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Mealey's Insurance - 8th Circuit Upholds Dismissal Of Dispute Seeking To Recover ACA Reinsurance Fee

ST. LOUIS - Finding sovereign immunity was not waived, the Eighth Circuit U.S. Court of Appeals on Nov. 27 affirmed the dismissal of a lawsuit filed by trustees of a self-insured group health plan seeking to recoup from the U.S. government a fee paid under the Affordable Care Act's transitional reinsurance...

Mealey's Insurance - Idaho Supreme Court Affirms Summary Judgment Ruling In Bad Faith Suit

BOISE, Idaho - In a split opinion, a majority of justices on the Idaho Supreme Court on Nov. 29 ruled that a state trial court did not err in granting an insurer's motion for summary judgment in an insurance bad faith lawsuit arising out of a claim for underinsured motorist (UIM) benefits because...

Mealey's Insurance - Magistrate Judge Recommends Denial Of Reinsurance Claims In 9/11 Insurance Dispute

NEW YORK - In a dispute over claims stemming from the attacks on Sept. 11, 2001, a New York federal magistrate judge on Nov. 27 recommended that insurers be awarded $221.5 million but that their claims arising out of reinsurance contracts be denied (In re: Terrorist Attacks on September 11, 2001, No...

Mealey's Insurance - 5th Circuit Vacates $4M Restitution, Forfeiture Order Against Physician Assistant

NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Nov. 30 overturned a federal judge in Texas' ruling ordering a physician's assistant found guilty of conspiracy to commit insurance fraud to pay $4 million in restitution and forfeiture, holding that the man should be required to reimburse...

Mealey's Insurance - 11th Circuit Panel Affirms Summary Judgment Ruling In Bad Faith Suit

ATLANTA - A federal district court did not err in granting an insurer's motion for summary judgment in an insurance bad faith lawsuit because an insured failed to provide sufficient evidence that would allow a reasonable jury to determine that the insurer acted in bad faith in its investigation into...

Mealey's Insurance - Negligence Claim For Practice Of Medicine Without License Is Preempted By ERISA, Judge Says

LEXINGTON, Ky. - A Kentucky federal judge on Nov. 28 determined that a plaintiff's claim for negligence per se for the practice of medicine without a license based on a defendant's certification of information about the plaintiff's disability without approval from the plaintiff's doctor...

Mealey's Insurance - Judge Certifies Investor Class In Securities Suit Against SeaWorld, Others

SAN DIEGO - Lead plaintiffs in a securities class action lawsuit against SeaWorld Entertainment Inc. and certain of its current and former executive officers over their alleged concealment of the negative impact the document "Blackfish" had on the company's business and financial condition...

Mealey's Insurance - Connecticut Federal Judge: Cracks In Foundation Are Not Sudden And Accidental Loss

BRIDGEPORT, Conn. - No coverage is owed to insureds seeking coverage for cracks discovered in their basement walls and caused by the presence of a mineral used in the concrete because the insureds' loss was not sudden and accidental as required under the policy, a Connecticut federal judge said Nov...

Mealey's Insurance - Subrogation, Unjust Enrichment Claims Properly Dismissed, Illinois Panel Says

CHICAGO - A trial court did not err in dismissing a primary insurer's counterclaim seeking contractual subrogation and alleging unjust enrichment against an insured's excess insurers in an asbestos coverage dispute because the primary insurer did not have a legal obligation to pay for any of...

Mealey's Insurance - GEICO's Insurance Fraud, RICO Claims Not Subject To Arbitration, Judge Says

CAMDEN, N.J. - A federal judge in New Jersey on Dec. 1 refused to dismiss a lawsuit brought by the Government Employees Insurance Co. (GEICO) over an alleged fraudulent billing scheme by doctors at two orthopedic firms, finding that the insurer's claims under the Racketeer Influenced and Corrupt...

Mealey's Insurance - Pennsylvania Judge Vacates No Coverage Ruling In Dispute Over Racetrack Death

PHILADELPHIA - A Pennsylvania judge found that a lower court erred in finding that a commercial umbrella liability insurer has no duty to indemnify its insured against $2.6 million in punitive damages that it paid to settle an underlying wrongful death and survival action, vacating and remanding for...

Mealey's Insurance - 11th Circuit Says District Court Did Not Err In Finding Bad Faith Claim Fails

ATLANTA - The 11th Circuit U.S. Court of Appeals on Nov. 30 affirmed a district court's judgment in favor of an insurer on a bad faith claim after determining that the district court did not err in concluding that no reasonable jury could find that the insurer acted in bad faith by failing to settle...

Mealey's Insurance - Pennsylvania Federal Judge Says ERISA Applies To Subrogation Dispute

SCRANTON, Pa. - A Pennsylvania federal judge on Dec. 1 denied a plaintiff's motion to remand a suit seeking a declaration that a recovery service company hired by a disability insurer is not entitled to collect reimbursement for paid disability benefits because the Employee Retirement Income Security...

