• July 28, 2015

    Calif. Appeals Court Rebuffs Claim Examiners' OT Cert. Bid

    A California appeals court on Tuesday affirmed a lower court's denial of certification to a putative class of about 90 workers' compensation claim examiners who allege an insurance consulting firm failed to pay them overtime.

  • July 28, 2015

    6th Circ. Restarts TRW Retiree Benefit Battle After Tackett

    TRW Automotive Holdings Corp. got another chance to challenge a union's victory in a fight over changes made in retiree lifetime health benefits Monday when the Sixth Circuit agreed to send the class action back to district court for reconsideration in light of a recent U.S. Supreme Court decision.

  • July 28, 2015

    Sedgwick Nabs Cybersecurity Pro From Wilson Elser

    Sedgwick LLP has snagged a former Wilson Elser Moskowitz Edelman & Dicker LLP attorney for its Chicago office in a move to strengthen its cybersecurity, employment and insurance litigation capabilities, the firm announced Tuesday.

  • July 28, 2015

    A Guide To Fluor's Asbestos Coverage Fight With Hartford

    The California Supreme Court will soon deliver its long-awaited decision on whether an obscure state insurance law overrides a 2003 ruling by the court that created a barrier to transferring insurance rights during mergers and corporate restructurings. Here, Law360 recaps Fluor Corp.'s case against Hartford Accident and Indemnity Co. in anticipation of the ruling.

  • July 28, 2015

    State Farm Asks 5th Circ. To Rehear Katrina FCA Row

    A State Farm Insurance unit asked a Fifth Circuit panel Monday to reconsider its ruling upholding a finding the insurance giant was liable for False Claims Act violations for submitting improper claims for a house destroyed by Hurricane Katrina, saying the panel ignored a lack of intent.

  • July 28, 2015

    Insurer Can't Fill In For Policyholder, 3rd Circ. Says

    Erie Insurance Exchange can’t substitute for a business owner in a suit holding him responsible for a worker’s accidental death, the Third Circuit held Tuesday, finding that the insurer’s case would present separate, unlitigated issues.

  • July 28, 2015

    'Wicked Tuna' Star Indicted On Federal Fraud Charges

    A fisherman who starred in a National Geographic Channel reality TV series was indicted on federal fraud charges in Vermont federal court on Friday for collecting over $44,000 in social security and Medicaid benefits based on false statements.

  • July 28, 2015

    Pittsburgh Corning Insurers Renew Ch. 11 Plan Opposition

    Two insurers Monday urged the Third Circuit to reverse a Pennsylvania federal judge's order that upheld a Chapter 11 plan ending Pittsburgh Corning Corp.’s 15-year bankruptcy and found the “insurance neutral” reorganization would not hamstring the insurers in related asbestos litigation.

  • July 28, 2015

    Health Orgs Criticize Spending Cap For Private Medicaid Plans

    Health insurers, hospitals and independent analysts are pressuring the Obama administration to relax a controversial proposal capping profits and overhead spending in private Medicaid plans, according to newly released comments.

  • July 28, 2015

    State Farm Takes Hospital Contract Row To Fla. High Court

    State Farm Mutual Automobile Insurance Co. continued its quest to learn whether a hospital overbilled it for accident patients' care while handing discounts to medical insurers, telling the Florida Supreme Court on Monday that the lower court botched its state statute interpretation.

  • July 27, 2015

    Insurer Can't Revive Negligence Claim For $11.5M Hotel Flood

    A Pennsylvania federal judge on Monday rejected Insurance Co. of Greater New York's bid to revive a professional negligence claim in its lawsuit over a flood at a Holiday Inn hotel that resulted in $11.5 million in damages, saying the company failed to support its attacks on defense deposition testimony.

  • July 27, 2015

    5th Circ. Burns Insured Vs. Insured Exclusion In Fire Row

    The Fifth Circuit ruled Monday that Kinsale Insurance Co. cannot escape Georgia-Pacific LLC's indemnity claim through a policy exclusion barring suits brought by one insured against another, reversing a decision that let Kinsale off the hook in a fire damage row.

  • July 27, 2015

    House Votes To Exempt Vets From ACA Employer Mandate

    The U.S. House of Representatives on Monday passed several bills related to military veterans, including measures to exempt vets from certain fees on U.S. Small Business Administration loans and to exempt them from calculations for the Affordable Care Act’s employer mandate.

  • July 27, 2015

    Aetna's $120M RICO Suit Against Texas Hospital Stays Alive

    A Houston-area hospital and CEO accused of bilking Aetna Life Insurance Co. out of as much as $120 million and offering kickbacks to physicians lost a bid to get rid of Aetna’s lawsuit Friday, though a Texas federal judge stayed the trial while other litigation between the parties proceeds.

  • July 27, 2015

    Military Hospitals Out $22M In 3rd-Party Insurance, DOD Says

    The U.S. military is out at least $21.7 million in outstanding outpatient claims from third-party health insurance plans, thanks to poor compliance measures at the six military hospitals reviewed, according to a U.S. Department of Defense Inspector General report released Friday.

  • July 27, 2015

    Consumers' Info Exposed In Health Care Fraud, Data Breach

    A non-profit New York health care provider said on Friday that the personal information — including names and health insurance information — of about 5,300 past and current members may have been breached during a criminal fraud scheme over a two-year period.

