News & Analysis as of

Claim Procedures

WilmerHale

In Narrow Victory for Tribal Nations, US Supreme Court Requires Federal Government to Reimburse Tribal Nations for Healthcare...

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On June 6, 2024, the US Supreme Court decided Becerra v. San Carlos Apache Tribe and Becerra v. Northern Arapaho Tribe (Nos. 23-250 and 23-253), holding that the Indian Health Service (IHS) must reimburse Native nations,...more

Zelle  LLP

When Are Insurance Code Chapter 542 Penalties Not Owed?

Zelle LLP on

There are a litany of deadlines an insurer must be mindful of, and this is especially true in Texas, which imposes a number of statutorily prescribed deadlines during the claim adjustment process. The Texas Prompt Payment of...more

Holland & Knight LLP

Tribes: Act Now to Take Advantage of Supreme Court's Decision on Contract Support Costs

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The U.S. Supreme Court ruled on June 6, 2024, that the Indian Health Service (IHS) must pay contract support costs with respect to program income – payments from Medicare, Medicaid and private insurers – received by tribes...more

Lathrop GPM

Payment Card Settlement Claim Deadline Extended to August 30, 2024

Lathrop GPM on

A very large class action settlement has an approaching deadline for class members to file claims. The class is very broad, defined as “all persons, businesses, and other entities that have accepted any Visa-Branded Cards...more

McDermott Will & Emery

This Week in 340B: May 14 – May 20, 2024

McDermott Will & Emery on

Find this week’s updates on 340B litigation to help you stay in the know on how 340B cases are developing across the country. Each week we comb through the dockets of more than 50 340B cases to provide you with a quick...more

Cooley LLP

Court of Appeal Decides Principles Permitting Group Litigation by Allowing Multiple Claimants to Make Individual Claims on Single...

Cooley LLP on

England has no direct equivalent to US class actions. However, there are various claim models under English procedural rules (CPR) that have similarities. They are summarised in our October 2022 blog post – Data Disputes: How...more

Polsinelli

HRSA Aims for Swift Dispute Resolution with new 340B ADR Final Rule

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On April 18, 2024, HRSA released its 2024 340B Administrative Dispute Resolution (ADR) Final Rule (2024 ADR Final Rule) and it is largely favorable to covered entities (CEs) with pending ADR claims against drug manufacturers....more

Polsinelli

Department of Labor Sues UnitedHealth TPA Over Claim Denials

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The U.S. Department of Labor (“DOL”) recently filed a lawsuit against UMR, Inc., a third-party administrator and UnitedHealth Group, Inc. subsidiary. The lawsuit alleges that UMR denied thousands of claims based on diagnosis...more

Keating Muething & Klekamp PLL

Benefits Monthly Minute - October 2023

In the October Monthly Minute, we highlight a 6th Circuit decision that puts a spotlight on the adequacy of claim procedures and related judicial standards of review, and review the Supreme Court’s unwillingness to enter the...more

J.S. Held

Integrating Independent Forensic Analyses in International Construction Arbitrations

J.S. Held on

This article discusses the various independent analyses that experts perform and how these analyses should be integrated when involved in a construction dispute that has progressed to international arbitration. While experts...more

Ward and Smith, P.A.

NC Courts Step Into the Digital Age With E-Filing Rollout: A Look at the Progress

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The rollout of a statewide electronic court filing system called Odyssey Integrated Case Management System, or Odyssey ICMS, is officially underway....more

Cranfill Sumner LLP

NC Court of Appeals Sets Standard for Extended Benefits in Sturdivant v. NC Department of Public Safety – What’s Next?

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In Sturdivant v. NC Department of Public Safety (No. COA22-421), the North Carolina Court of Appeals affirms Full Commission Opinion and Award denying extended benefits under N.C.G.S. 97-29 (c)...more

White & Case LLP

Important Changes to FIDIC’s Rainbow Suite

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In international construction contracts, few legal matters are more important than the definitions of "Claim" and "Dispute" or the procedure for the "Dispute Avoidance/Adjudication Board ("DAAB")". These are all the subject...more

Wiley Rein LLP

Court Requires Insurer Show Prejudice for Coverage Denial Where Notice of Claim Given After Reporting Window but Within Policy...

