GREENVILLE, Miss. - The U.S. Department of Justice announced Aug. 10 that a federal judge in Mississippi has sentenced a doctor to 39 months in prison and ordered him to pay $1.9 million in restitution to the Medicare program for referring patients to hospice care when such treatment was not necessary (United States v. Nathaniel Brown, No. 16cr74, N.D. Miss.).
BRIDGEPORT, Conn. - A reinsurer on Aug. 14 appealed to the Second Circuit U.S. Court of Appeals a ruling requiring it to pay up to an additional $18 million in reinsurance proceeds to an insurer pursuant to an arbitration award (General Re Life Corp. v. Lincoln National Life Insurance Co., No. 17-2496, 2nd Cir.).
NEW YORK - Reinsurance executives argue in an Aug. 14 reply brief that a New York federal court should compel arbitration of insurers' $50 million Racketeer Influenced and Corrupt Organizations Act case or, alternatively, stay the dispute "in the interests of fairness and judicial economy" (Bankers Conseco Life Insurance Co., et al. v. Moshe M. Feuer, et al., No. 16-7646, S.D. N.Y.).
DAYTONA BEACH, Fla. - A majority of a Florida appeals panel on Aug. 11 held that no Florida statute or case law precludes an insured from filing a civil remedy notice (CRN) while a demand for appraisal is outstanding, reversing and remanding a lower court's ruling in favor of the insurer in a bad faith lawsuit arising from the insured's claim for sinkhole damage (Phillip Landers v. State Farm Florida Insurance Co., No. 5D15-4032, Fla. App., 5th Dist., 2017 Fla. App. LEXIS 11543).
HOUSTON - A registered nurse who owned two home health care companies was found guilty on Aug. 10 by a federal jury in Texas of one count of conspiracy to commit health care fraud and four counts of health care fraud for her role in a $20 million Medicare fraud scheme (United States v. Evelyn Mokwuah, No. 16cr254, S.D. Texas).
SEATTLE - A Washington appeals panel on Aug. 14 found that because an insured intentionally struck another person in the face several times and the harm of a broken jaw was reasonably foreseeable, there are no issues of material fact regarding whether the insured's act was intentional (State Farm Fire and Casualty Co. v. Nikolas Peters, No. 75705-9-I, Wash. App., Div. 1, 2017 Wash. App. LEXIS 1935).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Aug. 15 affirmed a lower federal court's finding that parties were properly aligned in a dispute over whether additional coverage is owed to satisfy an underlying $3,736,278 judgment against an insured for breaching its duty to exercise ordinary care to maintain its common areas, affirming the lower court's reinstatement of its judgment in favor of the insurer (Evanston Insurance Co. v. Housing Authority of Somerset, et al., No. 16-6691, 6th Cir., 2017 U.S. App. LEXIS 15199).
SAN FRANCISCO - The Ninth Circuit U.S. Court of Appeals on Aug. 15 vacated and remanded a district court's ruling that a de novo standard of review rather than an abuse of discretion standard of review should be applied in a disability benefits dispute because the Employee Retirement Income Security Act preempts the application of California's insurance law, which prohibits the use of discretionary clauses (Yvette Williby v. Aetna Life Insurance Co., No. 15-56394, 9th Cir., 2017 U.S. App. LEXIS 15213).
MIAMI - An insured's suit seeking a declaration that coverage is owed for water damage to his home was removed to Florida federal court on Aug. 14 by the insurer on the basis that the amount in controversy satisfies the federal jurisdictional amount in controversy (Romeo Alcantara v. American Security Insurance Co., No. 17-23077, S.D. Fla.).
OKLAHOMA CITY - An Oklahoma judge on Aug. 10 terminated policy coverage and authorized the return of unearned premiums to insureds in the receivership of SeniorSure Healthplan Inc. (State of Oklahoma, ex rel. John D. Doak v. SeniorSure Healthplan Inc., No. CJ-2017-3547, Okla. Dist., Okla. Co.).
HUNTSVILLE, Ala. - A general contractor's insurance company was awarded summary judgment by a federal judge in Alabama on Aug. 10 after the judge found that the insurer was not obligated to defend the contractor against counterclaims brought by a couple who refused to pay for upgrades that increased the price of a home improvement project (Canal Indemnity Company v. Frankie Carbin, et al., No. 16-cv-00630-ABK, N.D. Ala., 2017 U.S. Dist. LEXIS 126662).
NASHVILLE, Tenn. - The Tennessee Insurance Guaranty Association (TIGA) argues in an Aug. 14 brief that a Tennessee federal court should remand its reimbursement dispute over a workers' compensation claim against book publishers because diversity jurisdiction is not present (Tennessee Insurance Guaranty Association v. Penguin Random House LLC, et al., No. 17-1070, M.D. Tenn.).
BOISE, Idaho - A trust bank on Aug. 14 moved for an order in an Idaho federal court to lift a stay pending an insurer's receivership proceedings and for a preliminary injunction, arguing that the receiver has ignored a summary judgment ruling for more than two years and recommended that the insured take nothing (Idaho Trust Bank v. BancInsure Inc., et al., No. 12-00032, D. Idaho).
