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Mealey's Insurance - Judge Upholds Convictions For Fraud Scheme Involving Urine Drug Screenings

FRANKFORT, Ky. - A federal judge in Kentucky on Sept. 29 affirmed a jury's decision to convict two physicians who owned addiction clinics, as well as the partial owners of a laboratory that conducted screenings for urine drug tests, of 17 counts of aiding and abetting one another to commit health...

Mealey's Insurance - Panel: Kentucky Insurance Guaranty Association Liable For Miner's Black Lung Benefits

CINCINNATI - The Kentucky Insurance Guaranty Association (KIGA) should provide benefits under the Black Lung Benefits Act to a disabled miner now that a mine operator and its insurer are both insolvent, the Sixth Circuit U.S. Court of Appeals affirmed Sept. 29 (Island Fork Construction v. Jimmy Bowling...

Mealey's Insurance - Judge: 'Deleterious Substances' Exclusion Bars Coverage For Insured's Grout Dust Work

PHILADELPHIA - A commercial general liability insurer did not breach its insurance contract nor did it act in bad faith in denying a claim, a Pennsylvania federal judge ruled Sept. 29 because "deleterious substances" exclusion precluded coverage for grout dust from construction work that led...

Mealey's Insurance - Colorado Federal Judge Affirms Denial Of LTD Claim Based On Pre-Existing Limitation

DENVER - A Colorado federal judge on Sept. 29 determined that a plan administrator's denial of long-term disability (LTD) benefits based on the plan's pre-existing condition limitation was not arbitrary and capricious because substantial evidence supports the plan administrator's finding...

Mealey's Insurance - Only 1 Plaintiff Can Proceed With Breach Of Contract Claim In Long-Term Care Dispute

CINCINNATI - An Ohio federal judge on Sept. 29 determined that only one of two plaintiffs can proceed with a breach of contract claim against an insurer that issued long-term care policies because Florida law banning the use of a hospital confinement provision includes the policy issued to only one of...

Mealey's Insurance - Missouri Appeals Panel Says 'All Sums' Method Of Allocation Applies

ST. LOUIS - The Eastern District Missouri Court of Appeals on Oct. 3 determined that a trial court properly applied an "all sums" method of allocation and properly determined that vertical exhaustion applies to a number of primary and excess policies under which an insured seeks coverage for...

Mealey's Insurance - Judge Overrules Man's Objections To Testimony On Benefits Fraud Scheme

ANN ARBOR, Mich. - A federal judge in Michigan on Oct. 4 overruled a man's requests for acquittal and/or new trial, finding that testimony about his role in an unemployment benefits fraud scheme was not inflammatory and that sufficient evidence was presented by the government to support his conviction...

Mealey's Insurance - 8th Circuit Grants Insurer's Petition In Venue Dispute Over Hailstorm Coverage Suit

ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on Oct. 6 granted a homeowners insurer's petition for a writ of mandamus seeking a venue transfer of the insured's breach of contract lawsuit arising from hail damage, vacating the lower court's denial of the insurer's motion to transfer...

Mealey's Insurance - Reinsurers Oppose Dismissal Of RICO, Breach Of Contract Claims Over Alleged Scheme

EL PASO, Texas - A shareholder of car dealerships and his reinsurance companies on Oct. 4 filed an opposition in Texas federal court to dismissal of their complaint alleging a scheme to take control over the dealership and to decline selling vehicle-protection products that are reinsured by the reinsurers...

Mealey's Insurance - Judge Issues $3.2M Default Judgment In Favor Of Reinsurer In Fraudulent Transfer Dispute

SAN DIEGO - A California federal judge on Oct. 4 granted a reinsurer's request for a $3.2 million default judgment in a dispute over alleged breach of reinsurance agreements as a result of a series of fraudulent transfers (Odyssey Reinsurance Co. v. Richard Keith Nagby, et al., No. 16-3038, S.D....

Mealey's Insurance - 5th Circuit Denies Request To Certify Question To Texas High Court In Asbestos Suit

NEW ORLEANS - The Fifth Circuit U.S. Court of Appeals on Oct. 5 denied an insurer's request to certify questions to the Texas Supreme Court regarding whether the "sudden and accidental" exception to the policies' pollution exclusion applies to afford coverage for the underlying asbestos...

Mealey's Insurance - Disability Claimant Properly Exhausted Administrative Remedies, Federal Judge Says

PEORIA, Ill. - An Illinois federal judge on Oct. 10 denied a motion to dismiss a complaint alleging wrongful denial of disability benefits after determining that the claimant exhausted her administrative remedies by submitting additional medical evidence in response to the disability insurer's denial...

Mealey's Insurance - Insurer Cannot Recover Amounts Over 'Reinsurance Accepted' Limit, Panel Says

ROCHESTER, N.Y. - An insurer is not entitled to recover any amounts exceeding the "reinsurance accepted" amount set forth in reinsurance certificates, a New York appeals panel ruled Oct. 6 (Utica Mutual Insurance Co. v. Alfa Mutual Insurance Co., et al., No. 17-00305, N.Y. Sup., App. Div.,...