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The United States District Court for the Eastern District of Oklahoma, applying Oklahoma law, granted an insured’s motion for summary judgment, finding that a claim was sufficiently made and reported during the policy period....more

Butler Weihmuller Katz Craig LLP

Bracing for Fiona – A pre and post analysis of hurricane risk in Puerto Rico and the Caribbean

How can carriers prepare for what is to come after Fiona’s direct impact on Puerto Rico? First and foremost, carriers should begin securing and mobilizing an adequate roster of independent adjusters, ready to respond to...more

J.S. Held

Using Public Records in Damages Analysis

J.S. Held on

“Garbage in, garbage out” is a popular adage in the world of analysis. The general concept is that faulty inputs produce low-quality outputs. This is especially true when it comes to evaluating economic damages claims for...more

Perkins Coie

Voyager Creditors—Deadline Set for Filing Bankruptcy Proofs of Claim

Perkins Coie on

Customers and creditors of Voyager Digital Holdings face a deadline to file official “proofs of claim” setting forth the amounts they assert that Voyager owes them. The deadline is 5:00 p.m. ET on October 3, 2022...more

Stark & Stark

A Simple Guide to Exactech Hip, Knee and Ankle Replacement Lawsuits and Settlements

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How Do I Know If I Have a Exactech Claim? STEP 1: Obtain Medical Records - We have written extensively about the different types of defects in certain Exactech products, and the various causes of those defects,...more

Robinson+Cole ERISA Claim Defense Blog

U.S. Supreme Court Denies Review Of Significant Second Circuit Ruling On The Scope Of California’s Anti-Discretion Statute And The...

The U.S. Supreme Court recently declined to review a significant decision of the Second Circuit which (1) clarified the scope of California’s statutory ban on discretionary clauses in life and disability insurance contracts,...more

Robinson+Cole ERISA Claim Defense Blog

Second Circuit Clarifies That Reclassification of Health Status That Limits Scope of Disability Benefits Does Not Constitute...

In Ruderman v. Liberty Mut. Grp., Inc., No. 21-817, 2022 WL 244086 (2d Cir. Jan. 27, 2022), the U.S. Court of Appeals for the Second Circuit ruled that reclassification of a claimant’s disability from one that is...more

Proskauer - Proskauer For Good

Demanding More for Our Disabled Veterans

A recent statement by the U.S. Department of Veterans Affairs (VA) announced that it is hiring 2,000 new employees to help with processing disability claims, which is welcome news given that the current backlog of claims...more

White & Case LLP

Extensions of time in construction projects: prospective or retrospective delay analysis?

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Contractors' extension of time (EOT) entitlements and associated financial rights are always to be assessed pursuant to the applicable contract mechanism. A recurring question is whether EOT entitlements are to be determined...more

PilieroMazza PLLC

5 Things Every Contractor Should Know About the Contract Disputes Act

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The well-worn adage that “you can’t fight City Hall” does not apply to federal government contractors.  The Contract Disputes Act (CDA) provides the statutory framework governing contract disputes between contractors and the...more

Burr & Forman

Investigating and Defending Identity Theft Claims Against Furnishers Under The Fair Credit Reporting Act

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Introduction - The Fair Credit Reporting Act (FCRA) was enacted to promote the accuracy, fairness, and privacy of information maintained by Consumer Reporting Agencies (CRAs). In addition to imposing duties on the CRAs,...more

Jones Day

Disclaimer Before Institution May Not Thwart PGRs

Jones Day on

In Microsurgical Tech., Inc. v. Regents of the Univ. of Colorado, No. PGR2021-00026, Paper 12 (P.T.A.B. June 16, 2021), the Patent Trial and Appeal Board (“PTAB”) held that disclaimed claims should be considered for...more

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