  • July 27, 2015

    Anthem Sued Again Over Gilead Hep C Drug Coverage

    Anthem Blue Cross is wrongfully withholding Gilead Sciences Inc.’s newly approved yet expensive treatment for hepatitis C by claiming policyholders aren’t sick enough to get it, a practice that violates ERISA law, according to a putative class action filed Friday in California federal court.

  • July 24, 2015

    White & Case Flexes Its M&A Muscle With Anthem-Cigna Deal

    With Friday’s blockbuster $52 billion proposal for Anthem Inc. to swallow fellow health insurer Cigna Corp., Anthem’s counsel White & Case LLP notched one of its biggest deals yet and solidified its status as a versatile deal-maker with a knack for health-related transactions.

  • July 24, 2015

    Anthem, Cigna Could Gain Pricing Power In Some Markets

    Anthem Inc.'s proposed $54 billion acquisition of fellow health insurance provider Cigna Corp. would create a juggernaut with the ability to drive up premiums for policyholders and force hospitals into charging lower prices, but only in the limited markets where the pair are already the dominant insurers, experts say.

  • July 24, 2015

    Equitable Subrogation Dispute Sent To Fla. Supreme Court

    A Florida appellate court on Friday asked the state's Supreme Court to review its decision that Allstate Insurance Co. and a policyholder who was found fully liable in an underlying personal injury action have the right to seek payment from a group of medical care providers who allegedly exacerbated those personal injuries.

Expert Analysis

  • Fact Questions May Save Duty To Indemnify Claims In Mass.

    Lon A. Berk

    The Massachusetts Appeals Court recently held that even if claims for breach of the duty to defend may be barred by statutes of limitations, claims for breach of the duty to indemnify may survive, especially when insurers — notwithstanding earlier disclaimers or reservations of rights — continue to investigate facts relating to the underlying liability, say attorneys at Hunton & Williams LLP.

  • Tips For An Efficient And Effective Fraud Investigation

    Megan Cafferkey

    It is important to gain control over the paper records and computers utilized by those under investigation for internal fraud. Within these networks, you will be exposed to a multitude of documents that may provide insight into potential fraud motives and evidence of fraudulent transactions, say Megan Cafferkey and Dan Ray, forensic accountants at Hemming Morse LLP.

  • A Primer On Insurance Dispute Resolution In China

    Qianwei Fu

    Owing to China's relatively young insurance market, the experience of judges and arbitrators in handling insurance disputes varies, with courts and arbitral tribunals taking an active role in facilitating settlements between parties through mediation, say attorneys at Zelle Hofmann Voelbel & Mason LLP.

  • Conn. Courts Should Not Follow Comind

    Cullen W. Guilmartin

    The District of Connecticut decisions in Comind and Associated Electric should never be followed by Connecticut courts in regard to bargained for waivers involving commercial parties. Their interpretation of Connecticut law is wrong and, perhaps more importantly, may hurt business in the state, says Cullen Guilmartin at Gordon & Rees LLP.

  • Are You Ready For ACA's 2016 Reporting Requirements?

    George W. Schien

    Beginning in early 2016, reporting provisions under the Affordable Care Act will require many employers to file annual information returns with the IRS and provide annual statements to employees containing health plan offerings and coverage information. Failure to file could result in both reporting penalties and penalties under the ACA’s shared responsibility provisions, say George Schien and Susan Hughes of Baker Hostetler LLP.

  • 5 Lessons Health Care Cos. Should Learn From Cyberattacks

    Richard DeNatale

    In the wake of the Anthem Inc. data breach, while it may be tempting to think the worst is over for the health care industry, unfortunately history suggests otherwise. Consider the rash of cyberattacks in the retail sector since the Target Corp. data breach in late 2013, say Richard DeNatale and Celia Jackson of Orrick Herrington & Sutcliffe LLP.

  • When Marine Insurance Laws Don't Protect Policyholders

    John M. Sylvester

    In Guam Industrial Services Inc. v. Zurich American Insurance Co. the Ninth Circuit should have interpreted the ambiguous language in Guam Industrial's marine insurance policy in favor of coverage for the policyholder, say John Sylvester and Syed Ali at K&L Gates LLP.

  • REBUTTAL: Reverse Bad Faith Does Not Exist

    Steve Knott

    A recent Law360 guest article tried to make the case for reverse bad faith and in doing so tried to alter the universally existing, socially appropriate distinction between insurance companies’ improper conduct and policyholders’ breaches of their obligations. There is no such thing as reverse bad faith and only a Victor Frankenstein jurist could stitch together such a beast, say Steve Knott and Kurt Melchior of Nossaman LLP.

  • A Compromise On Indexed Universal Life Insurance Visuals

    Frederick R. Bellamy

    The National Association of Insurance Commissioners recently adopted Actuarial Guideline 49 to promote greater consistency among illustrations used in the sale of indexed universal life insurance. This is a great compromise among industry participants with different views on the maximum interest rates that should be allowed in such illustrations, say Frederick Bellamy and Thomas Bisset of Sutherland Asbill & Brennan LLP.

  • The Changing Role Of A Reinsurance Contracts Specialist

    Louise Jarvis

    There was a time when a contracts specialist would only get sight of a reinsurance contract long after the underwriter and the broker had finished their negotiations. In recent years though — particularly given the regulatory requirements for contract certainty — the role of the contracts specialist has moved from the back office to the front line, says Louise Jarvis at Hiscox Re.