Insurance carriers that provide health care coverage in New York (and in other states) typically have developed comprehensive anti-fraud plans that help them identify and investigate insurance fraud. An important tool in these anti-fraud plans is post-payment reviews of claims submitted by health care providers. When insurance carriers detect fraud, and when they are unable

Corning sought coverage for thousands of claims arising from the distribution and/or manufacture of two asbestos-containing products. The court said the insurers failed to make out a prima facie case that each of the thousands of claims constituted a separate occurrence. The court reasoned that claims arising from exposure to an asbestos condition at

Valero Refining Company contracted with Encompass Power Services to design, engineer, and construct a co-generation facility. After a fire caused significant damage, Valero sought over $40 million in damages from Encompass.

A federal district court held that Encompass’ three primary insurers had to split the costs initially spent by one of them defending Encompass

The worker’s compensation claimant in this case worked as a collision shop technician in New York, repairing automobiles. In 2005, he suffered three injuries on the job. On February 21, he slipped on ice, injuring his hip and back. On March 18, he suffered a lower back sprain. He left his job on June 27

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A Landscape View of Privacy Issues

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In recent years, there has been uncertainty as to the standards to be applied when automobile repair shops challenge the conduct of automobile insurers in regard to the negotiation and payment of collision repair costs.  In Nadel v. Allstate Insurance Company, 2012 N.Y. Misc. LEXIS 1527 (N.Y. App. Term 2d Dep’t 2012), the Appellate

Retained life estates are once again protected from Medicaid claims.  A common elder law technique is for an individual to transfer the ownership of their house to their children, while keeping the right to live in the house for their life.  This is called a “retained life estate”.  At death, the house would immediately

When a Testator creates a Qualified Terminable Interest Property (QTIP) Trust or a Credit Shelter Trust under his or her Will, the Testator’s spouse is always a beneficiary of the QTIP Trust and frequently a beneficiary of the Credit Shelter Trust. The Testator will often appoint his or her spouse and another individual –

Trusts have become increasingly popular for asset protection and tax planning and yet the skills of an estate planning attorney are frequently not considered relevant when prenuptial agreements or divorce settlements are contemplated.  This misstep results in the loss of many estate and tax planning opportunities.  For example, one useful option to consider when

In what many are calling its most important decision since Bush v. Gore, the Supreme Court largely upheld the Patient Protection and Affordable Care Act (the “Act”). Chief Justice Roberts delivered the 5-4 ruling of the Court, upholding all of the provisions of the Act, except for a narrow portion of the Act’s Medicaid expansion.

The American Society of Composers, Authors and Publishers (“ASCAP”), which represents music composers, writers, and publishers and which has the non-exclusive right to license the non-dramatic public performances of its members’ music, was formed in 1914.[1] As technologies have evolved over the past century, so has ASCAP’s role.  It is inconceivable that performers at the

The Office of the Inspector General (the “OIG”) recently issued Advisory Opinion No 12-06 (the “Opinion”) on two proposed arrangements between the exclusive providers of anesthesia services to a group of ASCs (the “Provider”) and physician-owned ASCs (the “ASC”).  Briefly stated, the Provider wished to enter into one of two possible arrangements to provide anesthesia

Failure To Timely Notify Insurer Dooms Effort To Recover Default Judgment

The insured did not notify its liability insurer when the claimant slipped and fell on the insured’s property in July 1999, or when she was sued in 2001, or when the insured declared bankruptcy and entered into a stipulation allowing the claimant to

Two people were arrested in 1977 for the murder of a retired police officer and were convicted in 1978.  In 2003, they were released from prison. They then filed suit against the city of Council Bluffs, Iowa, alleging malicious prosecution.

After the city sought coverage from Genesis Insurance Company, Genesis sought a declaratory judgment

Retained life estates are once again protected from Medicaid claims.  A common elder law technique is for an individual to transfer the ownership of their house to their children, while keeping the right to live in the house for their life.  This is called a “retained life estate”.  At death, the house would immediately transfer