operations or occupy...more

Employers Must Notify Employees of the Availability of Health Insurance Exchanges - Employers Can Use Model Notices Issued by the...

by Allison De Tal, Isabel Safie, John Wahlin | Best Best & Krieger LLP on 5/16/2013

The Patient Protection and Affordable Care Act added Section 18B to the Fair Labor Standards Act (FLSA), requiring employers to give notice to employees of the coverage options available through state insurance exchanges....more