Insurance Coverage


Insurance Update
July 16, 2019 | Robert Tugander | Greg E. Mann | Insurance Coverage
Our July Insurance Update is now available.  Strap in, because we’re headed on a cross-country journey. We start out in New York where the Court of Appeals hands down an important ruling involving no-fault payments to non-physician controlled medical services corporations. We then cross the bridge into New Jersey where that state’s Supreme Court considers …
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Court Boosts Insurers in Fight Against Non-Physician-Owned Medical Providers
July 8, 2019 | Insurance Coverage
Nearly 15 years ago, in State Farm Mutual Automobile Ins. Co. v. Mallela, 4 N.Y.3d 313 (2005), the New York Court of Appeals ruled that an insurer may withhold payment under New York’s no-fault law for medical services provided by a professional medical corporation based on its “willful and material failure to abide by” the …
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New York Insurance Coverage Law Update
June 28, 2019 | Alan C. Eagle | Insurance Coverage
Insurers Need Not Prove Fraud To Deny No-Fault Payments To Healthcare Providers, New York Court Of Appeals Decides After insurance companies stopped paying no-fault claims submitted by Andrew Carothers, M.D., P.C., a professional service corporation, as assignee, the PC sued the insurers. The insurers asserted that, under State Farm Mut. Auto. Ins. Co. v. Mallela, …
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Employee Benefit Plan Review – From the Courts
June 26, 2019 | Ian S. Linker | Employment & Labor | Insurance Coverage
5th Circuit Applies Deferential Abuse-of-Discretion Standard of Review and Upholds Claim Administrator’s Application of Plan’s Weight-Loss Surgery Exclusion The U.S. Court of Appeals for the Fifth Circuit has upheld the adverse benefit determination of a claim administrator of a health insurance benefits plan governed by the Employee Retirement Income Security Act of 1974 (ERISA) after …
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Insurance Update
June 19, 2019 | Robert Tugander | Greg E. Mann | Insurance Coverage
Our June insurance update is now available.  Packed with cases, our update touches upon a variety of issues. We start off with two state high court decisions.  One deals with faulty work, the other considers whether a third-party claims administrator must answer to a claim for bad faith. Sticking with bad faith, a Delaware court …
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Does Your Cybersecurity Insurance Policy Cover Spoofing Losses? It Depends
June 12, 2019 | Robert Tugander | Gregory J. Klubok | Privacy, Data & Cyber Law | Insurance Coverage
It goes without saying that cybercrime is a growing concern. In April, the FBI released its annual IC3 (Internet Crime Complaint Center) Report, which showed that the FBI received over 350,000 cyber-crime complaints in 2018, with total losses of over $2.7 billion. One common type of cyber crime is spoofing, which is the cyber version …
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New York Insurance Coverage Law Update
May 30, 2019 | Alan C. Eagle | Insurance Coverage
Third Department Affirms Dismissal Of Coverage Case Filed More Than 24 Months After Loss After a building in the city of Troy was burglarized, the building owner sought coverage for the damage.  On September 18, 2014, the insurer denied the claim because of the policy’s lack of coverage for theft and water damage.  On October …
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Employee Benefit Plan Review – From the Courts
May 29, 2019 | Ian S. Linker | Employment & Labor | Insurance Coverage
Second Circuit Finds That Claim for ERISA Pension Plan Benefits Was Time-Barred Historically, employees leaving Xerox Corporation typically received a lump sum payment equal to the total value of their then-accrued pension benefit under the Xerox pension plan, an employee benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA). Employees who …
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Insurance Update
May 17, 2019 | Robert Tugander | Greg E. Mann | Insurance Coverage
Just like the abundance of rain we’ve had so far this spring, we’ve seen a recent downpour of coverage disputes. And just like the April showers that brought us May flowers, those coverage disputes have now blossomed into some interesting decisions. Our May Insurance Update discusses some of the best picks: The insured sells its …
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Employee Relations Law Journal – From the Courts
| Ian S. Linker | Insurance Coverage
Sixth Circuit Affirms District Court Decision That Anesthesiologist Was Not Disabled from His Own Occupation The U.S. Court of Appeals for the Sixth Circuit recently affirmed a district court’s decision upholding a determination by the claim administrator of an employee welfare benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA) that …
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