CHICAGO - The Illinois Insurance Guaranty Fund (IIGF) failed to assert a reimbursement claim against a borrowing employer's insurer for workers' compensation benefits paid to an injured worker after the insurer for the lending employer that was obligated to make payments was liquidated, an Illinois appeals panel affirmed Nov. 12 (Illinois Insurance Guaranty Fund v. Liberty Mutual Insurance Co., et al., No. 1-12-3345, Ill. App., 1st Dist., Div. 2; 2013 Ill. App. LEXIS 779).
HOUSTON - A federal judge in Texas on Nov. 12 held that an insurance company's claim notes created after it received a letter from a customer's client asking the company to fund a settlement that would exceed the limits of a policy the plaintiff company had with the client were sufficient for the insurer to anticipate litigation with the client (OneBeacon Insurance Company v. T. Wade Welch & Associates, et al., No. H-11-3061, S.D. Texas; 2013 U.S. Dist. LEXIS 161083).
WASHINGTON, D.C. - The federal government on Nov. 12 moved for summary judgment in a suit challenging an Internal Revenue Service regulation imposed under the Patient Protection and Affordable Care Act (PPACA) that extends eligibility for premium assistance subsidies to people who purchase health insurance through exchanges established by the PPACA (Jacqueline Halbig, et al. v. Kathleen Sebelius, et al., No. 13-623, D. D.C.).
PITTSBURGH - A Pennsylvania federal bankruptcy judge on Nov. 12 mostly denied a motion by two insurance companies to reconsider confirmation of Pittsburgh Corning Corp.'s Chapter 11 plan of reorganization, granting the request only to make clear what affiliates of the debtor are protected from asbestos personal injury suits by the plan's channeling injunction (In re: Pittsburgh Corning Corporation, No. 00-22876, W.D. Pa. Bkcy.; 2013 Bankr. LEXIS 4792).
NEW ORLEANS - Insureds' claims alleging that an insurance agent was negligent in failing to advise them as to the correct amount of insurance coverage are not cognizable under Louisiana law, a Louisiana federal judge held Nov. 11, granting the agent's motion to dismiss (Karon Morin, et al. v. American Bankers Insurance Company of Florida, et al., No. 13-5972, E.D. La.; 2013 U.S. Dist. LEXIS 161162).
TRENTON, N.J. - A school board must file its counterclaim for liquidated damages against an insolvent insurer in the insurer's liquidation proceeding, a New Jersey appeals panel affirmed Nov. 12 (American Motorists Insurance Co. v. North Plainfield Board of Education, No. A-2234-12T1, N.J. Super. App. Div.; 2013 N.J. Super. Unpub. LEXIS 2714).
SEATTLE - A lower court did not err in granting summary judgment dismissal to two excess insurers in an investment management company insured's lawsuit seeking excess coverage for settlements and costs stemming from its fraudulent tax shelter strategy, a Washington appeals panel found Nov. 12 (Quellos Group LLC v. Federal Insurance Co., et al., No. 68478-7-I, Wash. App., Div. 1; 2013 Wash. App. LEXIS 2626).
JACKSON, Miss. - A trial court correctly admitted expert testimony that wind from Hurricane Katrina damaged a couple's roof structure, but it wrongly shifted the burden of proof for other damage to the property owners, the Mississippi Supreme Court held Nov. 7 in reversing a directed verdict for the insurer on coverage (Jack and Margaret Ann Hoover v. United Services Automobile Association, No. 2011-CA-01486-SCT, Miss. Sup.; 2013 Miss. LEXIS 578).
CHICAGO - An Illinois federal judge on Nov. 7 refused to dismiss a commercial general liability insurer's argument that an underlying recovery-of-benefits claim against its insured is excluded from coverage because it is not based on a "negligent act, error or omission" (ISOP v. Oce-USA Holdings Inc., No. 12 C 04713, N.D. Ill.; 2013 U.S. Dist. LEXIS 159494).
KNOXVILLE, Tenn. - A Tennessee federal judge on Nov. 7 dismissed for lack of jurisdiction an insurer's coverage action regarding its duty to defend and indemnify an underlying case alleging poor workmanship because that case can resolve the issues (Certain Underwriters at Lloyd's London v. Gerald Cress, et al., No. 13-180, E.D. Tenn.; 2013 U.S. Dist. LEXIS 159393).
ROCHESTER, N.Y. - An insurer has no duty to defend its insured against an underlying personal injury suit arising out of lead exposure because the insurer submitted sufficient evidence that it properly notified its insured of the addition of a lead exclusion to the policy, a New York appellate court majority said Nov. 8 (Preferred Mutual Insurance Co. v. John Donnelly et al., No. 857 CA 13-00319, N.Y. Sup., App. Div., 4th Dept.; 2013 N.Y. App. Div. LEXIS 7363).
CAMDEN, N.J. - An insured's claim that her auto insurance provider uses unlicensed customer service representatives to make policy changes over the phone is not sufficient to support claims for bad faith and breach of contract, a New Jersey federal judge ruled Nov. 7, dismissing most of her putative class claims related to the insurer's practices surrounding its provision of uninsured and underinsured motorist (UM/UIM) coverage (Shannon L. Ensey v. Government Employers Insurance Co., et al., No. 1:12-cv-07669, D. N.J.; 2013 U.S. Dist. LEXIS 159373).
