Seventh Circuit, Joining Other Circuits, Rejects ERISA Plan’s “Coordination of Benefits” Lawsuit Against Health Insurers

The plaintiff in this lawsuit, filed in a federal district court in Illinois, was the trustee of the Central States, Southeast and Southwest Areas Health and Welfare Fund, a self-funded plan under the Employee Retirement Income Security Act of 1974

The South Carolina Supreme Court has found that letters issued by a commercial general liability insurer to its insureds were inadequate to reserve its rights as they amounted to “generic denials of coverage coupled with furnishing the insured with a verbatim recitation of all or most of the policy provisions (through a cut-and-paste method).”

The

A federal district court in Indiana has ruled that a claims-in-process exclusion in a commercial general liability insurance policy precluded coverage for the insureds’ claim where pollution at the insureds’ property had begun before the insureds even had purchased the property.

The Case

Property in Lake Station, Indiana, was used as a dry cleaning facility

The U.S. Court of Appeals for the Eleventh Circuit has ruled that a Florida claims handling statute did not preclude an insurer from declining to pay pre-tender defense fees and costs incurred by its insured prior to tendering its claim to the insurer.

The Case

After EmbroidMe.com, Inc., was sued in federal district court for

The U.S. Court of Appeals for the Tenth Circuit has ruled that the two insurance policies covering a leased building damaged in a fire – and not the lease itself – determined the insurers’ relative responsibilities for the damage.

The Case

Philadelphia Indemnity Insurance Company and Lexington Insurance Company insured the same school building that was

The U.S. Court of Appeals for the Ninth Circuit has ruled that an insured’s failure to tender an environmental lawsuit to three insurance companies was fatal to its coverage claim, even though the insured previously had tendered a potential administrative proceeding to the carriers.

The Case

M.B.L., Inc., a defunct dry cleaning products company, sued

The U.S. Court of Appeals for the Ninth Circuit has ruled that an insurer had no obligation to cover its insured’s agreement to settle a lawsuit where the insurer had not given its prior written consent to the settlement as required by the policy.

The Case

Assured Guaranty Municipal Corporation sued OneWest Bank, FSB, for

The U.S. Court of Appeals for the Eighth Circuit has ruled that an insurer did not have a duty to defend or indemnify an additional insured in connection with a lawsuit brought by a subcontractor’s employee who alleged that he had been injured in an explosion caused by condensate, concluding that the employee’s allegations fell

Twitter, Facebook, Instagram, and other forms of social media are becoming the dominant communication tools in today’s political and social discourse, often entirely supplanting traditional media’s role in public commentary. Social media’s emerging role, combined with the extreme divisions so evident in our country, have caused the courts to consider application of pre-Internet legal standards

Alan Rutkin article entitled, “Insight – Too Good to Be True?,” has been published in the February 2017 issue of Best’s Review magazine.

Click here to read the article.

Best’s Review:  February 2017. Copyrighted A.M. Best Company, Inc. 2017.  All Rights Reserved, Reprinted with Permission.

The Healthcare Fraud Prevention Partnership (“HFPP”), in conjunction with the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services (“CMS”), has recently issued a White Paper that outlines recommended actions to reduce opioid misuse and opioid-use disorders (“OUDs”) in the United States. It has been estimated that prescription opioid

For the first time in thirty years, the Substance Abuse and Mental Health Services Administration (“SAMHSA”), a branch of the U.S. Department of Health and Human Services (“HHS”), issued a final rule amending 42 CFR Part 2 (commonly referred to as “Part 2”) which governs the confidentiality of alcohol and drug abuse patient records. The

Christopher J. Kutner was quoted in a Part B News article entitled, “Beyond QPP: Check Your Readiness for Insurer-Based Physician Incentive Programs.”

Regarding non-federal physician incentive programs, Chris said they are about shifting to value-based payment options, so be sure you’re in a position to take it on. “Even without downside risk, you have to think about

No-Fault Insurer Timely Requested EUO Of Provider After Conducting Assignor’s EUO, Court Rules

On December 19, 2013, after receiving a health care provider’s bills requesting payment of assigned no-fault benefits, the insurer conducted a timely examination under oath (“EUO”) of the assignor. On January 9, 2014, believing that the assignor’s testimony raised questions regarding the

Please click the link below to view the New York Insurance Coverage Law Update – Compilation 2016.

New York Insurance Coverage Update — Compilation 2016