More Insurance Coverage
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March 26, 2024
Gender Pay Bias Claims Against MetLife Allowed To Proceed
A New York federal judge in Manhattan trimmed hostile work environment and biased firing claims Tuesday from a gender discrimination lawsuit a fired female executive brought against insurance company MetLife, but said there was enough evidence the insurance giant paid her less than her male co-workers and denied her promotions.
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March 26, 2024
Meet The Calif. Atty Taking On Health Insurers' Use Of AI
With the health insurance industry under scrutiny over its use of algorithms and artificial intelligence in the patient coverage review process, California appellate attorney Glenn Danas saw an opening for litigation with what he calls a "high outrage factor."
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March 25, 2024
Judge Probes If $54M Deal Will Affect Tehum Care Ch. 11 Plan
A Texas bankruptcy judge Monday mulled if approving a settlement for prison health care company Tehum Care Services Inc. will lock in releases for a future Chapter 11 plan at the third day of a trial asking him to confirm the deal or toss the "Texas two-step" bankruptcy.
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March 25, 2024
Berkshire Hathaway Unit's Patent Must Undergo 3 PGRs
The Patent Trial and Appeal Board has instituted three post-grant reviews challenging a single Columbia Insurance Co. fire wall hanger patent, following petitions from Simpson Strong-Tie Company Inc.
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March 25, 2024
Creditor Says Fruit Grower Can't Cover Ch. 11 Expenses
A creditor of fruit producer Prima Wawona is asking a Delaware bankruptcy court to reject the company's Chapter 11 plan, saying it does not provide for the payment of nearly $5.3 million in workers' compensation expenses and other post-bankruptcy debts.
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March 25, 2024
Ex-Root Exec Gets 51 Months In Prison For $10.2M Theft
The former chief marketing officer for Columbus, Ohio-based car insurer Root Inc. has been sentenced to 51 months in prison followed by five years of supervised release for embezzling more than $10.2 million from his employer and spending it on plastic surgery, a yacht, a plane, and other personal expenses.
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March 25, 2024
Trump Gets Late Reprieve After Failing To Post $465M Bond
A New York appellate panel said Monday that Donald Trump can pause enforcement of the state attorney general's $465 million civil fraud judgment by posting just $175 million while he appeals, after the former president complained that he was unable to secure a bond for the entire amount.
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March 22, 2024
Kaiser's Ozempic Coverage Denial Is Discriminatory, Suit Says
Two Kaiser plans' refusal to cover new prescription weight loss drugs like Ozempic and Wegovy is "without any medical or scientific basis," a Washington state resident told a state court, alleging disability discrimination.
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March 22, 2024
Ind. Factory Adds To Historic $112M Bad Faith Coverage Win
A flooded factory building that was awarded $112 million in a historic bad faith win added to its victory Friday when an Indiana federal court denied its insurers' requests for a new trial and granted the factory more than $7 million in costs and interest.
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March 22, 2024
Ex-Ga. Insurance Head Cops To Healthcare Kickback Scheme
Former Georgia Insurance Commissioner John Oxendine pled guilty Friday to working with an Atlanta-area doctor to run a multimillion-dollar medical testing kickback scheme just weeks before he was set to face trial in federal court.
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March 22, 2024
5th Circ. Asked For Do-Over In Hurricane Coverage Feud
The owners of a New Orleans apartment complex urged the Fifth Circuit to rethink ordering them to arbitrate Hurricane Ida damage claims under New York law, arguing New York's choice-of-law clause would ordinarily be unenforceable under Louisiana law if it weren't couched within the arbitration provision.
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March 22, 2024
Colo. Mandates Multistate Online Insurance Tax Filing
Insurance companies in Colorado will be required to pay certain taxes through multistate third-party web-based application under legislation that Democratic Gov. Jared Polis signed into law Friday.
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March 22, 2024
Congress Spares Employee Benefits From $400M DOL Cut
A commitment from Congress to keep funding level for the U.S. Department of Labor's sub-agency that oversees employee benefits despite a $400 million agency-wide cut was one of the highlights for benefits attorneys in a new fiscal year 2024 spending deal. Here are three takeaways from attorneys on the funding agreement.