Mealey's Insurance - Federal Judge Says Claimant Cannot Perform Material Duties Of Any Occupation

SEATTLE - A plaintiff who is receiving long-term disability (LTD) benefits is entitled to waiver of premium (WOP) benefits under a life insurance policy because the plaintiff cannot perform the material duties of any occupation as she is unable to perform the material duties of any occupation on a full...

Mealey's Insurance - Professional Liability Insurer Has Duty To Defend Attorney, Illinois Panel Affirms

MOUNT VERNON, Ill. - An Illinois appeals panel on Dec. 6 held that underlying claims against an attorney and his law firm can be rationally said to fall within coverage of a professional liability insurance policy, rejecting the insureds' argument that coverage is barred by the policy's'...

Mealey's Insurance - Justice Declines To Compel Arbitration Under Reinsurance Participation Agreement

GOSHEN, N.Y. - A New York justice on Dec. 5 refused to compel arbitration of a dispute pursuant to a provision under a reinsurance participation agreement (RPA) because the provision is invalid under Nebraska law (Milmar Food Group II, LLC, et al. v. Applied Underwriters Inc., et al., No. EF003101-2017...

Mealey's Insurance - Underlying Asbestos Claims Arose Out Of Single Occurrence, Illinois Panel Says

CHICAGO - The First District Illinois Appellate Court on Dec. 5 affirmed a trial court's ruling that underlying asbestos bodily injury claims constitute only one occurrence under an insurer's policies because the underlying claims arose from the single cause of the insured's manufacturing...

Mealey's Insurance - U.S. Supreme Court Refuses To Review 2nd Circuit's Offset Ruling

WASHINGTON, D.C. - The U.S. Supreme Court on Dec. 11 refused to review the Second Circuit U.S. Court of Appeals' ruling that a New York law barring the offset of a claimant's disability benefits with the proceeds of the claimant's settlement of a personal injury suit is not preempted by the...

Mealey's Insurance - Panel: Insurer Had Duty To Defend Additional Insured Against Defects Claims

SALEM, Ore. - An insurer had a duty to defend an additional insured general contractor in an underlying construction defects case, an Oregon appeals panel ruled Dec. 6, reversing a trial court's entry of summary judgment in favor of the insurer (Security National Insurance Co. v. Sunset Presbyterian...

Mealey's Insurance - Judge Orders Insurer To Produce Documents On Reinsurance, Mediation

PITTSBURGH - A Pennsylvania federal judge on Dec. 7 granted and denied in part an insured's request to compel an insurer to produce redacted documents pertaining to mediation in an underlying case, as well as reinsurance information (Golon Inc. v. Selective Insurance Company of the Southeast, et...

Mealey's Insurance - Minnesota Appeals Panel: Filed-Rate Doctrine Bars Claims Against Reinsurer

MINNEAPOLIS - The filed-rate doctrine precludes employers' claims to recover assessments that Workers' Compensation Reinsurance Association (WCRA) levied against them, a Minnesota appeals panel affirmed Dec. 11 (Ambassador Press Inc., et al. v. Trifac Workers' Compensation Fund, et al., Nos...

Mealey's Insurance - Federal Judge Denies Motion To Dismiss In Chemical Exposure Coverage Dispute

CHICAGO - An Illinois federal judge on Dec. 7 denied an insurer's motion to dismiss after rejecting the insurer's argument that the potential indemnitor for underlying liabilities arising out of exposure to polychlorinated biphenyls should be named as the defendant pursuant to a 1999 settlement...

Mealey's Insurance - Panel: Insurance Benefits Company Is Entitled To Producer Commission

CHICAGO - An insurance benefits company is entitled to a producer commission but not a marketer's fee for a health insurer's breach of an oral contract under a marketing agreement amended following the health insurer's termination of a reinsurance agreement, an Illinois appeals panel affirmed...

Mealey's Insurance - 11th Circuit: 'Overwhelming Evidence' Supported Health Care Fraud Conviction

ATLANTA - An 11th Circuit U.S. Court of Appeals panel on Dec. 12 upheld a man's conviction and sentence for his role in a health care fraud scheme, finding that the government presented "overwhelming evidence" to prove that he received illegal kickbacks and conspired with his co-defendants...

Mealey's Insurance - Genuine Issues Of Fact Regarding Settlement Of Auto Claim Exist, Judge Says

COLUMBUS, Ga. - Genuine issues of fact preclude summary judgment on a bad faith failure-to-settle claim because a jury could find that the insurer did not act reasonably in responding to a settlement offer for the full limits of an auto policy, a Georgia federal judge said Dec. 12 in denying the insurer's...