Insurance Civil Procedure

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NJ Supreme Court Gets it Right! Consequential Damages Caused by a Subcontractor's Defective Construction Work is Insured

The New Jersey Supreme Court’s August 4, 2016 decision in Cypress Point Condominium Association, Inc. v. Adria Towers, LLC opened the door for general contractors to obtain insurance coverage under their commercial general...more

Look, up in the sky! It’s a bird, it’s a plane, it’s… uh oh… a Super Lien!

Liability insurers have always gnashed teeth over the dreaded “super lien” – aka a lien asserted by Medicare for treatment expenses where the patient is reimbursed through a settlement obtained in personal injury litigation....more

Wyoming Requires Insurer Prejudice for Late Notice

The Wyoming Supreme Court ruled on August 17, 2016 that an insurer “must be prejudiced before being entitled to deny coverage when the insured has failed to give notice ‘as soon as practicable.’” In addressing a certified...more

Hospital and Fixed Indemnity Policies; Excepted Benefits; Supplemental Coverage under Recently Proposed Treasury Regulations; and...

We reported in a recent post on proposed regulations dealing with, among other things, the treatment of hospital indemnity or other fixed indemnity insurance products in the group market. This post takes a closer look at the...more

Eleventh Circuit Finds Insurer Liable for Medicare Lien Notwithstanding Insurer's Efforts to Satisfy the Lien in Settlement, also...

In a case with far-reaching implications, the Eleventh Circuit Court of Appeals issued an opinion concluding that the Medicare Secondary Payer Act (MSP) permits a private insurance company/PART C Medicare Advantage...more

A Constitutional Challenge to Florida's New Unclaimed Property Act Amendments

In April, Florida amended its Disposition of Unclaimed Property Act (“Act”) to require life insurers to perform Death Master File (DMF) searches for all policies issued since 1992. The amended Act also provides that a DMF...more

11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436. Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more

Michigan Health Insurance Claims Assessment Act is Not Preempted by ERISA

The Sixth Circuit, has decided, on remand from the Supreme Court, that the Michigan Health Insurance Claims Assessment Act (Act) is not preempted by ERISA. The Act imposes a 1 percent tax on all paid claims by insurers or...more

ERISA Preempts State Law Requiring Insurer “Prompt Payment”

Alaska’s prompt pay statute—which requires insurers to pay benefit claims within 30 days of submission—is preempted by federal laws governing employer-provided benefits and benefits for government workers, a federal judge...more

Key Arguments in Defending a Disability Claim Based on Subjective Complaints

Courts often do not clearly articulate what are key arguments in defending an action under the Employee Retirement Income Security Act of 1974 (ERISA) involving a claim for benefits based on subjective complaints. However,...more

STOLI Policies Cancelled, Insurers Retain Premium

Two federal appellate courts have affirmed, on different grounds, the cancellation of large life insurance policies that were alleged to be stranger originated life insurance (STOLI), permitting the issuing insurers to retain...more

New Wave of COI Rate Increase Lawsuits Hits the Industry

Historically, increases to cost of insurance (COI) rates on universal life (UL) policies have been met with legal challenges from policyholders, and sometimes, regulatory opposition spurred by policyholder complaints. The...more

Assignment v. Subrogation — Prosecuting Recovery Actions Arising from Personal Injury Claims

It is common in most jurisdictions that personal injury claims cannot be assigned. This can occasionally present a concern when an insurance carrier attempts to bring a contribution action against a third-party tortfeasor...more

Settling Defendants Beware: Eleventh Circuit Holds Settling Insurer Liable for Failure to Protect Medicare Payments Made by...

Congress created an uproar among personal injury tort defendants and their insurers when it passed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) less than 10 years ago. The $1,000 per day fine for failure to...more

Where Does a Third Party “Stand” on Liens?

Dion v. William Robert Batten, Sr. (8/2/16) Facts and Procedural History: Plaintiff was employed by Neuwirth as a servicing agent. In the course and scope of his employment with Neuwirth, he was involved in a car...more

Collateral lies: The lie is dishonest but the claim is not

The Supreme Court rules that a collateral lie embellishing a valid claim does not amount to a fraudulent claim. Versloot Dredging BV and another (Appellants) v HDI Gerling Industrie Versicherung AG and others [2016] UKSC...more

Missouri Western District Court of Appeals Reminds Us to Pay No Attention to the Headings for the Revised Statutes

The Missouri Western District Court of Appeals recently affirmed a trial court’s issuance of summary judgment and, in the process, reminded practitioners that the bold faced headings in the Revised Statutes are not part of...more

Florida’s Fifth District Allows Evidence of Prior Sinkhole Insurance Settlement in Subsequent Sinkhole Trial

In Tower Hill Signature Ins. v. Speck, 2016 Fla. App. LEXIS 12167 (Fla. Dist. Ct. App. 5th Dist. Aug. 12, 2016), the Fifth District found the trial court abused its discretion by not admitting into evidence the amount of a...more

“Low-Ball” Settlement Offer On Its Own Is Insufficient To Support A Claim for Bad Faith Under Pennsylvania Law

A low-ball settlement offer on its own is not enough to state a claim for a bad faith according to a federal district court for the Eastern District of Pennsylvania which granted the insurer’s motion to dismiss the insured’s...more

Control-of-Well Insurance: The Words of the Policy Control

Gemini Insurance Company at al v. Drilling Risk Management Inc construed control-of-well and redrill/extra-expense provisions in an insurance contract. The question and the rule - The question was whether an...more

Distinguishing ‘collateral lies’ from the fraudulent claims rules in insurance contracts: the lie is dishonest but the claim is...

In Versloot Dredging BV and another v HDI Gerling Industrie Versicherung AG and others [2016] UKSC 45, handed down, last month, the Supreme Court ruled that a “collateral lie” made during the course of an insurance claim...more

Claimants’ Demand for Superfluous Wording In Release Does Not Excuse Insurer’s Failure to Accept Policy Limit Offer Within Time...

In Barickman v. Mercury Casualty Co. (No. B260833, filed 7/25/16, ord. pub. 8/15/16) a California appeals court affirmed a $3 million bad faith award against Mercury Casualty Co. based upon its failure to accept a policy...more

ERISA: “Key Evidence Needed to Prove the Intoxication Exclusion”

You know that many insurance policies and ERISA-governed plans exclude from coverage disabilities “resulting from, or related to…any accident related to the voluntary influence of any drug, narcotic, intoxicant or chemical….”...more

Final Judgment Entered And Notice Of Appeal Filed In Longstanding Reinsurance Dispute

In the ongoing reinsurance dispute between cedent Utica Mutual Insurance Company and reinsurer Clearwater Insurance Company, about which we most recently posted on February 9, 2016, two developments occurred on July 14, 2016....more

New Jersey Supreme Court Holds CGL Policies Cover Developer/General Contractor for Damage Caused by Subcontractor’s Faulty...

The New Jersey Supreme Court recently considered whether damage caused by a subcontractor’s faulty workmanship constitutes property damage caused by an occurrence under a developer/general contractor’s commercial general...more

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