Insurance Civil Remedies

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Expanding When Liability is “Reasonably Clear”: Massachusetts Court Chips Away at Bad Faith Counterarguments

Earlier this month, a Massachusetts Appellate Court affirmed a trial court’s award of bad faith damages in a case where it found the insurer’s approach to a claim to be “at best inattentive, if not incompetent.” Although 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

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 Medicare...more

New Jersey Supreme Court Affirms General Contractor’s Insurance Coverage for Consequential Damages Caused by a Subcontractor’s...

In an important recent decision, New Jersey joined a growing number of states holding that Insurance Services Office’s (ISO) 1986 comprehensive general liability (CGL) policy extends coverage to a property developer faced...more

Eleventh Circuit affirms ruling of no coverage based on insured’s failure to cooperate

As a condition to coverage under standard liability policies, the insured is required to cooperate with its insurer. The provision, termed the “cooperation clause,” typically requires the insured to assist with and...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

Health Plan Case Managers Entitled to Overtime Pay

Managed care companies help insurers and government programs coordinate healthcare plans by making coverage determinations for participants. In many situations, case managers conduct utilization reviews to determine the...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

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

Insurance Coverage – Equitable Indemnity Claim by Excess Carrier

Ace American Insurance Company v. Fireman’s Fund Insurance Company - Court of Appeal, Second Appellate District (August 5, 2016) - Where an underlying insurer rejects a settlement offer within its policy limits, and...more

Summary Judgment May Be Appropriate When Insured Fails to Take Reasonable Measures to Prevent Property Damage

Many first party property insurance policies exclude claims for water damage that occurs when the insured premises is left vacant or unoccupied, unless the insured has used reasonable care to prevent such losses. In...more

Delaware Chancery Court Finds That Anti-Suit Injunction Bars Trustee Under Reinsurance Trust Agreement From Pursuing Third-Party...

Freestone Insurance Company is a Delaware-domiciled insurer that has been placed in liquidation. U.S. Bank National Association served as the trustee under a reinsurance trust agreement (the “Trust Agreement”) between...more

Eleventh Circuit’s Liberal Reading of Bonner Mall a Game Changer for Class Actions?

An Eleventh Circuit panel recently vacated two district court orders after sending the parties to mediation, and after the parties’ conditioned settlement on vacatur of the orders. In Hartford Casualty Insurance Company v....more

DOJ Sues to Block Health Plan Mergers

The U.S. Department of Justice (DOJ), joined by attorneys general from several states, filed a lawsuit last Thursday in the U.S. District Court for the District of Columbia seeking to block two major mergers between health...more

Alberta Government Updating 2004 Auto Insurance Reforms

The Alberta government has announced that it is in the process of updating the regulations involved in the 2004 auto insurance reform, namely the Minor Injury Regulation, Alta Reg 123/2004; the Diagnostic and Treatment...more

California Supreme Court Clarifies Constitutional Limits on Punitive Damages

In Brandt v. Superior Court, the California Supreme Court held that when a plaintiff proves that an insurance company withheld policy benefits in bad faith, attorneys' fees reasonably incurred to compel payment of the...more

Don’t Mess with the Texas Prompt Payment of Claims Act: One Court’s Appraisal Result

Virtually all property insurance policies contain an appraisal clause, which outlines the appraisal procedure in broad terms. Those broad terms sometimes do not provide much guidance about the process, or about the effect...more

More Common Sense: Coverage for Collapse Requires More Than an Engineer’s Finding of Substantial Impairment

In February this blog commented on Washington State’s newly-adopted definition of “collapse” in property insurance policies that contain no specific definition of the term. (Observer, February 8, 2016, Common Sense Prevails: ...more

Third Circuit Slams The Door On Coverage For The Cost of Defending Excluded Claims—Then Leaves It Wide Open

An insured corporation settles a class action, and a portion of the settlement pays the plaintiffs’ attorneys. Payments to the class are excluded from coverage under the terms of the corporation’s liability policy. But can...more

Third Parties (Rights Against Insurers) Act 2010 Comes Into Effect Soon

After years of delay, on 1 August 2016, the Third Parties (Rights against Insurers) Act 2010 will be brought into force in the United Kingdom, making it easier for a party with a claim against an insolvent business to bring...more

Subrogation recovery did not violate the made-whole-rule and was not in bad faith per Wisconsin Sup. Ct.

It is highly unusual to find an insurance bad faith case which stems from an insurance company’s subrogation recovery. On July 6th, Wisconsin’s highest court had such a case, reversing the appellate court and holding that...more

Employing Insurance to Protect You From Wage & Hour Suits In Light of Updated Regulations

In 2014, we reported that wage and hour lawsuits—claims in which employees and companies dispute the amount owed to an employee or class of employees for overtime work— had increased 432 percent over the last two decades. ...more

Insurance Coverage – Genuine Dispute as Defense to Bad Faith

Clayton D. Paslay, et al. v. State Farm General Insurance Company - Court of Appeal, Second Appellate District (June 27, 2016) - Under the genuine dispute doctrine, an insurer denying or delaying the payment of...more

Injunction Enjoining Enforcement of HHS Attestation Rule Affirmed

The Court of Appeals for the District of Columbia affirmed the District Court’s decision in Central United Life v. Burwell on July 1, 2016. This decision is very significant for those assessing the future strength of, and...more

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