LexisNexis® Legal Newsroom
    Mealey's Insurance - Louisiana Federal Judge Leaves Federal And State Claims In Reimbursement Dispute

    NEW ORLEANS - A Louisiana federal judge on Marcy 27 partially dismissed a health care reimbursement dispute brought by the provider of post-mastectomy breast reconstruction medical services against an insurance company, leaving claims brought under the Employee Retirement Income Security Act and state law claims for detrimental reliance, fraud, negligent misrepresentation and breach of contract (Center for Restorative Breast Surgery, et al. v. Humana Health Benefit Plan of Louisiana, et al., No. 10-4346, E. D. La.; 2014 U.S. Dist. LEXIS 41134).

    Mealey's Insurance - Massachusetts Federal Judge's Summary Judgment Order Leaves 1 Count

    BOSTON - A Massachusetts federal judge on March 26 denied the plaintiffs' motion for summary judgment in a health care reimbursement suit and partially granted the defendant's motion, leaving only one count involving 11 disputed claims to continue (Spinal Imaging Inc. v. Aetna Health Management, et al.; Radiology Diagnostics v. Aetna Health Management, et al., Nos. 09-11873, 12-11521, D. Mass.; 2014 U.S. Dist. LEXIS 40099).

    Mealey's Insurance - Illinois Federal Judge Dismisses Medicare Dispute For Lack Of Jurisdiction

    CHICAGO - A Chicago federal judge on March 26 dismissed a Medicare payment dispute, saying that the plaintiffs failed to exhaust the administrative review process before filing suit and that, therefore, the court lacked jurisdiction (Center for Dermatology and Skin Cancer, et al. v. Kathleen Sebelius, et al., No. 13 C 4926, N.D. Ill.; 2014 U.S. Dist. LEXIS 39907).

    Mealey's Insurance - Pennsylvania Federal Judge Dismisses Claims In Reimbursement Dispute

    PHILADELPHIA - A Pennsylvania federal judge on March 27 dismissed a suit challenging the coverage and reimbursement of chiropractor claims, saying that one plaintiff failed to exhaust administrative remedies and that two other plaintiffs lacked standing (American Chiropractic Association, et al. v. American Specialty Health Inc., et al., No. 12-7243, E.D. Pa.; 2014 U.S. Dist. LEXIS 41769).

    Mealey's Insurance - High Court Will Not Consider Termination Of Disability Benefits Under ERISA

    WASHINGTON, D.C. - The U.S. Supreme Court on March 31 declined to review a Fifth Circuit U.S. Court of Appeals ruling that held that a disability insurer did not act arbitrarily and capriciously by relying on emails furnished by a plan participant's acquaintance in determining that the participant was no longer disabled (Terri Truitt v. Unum Life Insurance Company of America, No. 13-861, U.S. Sup.).

    Mealey's Insurance - Top Court Rejects Religious Groups' Challenges In Birth Control Cases

    WASHINGTON, D.C. - The U.S. Supreme Court on March 31 denied petitions for certiorari from two nonprofit religious groups claiming that the contraceptive mandate contained in the Patient Protection and Affordable Care Act (ACA) violates the Religious Freedom Restoration Act (RFRA) (Priests for Life, et al. v. Kathleen Sebelius, et al., No. 13-891, U.S. Sup., Roman Catholic Archbishop of Washington, et al. v. Kathleen Sebelius, et al., No. 13-829, U.S. Sup.)

    Mealey's Insurance - Judge Stays Insurers' Special Deputy Receiver's Motion For In Camera Review

    ST. LOUIS - Pending receipt of a status report by the special deputy receiver (SDR) of three insolvent insurers, a Missouri federal judge on March 27 held in abeyance a motion filed by the SDR for an in camera review of produced documents in a lawsuit alleging a fraudulent scheme that left the insurers insolvent (Jo Ann Howard & Associates P.C., et al. v. J. Douglas Cassity, et al., No. 09-01252, E.D. Mo.; 2014 U.S. Dist. LEXIS 40575).

    Mealey's Insurance - Judge Dismisses Breach Of Contract, Bad Faith Claims In Employment Practices Suit

    PROVIDENCE, R.I. - A Rhode Island federal judge on March 27 dismissed breach of contract and bad faith claims in an insured's lawsuit seeking employment practices liability coverage for claims arising from the insured's termination of two employees (The Beacon Mutual Insurance Co. v. The St. Paul Mercury Insurance Co., No. 11-cv-559-M, D. R.I.; 2014 U.S. Dist. LEXIS 42562).

