Insurance

  • June 24, 2015

    Ariz. Court Nixes Arbitration In Medicare Coverage Suit

    An Arizona appeals court on Tuesday flipped a decision compelling health insurance plan administrator United Behavioral Health to arbitrate a health care provider's Medicare coverage claims, holding that Medicare's administrative procedure provides the exclusive remedy for such claims.

  • June 24, 2015

    Blue Cross Accuses Boehringer, Teva Of Pay-For-Delay Deal

    Blue Cross and Blue Shield of Louisiana accused Boehringer Ingelheim Pharmaceuticals Inc. and Teva Pharmaceutical Industries Ltd. on Tuesday in Connecticut federal court of violating antitrust laws through a pay-for-delay deal that they say inflated the price of a stroke medication. 

  • June 24, 2015

    PHH Asks DC Circ. To Nix $109M Penalty In CFPB's 1st Appeal

    PHH Corp. urged the D.C. Circuit to overturn the Consumer Financial Protection Bureau’s order that the mortgage lender pay a $109 million penalty over a mortgage insurance kickback scheme, saying the agency’s ruling in the first appeal of an administrative action was an abuse of discretion.

  • June 24, 2015

    Feds Make Hay As ACA Birth Control Foes Lose Ground

    The Obama administration is trumpeting its winning streak in continued litigation over the Affordable Care Act’s contraception mandate, alerting the U.S. Supreme Court and several circuit courts this week to a quartet of rulings that it hopes will tilt pending religious-freedom cases in its favor.

  • June 24, 2015

    Pharmacies, Patients Ask 3rd Circ. For Fees In ERISA Case

    Hemophiliacs and pharmacies who sued insurers that denied their claims for blood-clotting medications asked the Third Circuit on Tuesday to award them approximately $150,000 in attorneys’ fees related to an appeal they won in May, saying the award would act as a warning for insurance companies in future litigation.

  • June 24, 2015

    Fla. Court Flips Ruling That Struck Down Workers' Comp Law

    A Florida appeals court on Wednesday reversed a decision that declared the state's current workers' compensation system unconstitutional because the organizations bringing the constitutional challenge did not have standing to do so.

  • June 24, 2015

    Amtrak's Sandy Recovery Capped At $125M In Flood Finding

    A New York federal judge ruled Wednesday that a storm surge that filled several Amtrak tunnels after Superstorm Sandy constituted flooding under Amtrak's insurance policies, limiting the rail giant's recovery to a $125 million sublimit and dismissing a slew of excess insurers from the dispute.

  • June 24, 2015

    Cigna-Anthem $47B Deal Could Get Tough Antitrust Look

    Anthem Inc. and Cigna Corp. have called their potential $47.4 billion tie-up a complementary combination unlikely to raise competition issues, but experts say if two of the nation's biggest health insurers do strike a deal, they should be prepared for a long, hard look from antitrust enforcers.

  • June 24, 2015

    NY Chiropractor Pleads Guilty In $7M Medicare Fraud Scheme

    A New York chiropractor, and alleged ringleader of a $7 million Medicare fraud, pled guilty to health care fraud and obstruction of a federal audit on Wednesday, according to a U.S. Department of Justice announcement.

  • June 24, 2015

    Fla. Firm Wants Damages For 'Frivolous' 11th Circ. Fee Appeal

    A Florida law firm asked the Eleventh Circuit on Tuesday for damages, attorneys' fees and double costs for a condominium association's allegedly frivolous appeal seeking reimbursement of funds the firm got after representing the association in a property damage coverage dispute.

  • June 24, 2015

    Ill. Court Told To Review Life Insurer's $6M Junk Fax Deal

    An Illinois appeals court on Tuesday directed a lower court to take a second look at Wholesale Life Insurance Brokerage Inc.'s $6 million settlement with a putative class of businesses that received unsolicited faxes from Wholesale, concluding that there are still questions as to whether the deal was reasonable.

  • June 24, 2015

    No Tax Break For Risk-Pool Reinsurance, Texas Court Says

    Two insurers must pay over $1 million in taxes on premiums from reinsurance agreements with two public employee self-insurance risk pools because tax breaks on reinsurance premiums only apply when both parties are regulated insurers, a Texas appeals court ruled Wednesday.

  • June 24, 2015

    Fed Says Stress Tests Evolving To Accommodate Insurers

    Federal Reserve Vice Chairman Stanley Fischer on Wednesday said the stress tests that the central bank uses to determine financial institutions’ resiliency are evolving, and that regulators were developing tests to accommodate the unique qualities of three insurance firms that will now be subject to them.

  • June 23, 2015

    Judge Confirms $4.7M Atty Fees Award In Highmark IP Saga

    A Texas federal judge on Tuesday upheld an award of nearly $4.7 million in attorneys’ fees to Highmark Inc. in its long-running declaratory judgment fight against Allcare Health Management Systems Inc., finding that Allcare’s unsuccessful case over an information management system patent remained “exceptional” in light of the new standard set out by the U.S. Supreme Court in the Octane Fitness case.

  • June 23, 2015

    Indian Harbor Wins Appeal In Pollution Coverage Row

    The Ninth Circuit on Tuesday reversed a lower court's decision that Indian Harbor Insurance Co. had to cover a Hawaiian development company in underlying suits alleging property damage from red dust stirred up by construction, finding that Indian Harbor's policy was excess and shouldn't have kicked in until the primary coverage was exhausted.

