In State Farm Mutual Auto. Ins. Co. v. Mallela,[1] the New York Court of Appeals held that an insurer may withhold payment for medical services provided by “fraudulently incorporated” enterprises to which patients had assigned their no fault claims. As indicated in the Insurance Fraud column published here in January,[2] that ruling (in which the

Liability Issues Ultimately Lead to Insurance Concerns

Volunteer Firefighter Allegedly Injured Outside Truck While Directing Traffic At Accident Site Not Entitled to SUM Coverage

A volunteer firefighter sought supplementary uninsured motorist (“SUM”) coverage for injuries he allegedly suffered when he was directing traffic away from the scene of a motor vehicle accident. The court first found that the firefighter was

The plaintiff in this case worked for Airborne Express, Inc., which was acquired by DHL Holdings (USA), Inc., now called DPWN Holdings (USA), Inc., in 2003. The plaintiff had been a participant in Airborne’s Retirement Income Plan (RIP) and Profit Sharing Plan (PSP). The RIP was a defined benefit plan whose benefit formula was based

Please click the link below to view The Second Circuit Changes It’s Tune – “No More Mr. Nice Guy”. Adobe Reader is required to view the bulletin. If Adobe Reader is not installed on your PC, click here to download and install.

The Second Circuit Changes It’s Tune – “No More Mr. Nice Guy”

Reprinted

Following more than a year of public comments, the Federal Trade Commission in December enacted changes to its formal guidance[1] to advertisers as to the steps necessary to keep their endorsement and testimonial ads from running afoul of the Federal Trade Commission Act[2] and its potential consumer protection liabilities.

Many of the changes were required

Second Department Permits § 349 Claim To Proceed Against Homeowners’ Insurer

The insureds claimed that a storm caused a hillside on their property in the Village of Roslyn to collapse. Thereafter, the insureds filed suit and asserted a claim under General Business Law § 349 against the insurer that had issued a deluxe homeowners’

According to the administrator of the Continental Airlines Pilots Retirement Plan, a group of senior pilots became concerned several years ago about the health of the plan. These pilots already had reached retirement age, but had not retired or been otherwise separated from their employment at Continental. They allegedly engaged in a scheme to obtain

Paul Majkowski co-wrote an article in DRI’s For the Defense, “Thirty Years of Agent Orange Litigation.”

Click here to read.

© 2010 DRI. All rights reserved.

On December 16th, Park West Radiology, a practice of Lenox Hill-affiliated radiologists, agreed to a settlement with CareCore National, a radiology benefit management company used by major insurers in the New York City and Long Island areas. Park West agreed to withdraw the antitrust lawsuit that it had filed against CareCore and entered into a

The New York State Office of the Medicaid Inspector General (OMIG) requires the filing of a Mandatory Provider Compliance Certification on or before December 31, 2009 of each year. For your reference, we have set forth below the relevant portions from the OMIG website related to the Mandatory Provider Compliance Law.

The Mandatory Compliance Law

It has been almost exactly five years since the New York Court of Appeals issued its decision in State Farm Mutual Auto. Ins. Co. v. Mallela,[1] establishing that a violation of a licensing requirement by a medical provider renders the provider ineligible to be reimbursed by an insurance company for no fault[2] claims that have

Paul Majkowski co-authored an American Bar Association article, “Using Statistical Analysis in Mass Toxic Tort Cases: Are the Courts a Century Behind Science.”

Click here to read.

Published in Mass Torts, Volume 7, Number 1, Fall/Winter 2009. © 2008 by the American Bar Association. Reproduced with permission. All rights reserved. This information or any portion

When a company is scammed, who pays the insurance?

Insurance coverage case law sometimes reads like a supermarket tabloid, and no case has more tabloid-like facts than the October 2005, decision in Federal Insurance Co. vs. Ace Property and Casualty Co., a case from the United States Court of Appeals for the Fifth Circuit.

Finding That Plaintiff Is No Longer Disabled Is Affirmed, Despite Social Security Administration Determination That Plaintiff Was Disabled

Robert Muller appealed from a judgment of the United States District Court for the Northern District of New York that denied his claim that the termination of his employer-sponsored disability benefits by First Unum Life Insurance Company