LAFAYETTE, La. - A Louisiana federal judge on Nov. 8 granted a motion to dismiss a qui tam action for the false billing of Medicare claims, saying the plaintiff failed to support his allegations (Craig Thompson v. LifePoint Hospitals Inc., et al., No. 11-1771, W.D. La.; 2013 U.S. Dist. LEXIS 160678).
OAKLAND, Calif. - A California federal judge on Nov. 8 denied a plaintiff's motion for a temporary restraining order to keep her health insurance company from allegedly wrongfully denying benefits for her continued residential treatment for eating disorders (Alison O. v. Anthem Blue Cross Life and Health Insurance Co., No. 13-4787, N. D. Calif.; 2013 U.S. Dist. LEXIS 160663).
CHICAGO - A divided Seventh Circuit U.S. Court of Appeals on Nov. 8 reversed the denial of preliminary injunctions in two cases brought by secular, for-profit companies and their owners in challenges to the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Cyril B. Korte, et al. v. Kathleen Sebelius, et al., No. 12-384; William D. Grote III, et al. v. Kathleen Sebelius, et al., No. 13-1077, 7th Cir.; 2013 U.S. App. LEXIS 22748).
TALLAHASSEE, Fla. - The First District Florida Court of Appeal on Nov. 6 reversed a trial court's ruling that a mandatory forum selection clause was unreasonable to include in a storage tank liability insurance policy because the insured failed to provide evidence supporting the unreasonableness of including the clause in the policy (Illinois Union Insurance Co. v. Co-Free Inc., No. 1D13-927, Fla. App., 1st Dist.; 2013 Fla. App. LEXIS 17697).
PHILADELPHIA - A Pennsylvania Superior Court panel on Nov. 6 partly reversed and partly affirmed a trial court's summary judgment in favor of an umbrella insurer and its duties to defend and indemnify an engineering contractor in an underlying negligence lawsuit, finding that a professional services exclusion did not preclude coverage (Lexington Insurance Co. v. The Charter Oak Fire Insurance Co., et al., No. 2876 EDA 2012, Pa. Super.; 2013 PA Super 286; 2013 Pa. Super. LEXIS 3146).
LAKE CHARLES, La. - A Louisiana appeals panel on Nov. 6 reversed a lower court's ruling rejecting an insurer's request to have a judgment against it in a Hurricane Rita coverage dispute declared as satisfied, further reversing the lower court's judgment ordering the insurer to pay $36,853.86 to the insured or suffer an interest penalty (Clarence M. Leland, et al. v. Lafayette Insurance Co., No. 13-476, La. App., 3rd Cir.; 2013 La. App. LEXIS 22892013 La. App. LEXIS 2289).
NEW YORK - A New York federal judge on Nov. 7 refused to dismiss an insurance broker's claims for unjust enrichment and quantum meruit against an insurer regarding the termination of an agency agreement (Dart Brokerage Corp. v. American Commerce Insurance Co., No. 13-04015, S.D. N.Y.; 2013 U.S. Dist. LEXIS 160219).
WEST PALM BEACH, Fla. - An insurance professionals errors and omissions policy's criminal conduct exclusion absolves the insurer of its duty to defend an insurance broker against two underlying lawsuits, a Florida federal judge ruled Nov. 7, granting the insurer's motion for final summary judgment (Certain Interested Underwriters at Lloyd's, London v. AXA Equitable Life Insurance Co., et al., No. 10-62061, S.D. Fla.; 2013 U.S. Dist. LEXIS 159639).
CHICAGO - An Illinois federal judge on Nov. 7 dismissed a suit alleging the false billing of Medicare and Medicaid claims, saying that the relator failed to support any of his allegations (United States of America, et al. v. Ukrainian Village Pharmacy, et al., No. 09-7891, N.D. Ill.; 2013 U.S. Dist. LEXIS 159492).
LAKE CHARLES, La. - A Louisiana appeals court on Nov. 6 reversed the denial of a claim for penalties and attorney fees in a wrongful denial of health care benefits suit (Amanda Pousson v. Blue Cross Blue Shield of Louisiana, No. 13-481, La. App., 3rd. Cir.; 2013 La. App. LEXIS 2290).
CHICAGO - An Illinois federal judge on Nov. 7 declined to grant summary judgment motions brought by both sides in a reimbursement dispute between chiropractors and a group of insurance companies (Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., No. 09-5619, N.D. Ill; 2101 U.S. Dist. LEXIS 159331).
NEW ORLEANS - A Louisiana federal judge on Nov. 7 found that fact issues preclude a summary judgment ruling in favor of an insured in a dispute over building coverage for flood damage caused by Hurricane Isaac (Lisa Hillard v. Bankers Specialty Insurance Co., No. 13-200, E.D. La.; 2013 U.S. Dist. LEXIS 159674).
CHICAGO - A divided en banc Seventh Circuit U.S. Court of Appeals on Nov. 7 ruled that the husband of a health plan participant may proceed with his claims that the plan sponsor and insurer breached their fiduciary duties under the Employee Retirement Income Security Act by failing to inform him during telephone conversations that the medical providers who were going to perform emergency surgery on his wife were out of network (James E. Killian v. Concert Health Plan, et al., No. 11-1112, 7th Cir.; 2013 U.S. App. LEXIS 22657).