Deductibles

News & Analysis as of

New Jersey Court Holds $22 Million “Named Storm” Deductible Applicable to a Superstorm Sandy Loss

On October 29th, a New Jersey trial court held that a commercial policyholder’s Superstorm Sandy claims were subject to a $22 million “named storm” deductible equal to 2% of the total insurable values at risk at all of the...more

OIG Advisory Opinion Approves Medigap Insurer’s Plan to Use Preferred Hospital Network

On August 25, 2014, the OIG released an advisory opinion declining to impose civil monetary penalties on a Medicare Supplemental Health Insurance – or Medigap – insurer that planned to discount inpatient hospital deductibles...more

OIG Okays Medigap Insurer’s Arrangement for Discount on Inpatient Deductibles

Last Monday the Office of Inspector General (OIG) of Health & Human Services posted an advisory opinion (No. 14-07) allowing a Medigap insurance company to strike a deal with hospitals for discounts—even waivers—of the...more

ODSP – Is it deductible from Non-Earner and Income Replacement Benefits?

The decision by Arbitrator Alves in Anglin v. State Farm [FSCO A11-000817] resolves the issue of whether an Insurer is able to deduct ODSP payments from non-earner benefits. In this case, at the time of the accident, the...more

ACA’s Deductible Limits for Small Groups Repealed

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. The primary purpose of the law is to provide a one-year delay of a 24% reduction in payment rates for physicians who participate...more

Congress Passes Rare Bipartisan Amendment To Obamacare

There is not a lot that Democrats and Republicans can agree on with respect to Obamacare, but on April 1, 2014 the President signed into law a Medicare bill which had a provision tucked inside that will bring some important...more

The Affordable Care Act—Countdown to Compliance for Employers, Week 38: Congress Eliminates Separate Cap on Deductibles

In a rare display of bipartisanship, Congress voted to eliminate the Affordable Care Act’s separate cap on deductibles that applies to individual and small group insurance products. (These limits never applied to large...more

New York State Court Allows Policyholder to Pay Minimum Deductible for Flood Loss

In a January 2014 decision that may prove valuable to policyholders in their disputes over deductibles, a New York state trial court ruled that the appropriate deductible applicable to an oil terminal operator’s $2.28 million...more

October 2013: Insurance Litigation Update - Deductibles Need Not Be Made Whole

On July 30, 2013, the Connecticut Supreme Court released its opinion in Fireman’s Fund Insurance Company v. TD Banknorth Insurance Agency, Inc., SC 18796 (Conn. 2013), answering a certified question from the Second Circuit on...more

Connecticut Supreme Court: “Make Whole” Doctrine Is Default Rule, But Does Not Apply to Policy Deductibles

In Fireman’s Fund Ins., Co. v. TD Banknorth Insurance Agency, Inc., SC 18796 (Conn. 07/30/2013), the Connecticut Supreme Court answered two certified questions of first impression under Connecticut insurance law: - Is...more

Agencies Provide Guidance on Additional Health Care Reform Changes Impacting Non-Grandfathered Employer Group Health Plans

The Departments of Health and Human Services, Labor, and Treasury (collectively, the “Departments”) during the first half of the year issued guidance in the form of Frequently Asked Questions (the “FAQs”) on certain...more

Maryland Insurance Bill Makes it a Fraudulent Act to Compensate for Deductible

Senate Bill 736 will enacted as Code of Maryland Insurance Article § 27-407.2. It repeals and replaces §§ 27-408(a) and (b). The bill makes it a “fraudulent insurance act for a person to pay or otherwise compensate,...more

Real Estate Tip – Casualty Loss: High Insurance Deductibles Can Inflate Common Area Maintenance Charges

A single casualty loss can affect both the tenant’s commercial space and the landlord’s structure. When that happens, a surprise cost can effectively reduce tenant’s insurance proceeds. The landlord may pass along its high...more

S.B. 112 – Proposed Property Insurance Reform Bill in Texas

A Texas State Senator has introduced legislation that would require residential property insurance carriers to include on the declarations page a dollar amount and explanation for every deductible. ...more

Policy Observer - January 2013

It has been nearly three months since Superstorm Sandy battered the East Coast of the United States. With several hundred thousand residents still without homes and many businesses still operating out of temporary facilities,...more

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