Insurer Must Provide “Specific Objective Justification” For EUO Request Upon Provider’s Timely Inquiry

Avalon Radiology P.C. submitted no-fault claims to Ameriprise Insurance Company, and the insurer noticed an examination under oath (“EUO”) for Avalon. Avalon responded with a letter asking for the good faith, objective reason for Ameriprise’s request for an EUO pertaining to Avalon’s

The Centers for Medicare & Medicaid Services (“CMS”) recently released a proposed rule that would implement Section 603 of the Bipartisan Budget Act of 2015 (the “Act”) and could significantly limit payments made under the Hospital Outpatient Prospective Payment System (“OPPS”), effective January 1, 2017.

Specifically, the proposed rule would greatly affect Medicare payment for

A recent ruling[1] by the Internal Revenue Service has raised concerns about the applicability of tax-exempt status to accountable care organizations. The IRS has taken action which will cause tax-exempt organizations to pause and carefully examine their participation in ACOs or other provider networks, particularly when such an ACO or network does not participate in the Medicare Shared

The Supreme Court of California has ruled that a trial court’s post-verdict award of attorneys’ fees to an insured may be included in the amount of compensatory damages awarded to the insured for purposes of determining the punitive-compensatory damages ratio.

The Case

A man who spent weeks confined to a hospital bed at the Department

The Supreme Court of Texas has ruled that a “leased-in worker” exclusion in commercial general liability insurance policies precluded coverage of a claim brought by parents whose son had died in an accident on a drilling rig.

The Case

After an accident on a drilling rig, a deceased worker’s parents sued the company that owned

The Supreme Court of Washington has ruled that an insurance policy unambiguously excluded coverage for water damage to the insured building immediately when the building became vacant.

The Case

Kut Suen Lui and May Far Lui owned a building containing tenant space, but the building’s last tenant left the building in the first week of

The Supreme Court of Colorado has ruled that extrinsic evidence could not create an ambiguity in an insurance policy but only could be used as an aid to ascertaining the intent of the parties once an ambiguity was found.

The Case

After Jennifer Hansen was injured in a motor vehicle accident, she presented an underinsured

The Supreme Court of Wisconsin has ruled that there is no exception to the “four-corners” rule that permits courts to consider extrinsic evidence after an insurer had decided that it had no duty to defend the insured.

The Case

Water Well Solutions Service Group Inc. was hired by the City of Waukesha to replace a

The Supreme Court of Wisconsin has ruled that the “four-corners rule” includes consideration of exclusions in an insurance policy.

The Case

From 2007 to 2009, a number of lawsuits involving Titan Global Holdings, Inc., and the trustee of two trusts that owned a controlling interest in Titan were filed throughout the country.

The trustee provided

The U.S. District Court for the Western District of Texas recently rejected an attempt by two online content providers to secure coverage in connection with a copyright infringement action commenced against them by an adult entertainment company.[1]

Perfect 10, Inc. (“Perfect 10”) filed an action against Giganews, Inc. (“Giganews”) and Livewire Services, Inc. (“Livewire”) for

Given the proliferation of health care regulations and white-hot spotlight of government enforcement efforts, it is becoming increasingly important for all health care organizations, ranging from small physician practice groups to large regional or national health systems, to attain a heightened level of self­awareness concerning areas in which they could be vulnerable to allegations of

Recent examples of criminal insurance fraud in New York1 and elsewhere across the country2 highlight the continuing nature of the insurance fraud problem, despite significant efforts by local and state prosecutors and insurance companies themselves to combat it.

Increasing sophistication on the part of criminals, and increased resources available to them, is helping to make

The Office of Special Counsel for Immigration-related Unfair Employment Practices (“OSC”) at the U.S. Department of Justice recently issued Technical Assistance Letter (“TAL”) regarding employer compliance with the anti-discrimination provision of the Immigration and Nationality Act (“INA”).  The OSC concluded that an employer does not violate anti-discrimination laws by 1) refusing to hire all applicants

A federal bankruptcy court in New York, overseeing the case of a debtor facing approximately 275,000 asbestos-related personal injury claims, has ruled that the debtor’s underlying insurance policies must be exhausted by actual payment before its excess insurance policies are triggered. The bankruptcy court’s decision, in In re Rapid-American Corp., Case No. 13-10687 (SMB), Adv.

Court Upholds Administrator’s Ruling That New Plan Did Not Include Claimed Benefit

The plaintiff in this case was hired as an electrical engineer for Delco Electronics, a division of General Motors (GM), in 1991. The plaintiff was enrolled in an insurance plan covered by GM (the 1992 GM Plan) and was made aware of the