MADISON, Wis. - A Wisconsin federal judge on Nov. 5 dismissed a qui tam action brought against the owner and operator of a chain of retail pharmacies for Medicaid fraud, saying the claims were premised on an untenable legal theory (Carl Thulin v. Shopko Stores Operating Co., No. 10-196, W.D. Wis.; 2013 U.S. Dist. LEXIS 158170).
ORLANDO, Fla. - Hospice of the Comforter Inc. agreed to pay $3 million to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program for hospice services provided to patients who were not eligible for the Medicare hospice benefit program, the U.S. Department of Justice announced in a Nov. 5 news release (United States ex rel. Stone v. Hospice of the Comforter Inc., No. 11-1498, M.D. Fla.).
OTTAWA, Ill. - A trial judge erred in dismissing a builder's counterclaims against an insurer for its alleged breach of contract and bad faith in denying coverage for a roof collapse at a grain storage facility, an Illinois appeals panel found Nov. 4, reversing and remanding the judge's decision (Selective Insurance Company of South Carolina v. Cherrytree Companies Inc. d/b/a Macon General Contractors, No. 3-12-0959, Ill. App., 3rd Dist.).
SEATTLE - Even though a Washington federal judge on Nov. 1 determined that an insurer should have provided coverage for a contractor's claim related to a penalty from an alleged labor code violation, the judge found that the unique scenario presented by the claim and the insurer's thorough investigation precluded a finding of bad faith (Bayley Construction v. Great American E&S Insurance Co., No. 2:13-cv-00114, W.D. Wash.; 2013 U.S. Dist. LEXIS 157279).
WASHINGTON, D.C. - A District of Columbia federal judge on Nov. 5 granted the federal government's request to transfer a suit challenging the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) to another federal court, saying the plaintiffs engaged in forum shopping in their choice of where to file the suit (M & N Plastics Inc., et al. v. Kathleen Sebelius, et al., No. 13-919, D. D.C.; 2013 U.S. Dist. LEXIS 157945).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Nov. 5 held that an errors and omissions insurer has no duty to defend its insured against an underlying lawsuit because the claims were for intentional torts and not negligence (Matthew T. Szura & Co. v. General Insurance Company of America, No. 12-2505, 6th Cir.).
SEATTLE - A third-party bad faith claim against an insurer accrues on the date that final judgment is entered in the underlying suit at issue, a Washington federal judge ruled Oct. 31, denying an insurer's motion for partial summary judgment on statute of limitations grounds (Everest Indemnity Insurance Co. v. QBE Insurance Corp., et al., No. 2:13-cv-00828, W.D. Wash.; 2013 U.S. Dist. LEXIS 156949).
GALVESTON, Texas - A Texas federal judge on Nov. 4 granted a federal flood insurer's motion to certify for immediate interlocutory appeal the issues of whether Campo v. Allstate Insurance Co. (562 F.3d 751 [5th Cir. 2009]) should be reversed or has been superseded by a July 16, 2009, pronouncement by the Federal Emergency Management Agency and whether federal law preempts all National Flood Insurance Policy (NFIP) procurement disputes (Robert Spong, et al. v. Fidelity National Property and Casualty Ins. Co., et al., No. G-10-228, S.D. Texas, Galveston Div.; 2013 U.S. Dist. LEXIS 157763).
JACKSON, Miss. - A church insured's July 8, 2009, motion to set aside judgment or, in the alternative, for a new trial in a Hurricane Katrina coverage dispute tolled the statute of limitations on the underlying breach of contract claim; therefore, the trial court erred in dismissing the insured's second complaint against its insurer, the Mississippi Supreme Court ruled Oct. 31 (Sweet Valley Missionary Baptist Church v. Alfa Insurance Corp., et al., No. 2010-CT-01807-SCT, Miss. Sup.; 2013 Miss. LEXIS 574).
TAMPA, Fla. - There is no duty to defend and indemnify under a homeowners insurance policy and an excess liability coverage policy for claims arising from the sale of a home that had Chinese drywall installed, a Florida federal judge ruled Nov. 4, finding that intentional act exclusions applied (Chartis Property & Casualty Co. and American Home Assurance Co. v. John D. Jassy, et al., No. 12-2087, M.D. Fla.; 2013 U.S. Dist. LEXIS 157673).
JACKSONVILLE, Fla. - An insurer is not required to produce pending claims files related to pollution liability and environmental contamination coverage until after those claims are decided, a Florida federal magistrate judge said Nov. 1 (First Coast Energy LLP v. Mid-Continent Casualty Co., No. 12-281, M.D. Fla.; 2013 U.S. Dist. LEXIS 157039).
LAS VEGAS - Because an insurer based its denial of an underinsured motorist (UIM) policy limit claim on doctors' reports, a Nevada federal judge on Oct. 31 found the denial reasonable and not in bad faith, granting the insurer's motion for partial summary judgment (Tara Ann Sherwin v. Infinity Auto Insurance Co., et al., No. 2:11-cv-00043, D. Nev.; 2013 U.S. Dist. LEXIS 156682).