ST. LOUIS - Replacing drywall and insulation as a result of a subcontractor's faulty fire suppression system did not constitute an "accident" under a general liability insurance policy, the Eighth Circuit U.S. Court of Appeals held Aug. 11, affirming the dismissal of breach of contract and bad faith claims against an insurer (McShane Construction Company LLC v. Gotham Insurance Co., No. 16-2632, 8th Cir., 2017 U.S. App. LEXIS 14875).
ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on Aug. 14 affirmed a district court's ruling that a policy's pollution exclusion precludes an insurer's duty to indemnify an underlying personal injury suit arising out of carbon monoxide poisoning because the underlying injuries clearly arose out of the release, dispersal or migration of carbon monoxide into the atmosphere (Travelers Property Casualty Company of America v. Christopher A. Klick, et al., No. 16-4000, 8th Cir., 2017 U.S. App. LEXIS 15017).
HOUSTON - A Texas federal judge on Aug. 10 denied a motion to remand by insureds seeking coverage under a pollution liability policy after determining that the insurer's adjuster was fraudulently joined to defeat diversity jurisdiction (Waste Management Inc., et al., v. AIG Specialty Insurance Co., et al., No. 16-3676, S.D. Texas, 2017 U.S. Dist. LEXIS 126880).
HARRISBURG, Pa. - In the liquidation of Reliance Insurance Co., a Pennsylvania trial judge on Aug. 9 approved a direct payment of $269,341 in proceeds by a guarantor of a reinsurer to an insured (In re: Reliance Insurance Co. in liquidation, No. 1 REL 2001, Pa. Cmwlth.).
INDIANAPOLIS - Ruling on dueling summary judgment motions between a professional liability insurer and insureds who pleaded guilty to dealing in narcotic drugs, an Indiana federal judge on Aug. 9 found that "the existence of several genuine issues of material fact demonstrates the genuine need for a trial" (ProAssurance Indemnity Company Inc. v. Donald J. Wagoner, et al., No. 15-01389, S.D. Ind., 2017 U.S. Dist. LEXIS 125897).
DENVER - A Colorado appeals panel on Aug. 10 affirmed a man's convictions for first-degree arson, criminal mischief, theft and attempted theft for intentionally setting fire to a house he lived in with his mother and then-girlfriend to obtain insurance proceeds, finding that the trial judge did not err when allowing evidence regarding his previous insurance claims (People v. Christopher Wesley Welborne, No. 14CA2242, Colo. App., 5th Div., 2017 Col. App. LEXIS 1004).
ABERDEEN, Miss. - A Mississippi federal judge on Aug. 10 denied an insurer's motion for summary judgment in a suit alleging that the insurer acted in bad faith by failing to pay the insured the full replacement cost of his home after determining that genuine issues of material fact exist regarding the insured's claim for contractual damages (James Whitfield v. Allstate Vehicle and Property Insurance Co., No. 16-51, N.D. Miss., 2017 U.S. Dist. LEXIS 127732).
RICHMOND, Va. - A trial judge erred in applying the doctrine of judicial estoppel to hold that a "reinsurance participation agreement" (RPA) constituted an insurance contract under Virginia law, the Fourth Circuit U.S. Court of Appeals ruled Aug. 11, reversing in part a ruling and remanding for further proceedings (Minnieland Private Day School Inc. v. Applied Underwriters Captive Risk Assurance Company Inc., No. 16-1511, 4th Cir., 2017 U.S. App. LEXIS 14916).
SAN FRANCISCO - A Ninth Circuit U.S. Court of Appeals panel on Aug. 10 held that two medical assistants who filed a qui tam lawsuit under the False Claims Act (FCA) against a podiatrist they worked for could not intervene in a criminal forfeiture action brought by the federal government seeking $1.2 million for false billing to Medicare because the employees lacked standing (United States v. Neil A. Van Dyck, et al., No. 16-10160, 9th Cir., 2017 U.S. Dist. LEXIS 14780).
MONTGOMERY, Ala. - A nonprofit public insurer argues to an Alabama federal court in an Aug. 9 brief that it did not waive its right to arbitrate its $1.3 million lawsuit under a reinsurance agreement and that a reinsurer will not be prejudiced in sending the dispute to arbitration (Alabama Municipal Insurance Corp. v. Munich Reinsurance America Inc., No. 16-cv-00948, M.D. Ala.).
CHICAGO - Insurers have a duty to defend an insured against class action claims of leaks in windows because neither the economic loss doctrine nor the "your work" exclusion precludes coverage, the Seventh Circuit U.S. Court of Appeals held Aug. 8, reversing an underlying judgment and remanding with instructions to vacate that judgment (Mary Haley, et al. v. Kolbe & Kolbe Millwork Co., et al., Nos. 16-3563 & 16-3648, 7th Cir., 2017 U.S. App. LEXIS 14572).
HUNTSVILLE, Ala. - No coverage is owed to an insured for mold damages to an insured's home because the policy at issue contained an endorsement that specifically excluded coverage for mold, an Alabama federal judge said Aug. 9 in granting the insurer's motion for summary judgment (Prithpal Singh v. State Farm Fire & Casualty Co., No. 16-1447, N.D. Ala., 2017 U.S. Dist. LEXIS 125651).