  • June 23, 2015

    Gilbride Tusa Must Face Malpractice Claims In $85M Suit

    A New York state judge has ruled that Gilbride Tusa Last & Spellane LLC must face a pared-down $85 million malpractice suit in which lending fund Genesis Merchant Partners LP alleges it mishandled its security interests, rejecting the firm's argument that the claims are time-barred but striking several claims as redundant.

  • June 23, 2015

    House Votes To Repeal ACA Medicare Cost-Containment Panel

    The U.S. House of Representatives voted Tuesday to repeal the Affordable Care Act's Independent Payment Advisory Board, one of the rare areas with at least some bipartisan agreement regarding the sweeping, contentious health care law.

  • June 23, 2015

    Federal Gov't Formalizes Agreement In Fla. Health Care Row

    Florida Gov. Rick Scott declared victory Monday in response to a letter from the federal government formalizing an agreement in principle to extend the state's Lower Income Pool health care funding for two years, crediting a lawsuit he filed.

  • June 23, 2015

    XL Prevails In 11th Circ. 'Consent-To-Settle' Fight

    XL Specialty Insurance Co. doesn't have to cover Piedmont Office Realty Trust Inc.'s $4.9 million shareholder-suit settlement, the Eleventh Circuit held Tuesday, two months after the Georgia Supreme Court ruled that Piedmont's failure to obtain XL's consent for the deal doomed its breach of contract suit against the insurer.

  • June 23, 2015

    Number Of Uninsured Americans Dropped In ACA's 1st Year

    Four million more Americans had health care coverage last year than in 2013 as the Affordable Care Act went into effect, according to figures provided Tuesday by the U.S. Centers for Disease Control and Prevention.

Expert Analysis

  • Why Law Firms Collapse

    John D. Morley

    The leaders of the collapsed law firm Dewey & LeBoeuf are on trial and each new day of testimony delivers more damning evidence about how they built a massive financial fraud. The real cause of Dewey’s collapse, however, was not financial fraud. The more serious problem was that Dewey — like all American law firms — had deep cracks in its organizational structure, says John Morley, associate professor of law at Yale Law School.

  • Pa. High Court Clarifies Employer Liability Exclusions

    Lon A. Berk

    The Supreme Court of Pennsylvania's ruling in Mutual Benefit Insurance Co. v. Politsopoulos makes clear that companies added as additional insureds under another’s insurance policy in connection with a business relationship are covered under that policy for claims by employees of the named insured, say Lon Berk and Sergio Oehninger of Hunton & Williams LLP.

  • A Primer On Insurance Underwriting In China

    Jiangxiao Hou

    By 2020, China is expected to become the world’s third largest insurance market, following the United States and Japan. While China presents tremendous opportunities for international insurers and reinsurers it is critical to be mindful of its regulatory regime since certain practices, such as reservation of rights letters, that are routine in Western countries bear no legal effect in China, say attorneys at Zelle Hofmann Voelbel & Mason LLP.

  • A 5-Point Plan To Save Our Juries

    Mark Robinson

    The civil jury trial has virtually disappeared in the U.K. and it’s vanishing in Canada. It will vanish here too if we don’t act. The biggest asset we have in our fight to save the system is the pool of jurors who have served and enjoyed a positive experience, say Mark Robinson, Gilbert Dickinson, Harry Widmann and Lewis Sifford, co-chairmen of Save Our Juries.

  • Duty To Defend In Florida Extends To Excluded Claims

    Walter Andrews

    National Union Fire Insurance Co. v. Florida Crystals Corp. in the Southern District of Florida illustrates that allegations of unintentional harm may constitute an "accident” that could give rise to an occurrence under liability policies, triggering an insurer’s duty to defend even where the underlying complaint involves some intentional conduct, say attorneys at Hunton & Williams LLP.

  • Price Optimization: Regulators Struggling With Big Data

    Thomas W. Curvin

    Price optimization, an emerging practice that uses big data, predictive modeling and data analytics in pricing insurance products, continues to draw the attention of state regulators, consumer advocates and class action plaintiffs, especially given the lack of basic agreement on terminology, say attorneys at Sutherland Asbill & Brennan LLP.

  • How Will Insurers Respond To The Texas Floods?

    Lindsey Bruning

    In May, 37.3 trillion gallons of water fell in Texas — enough to cover the entire state with 8 inches of water. The nonstop barrage has caused unprecedented flooding throughout the state and caused severe property damage to countless homes and businesses, many in locations where it was never expected that such water damage would occur. Absent a separate flood policy, many Texans will now be left without insurance coverage for their... (continued)

  • Claims-Made Policies And The Notice-Prejudice Rule

    Whitney Fore

    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. Most courts also hold that the rule does not apply to late notice under a claims-made-and-reported policy, as opposed to an occurrence policy. In 2015, several cases have solidified this trend and some of them actually extend it, says Whitney Fore of Carlton Fields Jorden Burt.

  • Cos. In FIFA-Related Investigations Should Check Insurance

    Walter Andrews

    Even if costs associated with a government investigation were not specifically contemplated by a company when purchasing insurance, coverage may nevertheless be available for businesses that find themselves facing government inquiries and investigations, including those associated with criminal indictments like the one against FIFA representatives, say attorneys with Hunton & Williams LLP.

  • 'Cascading' Excise Tax After Validus

    Kristan Rizzolo

    Given the D.C. Circuit decision in Validus Reinsurance Ltd. v. U.S., in the case of reinsurance or retrocession transactions between insurance and reinsurance companies, we now seem to be back where we started before the IRS raised the “cascading” federal excise tax issue in Revenue Ruling 2008-15, says Kristan Rizzolo of Sutherland Asbill & Brennan LLP.