    Mealey's Insurance - Florida High Court To Hear Whether State-Created Insurer Can Be Sued For Bad Faith

    TALLAHASSEE, Fla. - In a March 26 order, the Florida Supreme Court accepted jurisdiction over a case in which the parties dispute whether a nonprofit insurer created by the Florida Legislature is statutorily immune from being sued for allegedly failing to attempt in good faith to settle its insured's claims (Citizens Property Insurance Corp. v. Perdido Sun Condominium Association Inc., No. SC14-185, Fla. Sup.; 2014 Fla. LEXIS 1077).

    Mealey's Insurance - Judge Says Fact Issue Exists Over Insurance Agent's Role In Insurance Application

    BROOKLYN, N.Y. - In a dispute between an insurance broker and its errors and omissions (E&O) insurer regarding a duty to defend an underlying action against the broker, a New York federal judge ruled March 27 that there is a genuine issue of material fact regarding whether an insurance agent was acting on behalf of the broker (Sils Brokerage Corp. v. U.S. Underwriters Insurance Co., No. 10-5176, E.D. N.Y.; 2014 U.S. Dist. LEXIS 42448).

    Mealey's Insurance - Judge Declines To Dismiss Insurers' Case Over Right To Control Insureds' Defense

    RIVERSIDE, Calif. - A California federal judge on March 26 refused to dismiss or stay a lawsuit filed by insurers against insureds regarding the rights and obligations under policies to control counsel for the insureds' defense in underlying construction defects cases (Fidelity and Guaranty Insurance Co., et al. v. Centex Homes, et al., No. 13-0938, C.D. Calif.; 2014 U.S. Dist. LEXIS 41716).

    Mealey's Insurance - Insured's Faulty Work Is An 'Occurrence,' Alabama Supreme Court Concludes

    MONTGOMERY, Ala. - An insured's faulty workmanship that led to water leaks was an "occurrence" under a commercial general liability insurance policy, the Alabama Supreme Court held March 28, withdrawing an earlier opinion and affirming that the insurer is obligated to pay an arbitration award against the insured (Owners Insurance Co. v. Jim Carr Homebuilder LLC, et al., No. 1120764, Ala. Sup.; 2014 Ala. LEXIS 44).

    Mealey's Insurance - Contraceptive Mandate Violates Religious Freedom Act, Georgia Federal Judge Says

    ATLANTA - The Patient Protection and Affordable Care Act (ACA)'s contraceptive mandate violates the Religious Freedom Restoration Act as it applies to two Georgia dioceses and related entities, a federal judge held March 26 in permanently enjoining its enforcement (The Roman Catholic Archdiocese of Atlanta, et al. v. Kathleen Sebelius, in her official capacity as Secretary, United States Department of Health and Human Services, et al., No. 12-3489, N.D. Ga.; 2014 U.S. Dist. LEXIS 39617).

    Mealey's Insurance - Appraisal Provision Inapplicable In Coverage Dispute, Georgia Majority Affirms

    ATLANTA - A majority of the Georgia Court of Appeals on March 26 affirmed a lower court's dismissal of an insured's lawsuit seeking to enforce the appraisal provision in his homeowners insurance policy (Lam v. Allstate indemnity Co., No. A13A1733, Ga. App.; 2014 Ga. App. LEXIS 225).

    Mealey's Insurance - Judge Denies Dismissal Or Stay Of Insurer's Action Over Faulty Basement Damages

    ROCK ISLAND, Ill. - An Illinois federal judge on March 26 declined to dismiss or stay an insurer's coverage action regarding damages from a defective basement pending resolution of a homeowner's lawsuit against the insurer's contractor (Secura Insurance Co. v. Rick R. Plumb d/b/a Superior Home Improvement and Linda R. Plumb, No. 13-04054, C.D. Ill.; 2014 U.S. Dist. LEXIS 39845).

    Mealey's Insurance - Insurer Owes More Than $11M To Insured For Fees And Costs, Federal Judge Says

    BATON ROUGE, La. - A Louisiana federal judge on March 26 granted an insured's motion to recover more than $11 million in attorney fees, defense costs and interest because the insured filed the Louisiana federal court lawsuit in response to the insurer's suit in New York federal court and because it was previously determined that the insurer owes a duty to defend the insured for the injunctive relief imposed by the U.S. Environmental Protection Agency and stemming from violations of the Clean Air Act (CAA) (Louisiana Generating LLC, et al., v. Illinois Union Insurance Co., No. 10-516, M.D. La.; 2014 U.S. Dist. LEXIS 40617).

