Personal Injury Health Insurance

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Health Alert (Australia) - November 2, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpt from Judgments Australian Capital Territory 29 October 2015 - In the matter of ER (Mental Health and Guardianship and...more

Health Alert (Australia) - October 19, 2015

In This Issue: -Judgments; Legislation; and Reports -Excerpt from Judgments New South Wales (NSW) 12 October 2015 - Klewer v Sydney Children’s Hospital Specialty Network [2015] NSWSC...more

Insurance Limits and Case Value - A Clear Correlation? [Video]

From the 2015 PLUS Medical PL Symposium session “Mo' Money, Mo' Problems: Do Limits Increase Claims Values?,” moderator Jonathan S. Ziss, Esq. (Goldberg Segalla) and plaintiffs' attorney Michael F. Barrett, Esq. (Barrett...more

Cancellation and Delay Waive Right to Later Rescind Ab Initio

In DuBeck v. Cal. Physicians' Service (No. B250129, filed 3/5/15), a California appeals court held that Blue Shield’s initial decision to cancel a healthcare policy for application misrepresentations constituted a waiver of...more

Anthem Data Breach Spawns Class Action Suits and “Phishing” Scams

Last week, Anthem Inc. – the nation’s second largest health insurer – reported a data breach involving the disclosure of the personal information of over 80 million patients and employees. Plaintiffs wasted little time...more

The Anthem Data Breach: The Fallout and What’s Next

By now (unless you have been under a snow drift), you have likely heard about the apparent intrusion into a database at the nation’s largest health insurer, Anthem, Inc. Rather than reiterate the facts as currently known...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

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

Update on medical indemnity claims statistics – Trends and risk areas

On 11 July 2014, the Australian Institute of Health and Welfare released the latest in its series of reports on medical indemnity claims in the public and private sectors. The report examined claims made, current or...more

Missouri Supreme Court Holds Federal Act Does Not Preempt Missouri Law Barring Subrogation Of Personal Injury Claims

In essence overruling a previous opinion from the courts of appeal, the Missouri Supreme Court has held that the Federal Employee Health Benefits Act (“FEHBA”) does not preempt Missouri law prohibiting the subrogation of...more

Health Alert (Australia) - 18 November 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Reports: Australia. Private Health Insurance Administration Council - 13 November 2013 - Industry consultation – Second round...more

Health Alert (Australia) - 4 November 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Reports: Australia. Department of Health & Ageing - ..1 November 2013 - GPs can now order subsidised magnetic resonance...more

Health Alert (Australia) - 7 October 2013

In This Issue: - Judgments - Legislation - Reports - Excerpt from Legislation: Commonwealth - 26 September 2013 Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No. 5)...more

Pennsylvania Commonwealth Court Holds Structured Settlement Annuity Is Transfer for Less Than Fair Market Value Under the Deficit...

The Pennsylvania Commonwealth Court’s recent decision in the matter of Sams v. Department of Public Welfare may significantly affect the structured settlement industry, and the settlement of lawsuits on behalf of certain...more

The Supreme Court Defers to Plan Language in U.S. Airways, Inc. v. McCutchen

Summary - In U.S. Airways, Inc. v. McCutchen, the US Supreme Court recently considered whether certain equitable defenses override the terms of a welfare plan in a plan fiduciary's suit for reimbursement under §...more

Florida Legislature Allows Plaintiffs to Contest Their Reimbursement to Medicaid

Effective July 1, 2013, Florida’s Medicaid Third-Party Liability Act now provides a mechanism for recipients of Medicaid to challenge the amount they must reimburse Florida’s Agency for Healthcare Administration (AHCA) after...more

Florida Medicaid Liens After Wos

The 2013 Florida legislature wasted no time responding to the March 20 Supreme Court opinion in Wos v. E.M.A., 568 U.S. __ (2013)....more

BOOK REVIEW: An Excellent Resource for Litigators Preparing for Depositions

This Book Review by Northeastern Pennsylvania insurance defense attorney of the Scranton, PA law firm of Foley, Comerford & Cummins appeared in the July 2013 edition of the Pennsylvania Lawyer Magazine. The review analyzes...more

A prerequisite to the recovery of fees: How "reasonable and necessary" are your charges?

In State Farm Mutual Automobile Insurance Co. v. Huff, 2013 DJDAR 7379 (2013), the California Court of Appeal for the Fourth Appellate District decided a novel fee case in the medical context, referencing standards used to...more

Express Plan Terms Allow Self-Insured Plan to Recover Medical Benefits Paid to Employee Post-McCutchen

In Quest Diagnostics v. Bomani, et al., 11-CV-00951 (D. Conn., June 19, 2013), the court granted Quest Diagnostic’s (“Quest”) motion for summary judgment, ruling that Quest, as the fiduciary to its self-insured medical plan,...more

High Court Holds Equitable Defenses Do Not Trump ERISA Plan’s Clear Reimbursement Language

The Supreme Court’s April decision in U.S. Airways, Inc. v. McCutchen resolves a circuit split on the issue of a medical plan’s right to reimbursement of medical expenses from a plan participant who recovers on a personal...more

Court of Appeal Applies Howell Rule to Future Medical Expenses and Noneconomic Damages

In Howell v. Hamilton Meats & Provisions, Inc., the California Supreme Court ruled that where a plaintiff’s medical care provider, pursuant to a prior agreement with the plaintiff’s health care provider, accepted less than...more

Massachusetts Mandates Prompt Investigation, Encourages Insurers to Offer Deadline Extensions to Bombing Victims

On Monday of this week, the Massachusetts’s Division of Insurance issued a bulletin mandating prompt investigation of business interruption, property damage and medical insurance claims by policyholders victimized by the...more

California Appellate Court Confirms Cap on Past Medical Expenses Applies to Medicare Payments and Should Be Imposed before Further...

In Luttrell v. Island Pacific Supermarkets, Inc. (April 8, 2013, A134089), California’s First District Court of Appeal held that Howell v. Hamilton Meats & Provisions, Inc. (2011) 52 Cal.4th 541 specifically applies to limit...more

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