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March 22, 2024
Aflac Legal Chief's Total Pay Rose To $4M In 2023
Aflac Inc. compensated its longtime top legal leader more than $4 million in 2023, marking the second year her pay increased since earning $3.6 million in 2021, according to the company's most recent securities filing.
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March 22, 2024
Fox Rothschild Hires Lewis Brisbois Insurance Vet In Seattle
Fox Rothschild LLP has hired an insurance litigator in Seattle who focuses her practice on a range of commercial and liability disputes and joins the firm after working for a decade at Lewis Brisbois Bisgaard & Smith LLP, the firm has announced.
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March 21, 2024
AI Presents Risk To Insurers And Policyholders, Panelists Say
The growing use of artificial intelligence presents a risk to both insurers and insureds, experts said during a webinar Thursday, advising policyholders and their attorneys on how to navigate novel issues arising from the use of AI in the insurance industry.
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March 21, 2024
Cigna Slams Suit's Claims Of Algorithm-Led Coverage Denials
Insurance giant Cigna Group wants a Connecticut federal court to toss a proposed class action alleging that an algorithm unlawfully rejected hundreds of thousands of claims en masse and without a proper review, arguing the suit is based on a "misleading" news article and shows a misunderstanding of the health insurer's claim denial process.
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March 21, 2024
VA May Have Acted In Bad Faith On $30M Debt Collection Deal
The U.S. Civilian Board of Contract Appeals refused to toss a $29.6 million appeal accusing the U.S. Department of Veterans Affairs of hampering a contractor's efforts to collect funds from outside insurers, saying the VA may have acted in bad faith.
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March 21, 2024
2nd Circ. To Weigh 'Claim' Meaning In Family Share Dispute
The Second Circuit on Wednesday will hear arguments over whether a New York federal court erred in finding that a contract exclusion barred any duty a Liberty Mutual unit had to defend a propane company and two of its executives in a family shareholder dispute.
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March 21, 2024
Anadarko Wants Defense Coverage In 2013 La. Kickback Case
Anadarko told a Houston federal court that an environmental remediation company should be required to defend it in a decade-old Louisiana kickback lawsuit that has already made its way through an appeals court twice.
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March 21, 2024
Compensation For Cigna GC Dropped Slightly To $5.2M In '23
The top attorney for Connecticut-based health insurer Cigna Group saw her compensation package drop slightly in 2023 to $5.21 million from $5.23 million in 2022, according to a recent securities filing.
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March 21, 2024
Sanitizer Co. Faces Tough Ad Injury Coverage Bid In 2nd Circ.
A company accused of falsely advertising that its sanitizing products were effective in disinfecting surfaces faces an uphill battle, experts say, as the Second Circuit is poised to hear oral arguments Monday over whether the company is owed coverage under its commercial general liability policy for an underlying class action.
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March 21, 2024
Plan Admin. Escapes Ex-Aerospace Execs' Death Benefits Suit
A third-party administrator isn't liable for misrepresentation and negligence claims from former aerospace company executives over death benefits, a Pennsylvania federal judge has ruled, saying the administrator isn't to blame for the plaintiffs' lack of understanding about the termination of a deferred compensation plan.
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March 21, 2024
EBSA Gets Level Funding Of $191.1M In Spending Deal
Spending leaders in the House and Senate agreed Thursday to provide $191.1 million in fiscal year 2024 for the U.S. Department of Labor's sub-agency overseeing employee benefits, a level that's identical to what lawmakers agreed to last fiscal year.
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March 20, 2024
7th Circ. Closes Door On Italian Hotel's Virus Coverage Bid
A luxury Italian hotel has no coverage for certain coronavirus-related losses, the Seventh Circuit affirmed on Wednesday, saying that the hotel's own filings contradicted its claim that it suffered a covered physical loss.
Expert Analysis
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What ACA Preventive Care Ruling Means For Employers
Though a Texas federal court's recent ruling in Braidwood v. Becerra paves the way for employers to reimpose cost-sharing requirements on preventive care, companies considering making these changes to their group health and welfare plans should first analyze the financial and social impacts, says Rachel Shim at Holland & Knight.
