News & Analysis as of

Medical Expenses Insurance Industry

Rumberger | Kirk

Florida Supreme Court Says Permissive Language of Florida PIP Statute and Policy Provisions Dictate Payment of Medical Expenses by...

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In Florida, personal injury protection (PIP) coverage limits reimbursement of medical charges to 80% of “all reasonable expenses.” What is “reasonable” is generally determined by a statutory schedule of maximum charges...more

Chartwell Law

New York Governor Vetoes Grieving Families Act

Chartwell Law on

On December 29, 2023, New York Governor Kathy Hochul vetoed, for a second time, the Grieving Families Act (the Act), a proposed amendment to New York’s wrongful death statute; that statute remains unchanged....more

Rivkin Radler LLP

A Sleeping Giant: New York’s Grieving Families Act

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The pen is mightier than the sword — especially a pen held by a sitting governor. Currently sitting on the desk of New York’s governor is a piece of proposed legislation known as the “Grieving Families Act” which, if signed...more

Proskauer - Employee Benefits & Executive...

Sixth Circuit Highlights Importance of the Plan Document

A recent decision by the U.S. Court of Appeals for the Sixth Circuit (Patterson v. United HealthCare Ins. Co., No. 22-3167, 2023 WL 4882436 (6th Cir. Aug. 1, 2023)) illustrates the importance of clearly describing key plan...more

Rumberger | Kirk

The Multiple Issues Surrounding Medicare and Past Damages

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What amount of past medical expenses can a plaintiff present to the jury when he or she is a Medicare recipient? The short answer: only the amount of past medical expenses the plaintiff is obligated to pay, not the gross...more

Rumberger | Kirk

Florida Supreme Court Could Finally Provide Clarity on Payment of Medical Expenses by Insurers under Florida PIP Statute

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The Florida Supreme Court heard arguments Wednesday, March 8, 2023, in the case of Allstate Insurance Co. et al. v. Revival Chiropractic LLC, case number SC22-735, regarding payment of medical expenses that could affect...more

Rumberger | Kirk

Eleventh Circuit Finds Medicare Secondary Payer Act Not Preempted by Procedural Requirements

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This past week, the United States Court of Appeals for the Eleventh Circuit held that private causes of action brought under the Medicare Secondary Payer Act (MSP Act) are not preempted by contractual and state procedural...more

Jaburg Wilk

Arizona Insureds are Legally Entitled to Recover Reasonable Rather Than Incurred Medical Expenses

Jaburg Wilk on

Is an insured legally entitled to recover the incurred amount of medical expenses or a reasonable amount of medical expenses? This issue often arises in first-party bad faith cases arising from uninsured motorist (“UM”) and...more

Dentons

Iowa Legislature Addresses "Phantom Damages" in New Bill

Dentons on

Governor Reynolds signed a bill this week altering and clarifying the amount of damages a claimant may recover for medical expenses in a personal injury lawsuit. This new law remedies confusion that had arisen over time...more

Sands Anderson PC

Virginia's "Collateral Source Rule" Applies to Breach of Contract Matters

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In negligence actions, Virginia has long adhered to the “collateral source rule” which holds that payments received by an injured plaintiff from a source other than the tortfeasor/defendant are not deducted from the damages...more

Maynard Nexsen

Collateral Source Rule - Is Change Coming to South Carolina?

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South Carolina has long recognized the common law collateral source rule. The rule provides that any compensation received by an injured party from a source independent of the tortfeasor cannot be applied to reduce damages...more

Michigan Auto Law

Rep. Lucido’s Macomb Solution to get rid of Michigan’s Mandatory Car Insurance is Ludicrous

Michigan Auto Law on

So-called “Macomb Solution” to get rid of mandatory car insurance in Michigan and allowing drivers to elect to be uninsured is epically bad idea; financial ruin if a car crash occurs - Macomb County Rep. Pete Lucido’s...more

Ward and Smith, P.A.