Mealey's Insurance - 11th Circuit Says Insurer Did Not Act In Bad Faith In Handling Of Auto Claim

ATLANTA - An insurer did not act in bad faith in its handling of settlement negotiations because no reasonable jury could conclude that the insurer's potential negligence caused a failure to settle a claim arising out of an auto accident, the 11th Circuit U.S. Court of Appeals said Oct. 10 (Dennis...

Mealey's Insurance - Judge Finds Fact Issues Exist Over Knowledge Of Claim Under Performance Bond

CHICAGO - Material fact issues remain as to when a contractor knew of a construction defects claim under a performance bond, an Illinois federal judge ruled Oct. 10, denying summary judgment on a surety's statute of limitations defense (James McHugh Construction Co. v. International Fidelity Insurance...

Mealey's Insurance - New Jersey Panel Says Continuous Trigger Applies In Defects Coverage Dispute

TRENTON, N.J. - A New Jersey appeals panel on Oct. 10 agreed with a subcontractor that the continuous trigger theory applies to a dispute over whether coverage is owed by one of its insurers but remanded to the trial court the issue of when the manifestation began (Air Master & Cooling Inc. v. Selective...

Mealey's Insurance - Disability Claimant Failed To Provide Objective Medical Evidence To Support Claim

CINCINNATI - A disability plan administrator did not act arbitrarily or capriciously in denying a plan participant's claims for short-term disability benefits because the participant failed to provide objective medical evidence supporting the disability, the Sixth Circuit U.S. Court of Appeals said...

Mealey's Insurance - No Disparagement Alleged To Trigger Insurer's Duty To Defend, 9th Circuit Affirms

PASADENA, Calif. - The Ninth Circuit U.S. Court of Appeals on Oct. 11 affirmed a lower federal court's finding that there was no potential for coverage that could trigger a general liability insurer's duty to defend against an underlying lawsuit alleging the insured interfered with prospective...

Mealey's Insurance - 3rd Circuit: Commerce Clause Criminalizes Arson Of Rental Property For Benefits

PHILADELPHIA - A woman cannot seek to rescind her guilty plea on one count of malicious destruction of property by fire, the Third Circuit U.S. Court of Appeals ruled Oct. 12, finding that the commerce clause of the U.S. Constitution criminalizes the destruction of the rental property she set fire to...

Mealey's Insurance - Mass. Appeals Court Reverses Ruling In Asbestos Suit, Says No Defense Costs Owed

BOSTON - The Massachusetts Appeals Court on Oct. 16 vacated a trial court's ruling that an insurer owes its insured more than $2.4 million in defense costs for underlying asbestos bodily injury claims because the insured failed to prove that the insurer was operating under a conflict of interest...

Mealey's Insurance - Insurer Acted In Good Faith In Handling Underinsured Motorist Claim, Judge Rules

TAMPA, Fla. - An insured failed to show that injuries he sustained in an automobile accident were permanent in nature during negotiations with his automobile insurance provider, and thus, the insurer did not act in bad faith in the handling of his claim, a federal judge in Florida ruled Oct. 13 in granting...

Mealey's Insurance - Judge OKs Forbearance Agreement Between Reinsurer, Insurer In Arbitration Dispute

ATLANTA - A Georgia federal judge approved on Oct. 12 an amended forbearance agreement in a dispute between a Bermuda reinsurer and an insurer and administratively closed the case (TIG Insurance Co. v. Appalachian Reinsurance [Bermuda] Ltd., No. 17-02938, N.D. Ga.).

Mealey's Insurance - Panel: Environmental Claim To Insolvent Insurer Is Barred By Res Judicata

NEW YORK - A New York appeals court affirmed on Oct. 12 that an insured's environmental claim submitted to an insolvent insurer is barred by res judicata and collateral estoppel, based on prior rulings on the same claim and issues (Northern States Power Co. v. Maria T. Vullo, No. 41294/86, N.Y. App...

Mealey's Insurance - Panel: Michigan Insurance Guaranty Association Failed To Pay Settlement Agreement

LANSING, Mich. - The Michigan Property & Casualty Guaranty Association (MPCIGA) could not raise any valid defense as to why it wrongfully failed to pay an amount owed to an estate by an insolvent insurer, a Michigan appeals panel ruled Oct. 12, affirming summary disposition to the estate (Dorothy...

Mealey's Insurance - Dismissal Sought In Reinsurers' RICO, Breach Of Contract Dispute Over Alleged Scheme

EL PASO, Texas - In a lawsuit alleging a scheme to take control over a dealership and to decline selling vehicle-protection products that are reinsured by the reinsurers, defendants argue in their Oct. 11 reply brief to a Texas federal court for dismissal in favor of a state probate court action (Richard...