    Mealey's Insurance - Rain Limitation Clause Under Policy Does Not Bar Insured's Loss, Panel Concludes

    DES MOINES, Iowa - A rain limitation clause under a business insurance policy did not apply to preclude coverage for an insured's loss from rain damage, an Iowa appeals panel held March 26, reversing and remanding a grant of summary judgment to an insurer (Amish Connection Inc. v. State Farm Fire and Casualty Co., No. 13-0124, Iowa App.; 2014 Iowa App. LEXIS 281).

    Mealey's Insurance - Judge OKs Correction To Order In Retrocessional Reinsurance Dispute

    TRENTON, N.J. - A federal judge in New Jersey on March 25 granted a retrocessionally reinsured reinsurer's motion to amend/correct an earlier order to include an inadvertently omitted payable claim (Munich Reinsurance America, Inc. v. American National Insurance Company, No. 09-cv-06435, D. N.J.).

    Mealey's Insurance - Majority: Jury Erred In Finding Patient Did Not Prove Applicable Standard Of Care

    GRETNA, La. - A majority of a Louisiana appeals court found March 26 that a jury's finding that a patient failed to establish the applicable standard of care by a preponderance of the evidence was "clearly wrong," vacating the verdict and subsequent judgment and remanding the medical malpractice lawsuit for a new trial (Rommel Mladenoff v. Louisiana Medical Mutual Insurance Co., et al., No. 13-CA-477, La. App., 5th Cir.; 2014 La. App. LEXIS 811).

    Mealey's Insurance - Judge Decides On Insurers' Duty To Defend, Indemnify Construction Defects Cases

    PHOENIX - An Arizona federal judge on March 26 ruled on several motions for summary judgment filed by commercial general liability insurers regarding their duty to defend and indemnify underlying construction defects cases and whether two of the insurers owe an equitable contribution to the one insurer that settled the underlying cases (Quanta Indemnity Co. v. Amberwood Development Inc., et al., No. 11-01807, D. Ariz.; 2014 U.S. Dist. LEXIS 40211).

    Mealey's Insurance - 8th Circuit Panel: Pollution Exclusion Bars Coverage For Carbon Monoxide Claims

    ST. LOUIS - A pollution exclusion clearly bars coverage for claims arising out of carbon monoxide poisoning, the Eighth Circuit U.S. Court of Appeals said March 25 in affirming a federal judge's ruling that bodily injury caused by indoor pollutants is barred by pollution exclusions (Church Mutual Insurance Co. v. Clay Center Christian Church, et al., No. 13-1613, 8th Cir.; 2014 U.S. App. LEXIS 5450).

    Mealey's Insurance - Federal Judge Finds Mold Damage Is Excluded Under Homeowners Policy

    CAMDEN, N.J. - A New Jersey federal judge on March 25 granted an insurer's motion for summary judgment in a coverage action, finding that homeowners failed to show that mold growth caused by a long-term leak was covered under their insurance policy (James Fifth, et al. v. State Farm Insurance Co., No. 11-7440, D. N.J.; 2014 U.S. Dist. LEXIS 39731).

    Mealey's Insurance - HHS Delays Closing Of ACA Open Enrollment For Certain Individuals

    WASHINGTON, D.C. - Open enrollment under the Patient Protection and Affordable Care Act (ACA) will continue past the March 31 deadline for those with pending applications, those who have been stymied by errors and others with exceptional circumstances, the U.S. Department of Health and Human Services (HHS) said March 26.

    Mealey's Insurance - Plaintiffs' Extracontractual Claims Do Not Meet Twombly Standard, Judge Rules

    LAS VEGAS - The plaintiffs in a dispute over underinsured motorist (UIM) benefits "failed to plead sufficient facts to support" their bad faith and unfair trade practices claims under "modern pleadings standards," a Nevada federal judge ruled March 24, granting their insurer's motion to dismiss all of their extracontractual claims (Timothy Korhonen, et al. v. Sentinel Insurance Ltd., et al., No. 2:13-cv-00565, D. Nev.; 2014 U.S. Dist. LEXIS 38321).

    Mealey's Insurance - New Jersey Federal Judge Dismisses Negligence Case Against Insurance Agents

    CAMDEN, N.J. - A New Jersey federal judge on March 25 dismissed a negligence lawsuit against an insurance agent and her employer for their alleged failure to obtain flood insurance because insureds failed to file an affidavit of merit and failed to raise any defense or exception to filing an affidavit of merit (Jason Robbins and his wife, Melanie Robbins v. Renee Forgash, et al., No. 13-0624, D. N.J.; 2014 U.S. Dist. LEXIS 38808).