NEWARK, N.J. - A New Jersey federal judge on Oct. 31 granted in part and denied in part motions to dismiss a qui tam case brought under the False Claims Act against multiple hospitals and health care providers for allegedly improperly billing Medicare for inpatient admissions (United States of America ex rel. Paul Tahlor, M.D., et al. v. AHS Hospital Corp., et al., No. 088-03042, D. N.J.; 2013 U.S. Dist. LEXIS 156226).
DENVER - A Colorado federal judge on Nov. 1 denied certification of appeal for third party to a coverage action involving a commercial general liability insurer's duty to defend its insured against underlying construction defect actions (D.R. Horton Inc. - Denver d/b/a Trimark Communities and D.R. Horton Inc. v. The Travelers Indemnity Company of America, et al., No. 10-02826, D. Colo.; 2013 U.S. Dist. LEXIS 157006).
KANSAS CITY, Kan. - An insurer has a duty to defend its professional association insured and the insured's dentists and office administrator against an underlying lawsuit brought by two of the insured's other dentists, a Kansas federal judge ruled Nov. 1 (The Cincinnati Insurance Co. v. Gage Center Dental Group, et al., No. 12-2387-KHV, D. Kan.; 2013 U.S. Dist. LEXIS 156844).
ATLANTA - An injured worker was not an "emergency claimant" entitled to workers' compensation benefits from the Georgia Insurers Insolvency Pool, a Georgia appeals panel affirmed Oct. 31 (Hugh Reece v. Georgia Insurers Insolvency Pool, No. A13A1409, Ga. App., 4th Div.; 2013 Ga. App. LEXIS 858).
DENVER - The 10th Circuit U.S. Court of Appeals on Nov. 1 reversed and remanded a lower federal court's ruling in favor of a commercial general liability insurer in a coverage dispute arising from defective connector adapters for hunting arrows (Magnus Inc. v. Diamond State Insurance Co., No. 12-3091, 10th Cir.; 2013 U.S. App. LEXIS 22266).
HARRISBURG, Pa. - Claims against a reinsurance policy issued by an insolvent insurer were properly classified as priority (e) under 40 Pennsylvania Statutes Section 221.44, the Pennsylvania Supreme Court affirmed Oct. 30 (CSAC Excess Insurance Authority v. Reliance Insurance Co. in liquidation (ancillary matter to In re: Reliance Insurance Co., No. 102 MAP 2012, Pa. Sup.; 2013 Pa. LEXIS 2559).
SAVANNAH, Ga. - A Georgia federal judge on Oct. 30 denied a health insurer's motion to dismiss a wrongful denial of health care benefits suit but granted the plaintiff's motion to amend his complaint to plead claims under the Employee Retirement Income Security Act (Marwin Moss v. Blue Cross and Blue Shield of Florida Inc., et al., No. 13-159, S.D. Ga.; 2013 U.S. Dist. LEXIS 155751).
LOS ANGELES - After finding that a condominium owner suffered no covered loss in relation to the demolition of an allegedly leaking shower that caused mold, a California appeals court on Oct. 30 affirmed a decision to deny him coverage under his insurance policy (Paul Sigelman v. State Farm General Insurance Co., No. B241981, Calif. App., 2nd Dist., Div. 1; 2013 Cal. App. Unpub. LEXIS 7843).
PROVIDENCE, R.I. - A Rhode Island federal judge on Oct. 31 granted summary judgment in favor of a health maintenance organization in a wrongful denial of benefits dispute, saying that the plan clearly did not cover the services sought (Jean Ho Rath, et al. v. Tufts Associated Health Maintenance Organization, No. 12-546, D. Rhode Island; 2013 U.S. Dist. LEXIS 156469).
RICHMOND, Va. - A federal judge in Virginia on Oct. 31 denied the plaintiffs' request for a preliminary injunction in their 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 federal government (David King, et al. v. Kathleen Sebelius, et al., No. 13-630, E.D. Va.).
WASHINGTON, D.C. - The U.S. Supreme Court on Nov. 4 declined to review an 11th Circuit U.S. Court of Appeals unpublished ruling that an action under the Employee Retirement Income Security Act to recover disability benefits is time-barred because the claimant failed to file a claim within the plan's one-year notification period (Beatriz Martinez-Claib, M.D. v. Business Men's Assurance Company of America, et al., No. 12-1403, U.S. Sup.).
WASHINGTON, D.C. - A divided District of Columbia Circuit U.S. Court of Appeals Court on Nov. 1 reversed a decision denying the plaintiffs' request for a preliminary injunction to halt the implementation of the birth control mandate contained in the Patient Protection and Affordable Care Act (PPACA) (Francis A. Gilardi, et al. v. United States Department of Health and Human Services, et al., No. 13-5069, D.C. Cir.; 2013 U.S. App. LEXIS 22256).
SEATTLE - Finding no evidence that an insurer "fully and fairly" investigated a policyholder's claims for injuries and expenses related to auto accidents, a Washington federal judge on Oct. 29 mostly denied the insurer's motion for summary judgment on bad faith and related state law claims against it (Richard Bird v. American Family Mutual Insurance Co., No. 2:12-cv-01553, W.D. Wash.; 2013 U.S. Dist. LEXIS 155176).