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Seeking IRS Accountability For Faulty Microcaptive Notice
Like the taxpayers in Standard Insurances v. U.S. seeking to expand earlier wins in microcaptive insurance cases that limit IRS use of improperly obtained information, others should consider ways to hold the agency accountable and provide incentive for it to follow the law going forward, says Joshua Smeltzer at Gray Reed.
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AmEx Ruling Proves A Double-Edged Sword In Labor Antitrust
Though the U.S. Supreme Court's 2018 decision in Ohio v. American Express was a defense victory, both the plaintiff and defense bars have learned to use the case's holdings to their advantage, with particularly uncertain implications for labor antitrust cases, say Lauren Weinstein and Robert Chen at MoloLamken.
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Ch. 11 Ruling Stresses 5th Circ. Courts' Asset Sale Deference
A Texas federal court recently rejected a challenge to Fieldwood Energy’s Chapter 11 plan by several surety bond companies, serving as a reminder that courts within the Fifth Circuit give deference to the finality of asset sales where a stay of the applicable order has not been obtained, say Jonathan Lozano and Mark Dendinger at Bracewell.
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The Important Role Of Contra Proferentem In ERISA Cases
A Pennsylvania federal court's recent decision in Stein v. Paul Revere Life Insurance illustrates what happens when ERISA plan terms are unclear, and why the contra proferentem principle should be applied uniformly in all ERISA cases, says Mark DeBofsky at DeBofsky Law.
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No Surprises Act Gives Plan Sponsors Savings Opportunities
Under the No Surprises Act, the potential savings for an ERISA group health plan and its participants are significant, and sponsors should focus on the negotiation of third-party administrator service agreements to avoid exposure to breach of fiduciary claims for payment of excessive fees, say attorneys at Hall Benefits.
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HHS Advisory Opinion Serves As Free Drug Program Guide
A careful review of the U.S. Department of Health and Human Services' recent advisory opinion and track record on free drug programs provides a rubric for manufacturers to ensure that similar programs are viewed favorably under the Anti-Kickback Statute, say Dominick DiSabatino and Cortney Inman at Sheppard Mullin.
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ACA Anti-Discrimination Rules May Apply To 3rd-Party Admin
A Washington federal court's recent ruling in C.P. v. Blue Cross Blue Shield, where a third-party administrator applied plan rules that excluded gender-affirming care, potentially expands the scope of covered entities under the Affordable Care Act's anti-discrimination rule, say Kara Backus and Allison Jacobsen at Lane Powell.
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Courts Should Follow 8th Circ. On ERISA Procedure Rules
Other courts should take note of the Eighth Circuit's refusal to view Yates v. Symetra Life Insurance as an administrative law claim and join the growing effort to restore regular civil procedure to Employee Retirement Income Security Act cases, says Mark DeBofsky at DeBofsky Law.
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High Court Ax Of Atty-Client Privilege Case Deepens Split
The U.S. Supreme Court's recent dismissal of In re: Grand Jury as improvidently granted maintains a three-way circuit split on the application of attorney-client privilege to multipurpose communications, although the justices have at least shown a desire to address it, say Trey Bourn and Thomas DiStanislao at Butler Snow.
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Biden Admin.'s Anti-Merger Stance Is Leading To Bad Policies
A U.S. Department of Justice Antitrust Division speech reflects the Biden administration's goal to move enforcement in a markedly anti-merger direction, an approach that is leading to bad policies and enforcement decisions, says Cleary attorney David Gelfand, a former DOJ Antitrust Division official.
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9th Circ. Should Rethink Inadequate UBH Ruling
The Ninth Circuit should seriously consider rehearing Wit v. United Behavioral Health en banc because its recent claims reprocessing decision in the case raises troubling questions about the future of Employee Retirement Income Security Act's class actions, says Mark DeBofsky at DeBofsky Law.
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Hertz Ruling Could Help Debtors Avoid Make-Whole Premiums
A Delaware bankruptcy court’s recent ruling in Hertz, disallowing claims for make-whole premiums and post-petition interest at the contract rate, could be relied upon by debtors to sidestep those provisions, and potentially provide higher recoveries for equity holders, say Theresa Foudy and Alexander Severance at MoFo.