Policies that include the cost of defending a particular claim or action in the policy’s limit of liability are commonly referred to as “Burning Limits” or “Defense Within Limits” policies.  Such policies raise a number of significant coverage issues for the insurer, the insured, and the third-party claimant.  This article examines how courts around the

Insurer Must Defend Restaurant Owner In Suit Following Fight At Party

A restaurant employee fatally stabbed a guest and injured another person at a party hosted at the restaurant by the owner. The Appellate Division, First Department, agreed with one insurer that it had no duty to defend or to indemnify the restaurant owner

Section 1132(g)(1) of ERISA states that in an action under ERISA, such as one by an employee to obtain benefits pursuant to an employer’s disability income insurance plan, the court, in its discretion, may allow reasonable attorney’s fees and costs of action to either party. This past May, in Hardt v. Reliance Standard Life Ins.

The Affordable Care Act has created within Centers for Medicare & Medicaid Services (“CMS”) a new Center for Medicare and Medicaid Innovation (“CMMI”).  The purpose of CMMI is to develop and test innovative payment and delivery system models designed to encourage coordinated care in Medicare, Medicaid and CHIP.  $10 Billion has been appropriated for

Construction Industry Fair Play Act

New York Governor David A. Paterson recently signed into law the “Construction Industry Fair Play Act,” a new piece of legislation that will drastically affect employers in the construction industry. Reflecting a continued concern over employer misclassification of independent contractors, the new law, which took effect on October 26,

The midterm elections, now just two days away, have been marked by explosive growth in the use of Web 2.0 tools such as online social networking and blogging in an effort to garner support and electrify voters.

The sophisticated nature of today’s political campaigns makes the results of a recent survey by the Coalition Against

Insured’s Assignees May Not Bring Bad Faith Action Against Insurer Where Insured Could Not Assert That Claim

Personal injury plaintiffs obtained a judgment against a restaurant, which assigned them its rights against its insurer. The plaintiffs, as the restaurant’s assignees, then brought suit against the insurer, arguing that it had refused in bad faith

As of January 1, 2012, information must be collected identifying the amount and nature of any compensation, reimbursements or other payments that physicians and teaching hospitals receive from manufacturers of pharmaceutical drugs, medical devices, biologicals and medical supplies, for consulting services or other arrangements.  This information will be made publicly available beginning on September 30,

The Patient Protection and Affordable Care Act (PPACA) created several new requirements for tax-exempt hospitals which must be compiled with in order to maintain federal tax-exempt status.  The PPACA creates a new IRS Code Section 501(r) which imposes four requirements on tax-exempt hospitals (these requirements are in addition to existing law under Section 501 (c)(3),

The Patient Protection and Affordable Care Act (the “Act”) seeks to reduce the cost of healthcare and improve quality by incentivizing providers to collaborate with each other to create integrated healthcare delivery systems.  These integrated delivery systems will be paid based on new reimbursement methodologies which are designed to incentivize providers to improve care and

The Centers for Medicare and Medicaid Services (“CMS”) has proposed revisions to the existing federal physician self-referral law (“Stark Law”) regulations to implement provisions enacted as part of the Patient Protection and Affordable Care Act of 2010 (“Affordable Care Act”).  The proposals appear in two separate rulemakings:  (1) the CY 2011 Medicare Physician Fee Schedule

Copyrighted A.M. Best Company, Inc. 2010. All Rights Reserved. Posted with Permission.

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Getting To Yes

Richard Smith was employed by Bonetti Company, Inc., and participated in the group life insurance plan that the company provided. Smith had basic life insurance coverage of $50,000 and supplemental life insurance coverage of $50,000, and he designated Alma, to whom he was married at the time his application for coverage was accepted, as the

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Without Question, The Answer is Yes

Copyright © 2010 by A.M. Best Company, Inc.  Reprinted with permission.  All rights

Almost a century ago, the U.S. Supreme Court recognized the importance of the “insurable interest” requirement in connection with life insurance policies. In Grigsby v. Russell, the Court explained that, “[a] contract of insurance upon a life in which the [policy owner] has no interest is a pure wager that gives the [policy owner]