North Carolina Cases Involving Traumatic Brain Injuries

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A traumatic brain injury ("TBI") results from a specific traumatic event causing some type of damage to the brain. Such trauma could be the head being struck by an object or being jolted by a collision, or even having an...more

Butler Snow LLP

Bills, Bills, Bills: Calculation of Past Medical Expenses under Texas Law

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Under Texas law, recovery of past medical expenses is limited to the amount actually paid or incurred. Section 41.0105 was enacted in 2003 by the Texas Legislature as a tort reform initiative to limit past medical damages to...more

Butler Weihmuller Katz Craig LLP

Florida's SIU Tool Belt Is a Bit Lighter Today

Florida has been plagued with insurance fraud for decades.  All insurance coverages are susceptible to fraud, but scams are especially prevalent in the context of automobile accidents.  Staged crashes, patient brokering,...more

Pullman & Comley, LLC

Washington Weighs In On The Scope Of Insurance Regulators’ Authority

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In January, we reported that California’s Supreme Court had embraced a problematic approach to the state’s Unfair Insurance Practices Act—one that allows the Commissioner of Insurance to create new statutory torts by...more

Pullman & Comley, LLC

The Ghost of Systems Past: “Big Data” Suits Loom, But Old Data Issues Remain Unresolved

Pullman & Comley, LLC on

2017 could be big for litigation over “Big Data” applications in insurance. This past year saw the filing of several “price optimization” class actions, and claims against a fraud detection tool, similar to the ones used by...more

Robins Kaplan LLP

How Concerned Should Insurers be About Punitive Damages in California?

Robins Kaplan LLP on

The California Court of Appeal recently published another opinion about the Nickerson v. Stonebridge Life Insurance case. The court held to its maximum 10:1 punitive-to-compensatory-damages ratio and analyzed whether this...more

Pullman & Comley, LLC

No Health Insurers Need Apply: Health Plan Can’t Recover Medical Costs From NY No-Fault Insurer

Pullman & Comley, LLC on

Under no-fault laws, automobile policies typically must cover the cost of certain medical services provided to policyholders who have been injured in covered accidents. New York’s insurance laws also permit those costs to be...more

Carlton Fields

Seeing the Finish Line: Courts Increasingly Exempt Claims-Made Policies from the Notice Prejudice Rule

Carlton Fields on

In a majority of jurisdictions, the “notice-prejudice rule” provides that an insurer may not deny a claim on grounds of late notice without demonstrating prejudice. The rule is statutory in some states and judicially crafted...more

Cozen O'Connor

An Insurer Cannot Claim That It Was Unaware of Claims Handling Statutes As A Defense To Bad Faith

Cozen O'Connor on

The South Dakota Supreme Court in Bertelsen v. Allstate Insurance Co., 833 N.W.2d 545, No. 26442 (June 12, 2013) (1) held that an insurer cannot avoid bad faith liability by claiming it did not know about controlling claims...more

Hinshaw & Culbertson LLP

Could Medpay Be The Latest Target In California Bad Faith Claims?

Marina Karvelas was quoted in a July 18, 2013, article published by Claims Journal, Could Medpay Be The Latest Target In California Bad Faith Claims, about a recent appeals court decision in California dealing with bad faith...more

Mintz - Health Care Viewpoints

Examining Charitable Patient Assistance Programs Part Two in a Series: Independent Audits of Charitable Entities

In today’s challenging health care environment, Charitable Patient Assistance Programs (Charitable PAPs) have emerged to meet the needs of the nearly 30 million Americans that are underinsured and have difficulty paying...more

Hinshaw & Culbertson LLP

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

Hinshaw & Culbertson LLP

Howell Rule Applies When Medical Services Were Paid by Medicare, Court of Appeal Concludes

In Howell v. Hamilton Meats & Provisions, Inc. the California Supreme Court ruled that a plaintiff’s recovery of medical damages is limited to the amount paid by the plaintiff’s health insurer and accepted by the health care...more

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