News & Analysis as of

Securitisation: Keeping it Simple?

On 30 September 2015, the European Commission (the “Commission”) published a proposal for a regulation (the “Proposed Regulation”)1 intended to harmonise existing EU laws applying to securitisations (including proposed...more

IREG Update - October 2015

Hot Topic - How Central United Life v. Burwell will affect the fixed indemnity market - Background - For many years, at least some state insurance regulators have sought to place limitations on the sale of fixed...more

A Summary of Predicted Litigation Under the DOL’s Proposed Fiduciary Rule

The Department of Labor’s recent Proposed Rule, which defines the term "fiduciary" as it applies to persons who provide "investment advice" to ERISA plans and IRAs, will impact the likelihood and severity of fiduciary...more

Catching Up To Insurers’ Use of Big Data

Various groups within the NAIC are beginning to study the way in which insurers are using big data. On the property and casualty front, the Market Regulation (D) (Market Reg) Committee is reviewing the use of big data in...more

UnitedHealthcare Services Denied Injunction Against Out-of-Network Physician Seeking to Bar Balance Billing of the Patient

In UnitedHealthcare Servs., Inc. v Asprinio (2015 NY Slip Op 25298), decided on August 31, 2015, in the Supreme Court of Westchester County, UnitedHealthcare suffered a set-back against attempts to prevent balance billing by...more

Business Interruption Insurance: Why You Need It and How You Can Maximize Your Coverage

In his recent blog post on disaster planning for businesses, Foley associate Nicholas E. Williams noted: “Business interruption insurance, which covers the loss of income suffered by a business after a disaster, plays an...more

Texas Supreme Court Declines Opportunity to Review Appellate Decision Clarifying Insurer’s Settlement Obligations In...

Last year in Patterson, et al. v. Home State County Mut. Ins. Co., 2014 Tex. App. LEXIS 4460, 2014 WL 1676931 (Tex.App., Apr. 24, 2014), the Texas First Court of Appeals (Houston) held that an insurer was not obligated to...more

Final 2015 Forms 1094-B, 1095-B, 1094-C, 1095-C and Instructions

On September 16, 2015, the IRS finalized these ACA coverage reporting Forms and Instructions... We report here, with minimal analysis, changes that we recognized on first comparison to the 2015 Draft Forms and Instructions....more

Symptoms of the Texas Progressive Claim Syndrome

Those familiar with the issues faced by insurers in Texas first-party insurance claims, particularly in the realm of hail damage claims, are undoubtedly aware of what has been labeled the "Progressive Claim Syndrome.” In a...more

U.S. Third Circuit Allows Providers to Sue Health Insurers Directly

For many years, the United States Court of Appeals for the Third Circuit was out of step with its sister Courts of Appeal when it came to the issue of suing health insurance companies for failing to cover the medical expenses...more

Third Cir. Holds Hospitals May Sue Health Insurers Directly

Before September 11 the Third Circuit Court of Appeals had been out of step with its sister federal circuits when it came to the right of hospitals, physicians and other health providers to sue health insurers that failed to...more

Allocation Of Covered And Uncovered Claims: Recent Decisions On Burden Shifting And Pre-Approval Requirements

Ongoing efforts by insurers to recover amounts paid for uninsured losses after settlement or judgment have resulted in extensive litigation over allocation issues. Conflicting opinions have arisen over which party bears the...more

Validus Round Two: Court of Appeals’ Decision Holding That Wholly-Foreign Retrocessions Are Not Subject to Federal Excise Tax...

On May 26, 2015, the United States Court of Appeals for the District of Columbia upheld a District Court decision and ruled that the Internal Revenue Service could not impose excise tax on certain wholly-foreign retrocessions...more

Insurance Recovery Law - September 2015

Exception to Mold Exclusion Requires Defense of Suit Alleging Injuries From Moldy Water - Why it matters: An exclusion for "Fungi or Bacteria" did not prevent a federal court judge in Tennessee from ordering an insurer...more

The Consumer Financial Protection Bureau: What Insurers Should Know

Q: When does the Consumer Financial Protection Bureau (CFPB) have authority over insurance ?companies? The federal legislation commonly known as the Dodd-Frank Wall Street Reform Act, which created the ?CFPB,...more

Louisiana Court Grants Summary Judgment In Favor Of Insurer Based On Application Of Cooperation Clause

In Johnson v. GeoVera Specialty Ins. Co., 2015 U.S. Dist. LEXIS 113838 (E.D. La. Aug. 27, 2015), the court granted summary judgment in favor of an insurer based upon the cooperation clause of the insurer’s...more

California Court of Appeal Finds Life Insurance Policy Ambiguous and Rules in Favor of the Insured

Sequeira v. Lincoln Nat’l Life Ins. Co., No. A139639 (Cal. Ct. App. Aug. 31, 2015) - The California Court of Appeal recently reiterated the importance of careful drafting to insurers when it reversed a trial court’s...more

Kissing Camels Antitrust Suit Against Health System Moves Past Another Hump in the Road

In June, an antitrust suit brought by plaintiff ambulatory surgery centers (“ASCs”) against a health system, health insurers, and a trade association survived a motion to dismiss. Last week, the ASCs’ case cleared the hump of...more

Eleventh Circuit Finds No Bad Faith in Multiple-Claimant Claims-Handing Situation

In a new decision, Mesa v. Clarendon National Ins. Co., 2015 WL 5059496, 2015 U.S. App. LEXIS 15203 (11th Cir., Aug. 28, 2015), the Court of Appeals found that the insurer’s claims-handling of multiple claimants did not rise...more

NAIC Report: 2015 Summer National Meeting

The National Association of Insurance Commissioners (NAIC) held its 2015 Summer National Meeting from August 13 through August 18 in Chicago, Illinois. The meeting was notable for the number of new insurance commissioners...more

Joint Letter to the Market by IVASS and the Bank of Italy of 26 August 2015

Considering the critical issues brought to light during the respective enquiries, in part in response to reports by several consumer associations, on 26 August 2015 IVASS and the Bank of Italy (the “Supervisory Authorities”)...more

Death v. Suicide in Event Cancellation Policies

While many Event Cancellation/Non-appearance policies offer effective coverage for financial losses and additional costs when the insured performer dies from natural causes or an accident, they reach their limits if the...more

Seventh Circuit Issues Stern Warning For Insurers That Reject Their Duty to Defend

The first line of the Seventh Circuit’s opinion says it all: “This case provides a warning for insurance companies who refuse to defend their insureds.” As the court’s admonishment suggests, insurers that improperly refuse to...more

11th Circuit to decide whether construction defect notice under Florida repair statute is a “suit”

Recently, the United States District Court for the Southern District of Florida addressed what constitutes a “suit” within the context of Florida’s right-to-repair procedure for construction defect disputes. In Altman...more

DIR Conference Oriented Toward Insurers

The fifth annual Division of Industrial Relations Workers’ Compensation conference, held on August 19 and 20, 2015, was attended mostly by people servicing employers , insurers,  and third-party administrators in the workers’...more

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