LexisNexis® Legal Newsroom
    Mealey's Insurance - 2nd Circuit Orders Judge To Recalculate Loss From Insurance Fraud Scheme

    NEW YORK - A federal judge in New York was ordered by a Second Circuit U.S. Court of Appeals panel on Jan. 26 to recalculate the amount of loss an insurance company incurred as part of a fraud scheme, finding that the judge erred when including $15,228 in his calculations (United States of America v. Julian Brown, No. 16-2841-cr, 2nd Cir., 2018 U.S. App. LEXIS 1943).

    Mealey's Insurance - Judge Grants Judgment In ERISA Health Insurance Proton Beam Therapy Action

    BIRMINGHAM, Ala. - A man undertook proton beam therapy treatment for his prostate cancer knowing that his insurer declined coverage, and nothing in the record suggests that the insurer erred in reaching that decision, a federal judge in Alabama held in granting judgment on the Employee Retirement Income Security Act claim Jan. 26 (Jeffrey Woodruff v. Blue Cross and Blue Shield of Alabama, et al., No. 16-281, N.D. Ala., 2018 U.S. Dist. LEXIS 13014).

    Mealey's Insurance - Panel: New Jersey Insurance Guaranty Association Not Subject To Attorney Fees

    TRENTON, N.J. - The New Jersey Property-Liability Insurance Guaranty Association (NJPLIGA) is not subject to awards of attorney fees, a state appeals panel affirmed Jan. 26 because attorney fees are not a "covered claim" paid by the NJPLIGA (Rafaela A. Guichardo v. New Jersey Property-Liability Insurance Guaranty Association, No. A-4410-15T3, N.J. Super., App. Div., 2018 N.J. Super. Unpub. LEXIS 196).

    Mealey's Insurance - Judge Refuses To Dismiss Indictment Over Illegal Acquisition Of Insurance

    HARRISBURG, Pa. - A federal judge in Pennsylvania on Jan. 24 ruled that the government adequately alleges that a man should face charges of mail fraud, conspiracy to commit mail fraud and conspiracy to defraud the United States as a result of his role in a scheme to illegally obtain insurance for buses that were part of a commercial transportation company (United States of America v. Yalin Liu, No. 16cr42, M.D. Pa., 2018 U.S. Dist. LEXIS 11243).

    Mealey's Insurance - 8th Circuit Affirms No Property Damage Triggered Coverage For Defective Bags

    ST. LOUIS - The Eighth Circuit U.S. Court of Appeals on Jan. 29 affirmed a lower federal court's ruling in favor of a commercial general liability insurer in a coverage dispute arising from the contamination of landscaping materials with plastic from defective storage bags that were manufactured by the insured (Decker Plastics v. West Bend Mutual Insurance Co., No.17-1319, 8th Cir., 2018 U.S. App. LEXIS 2085).

    Mealey's Insurance - Man's Claims Against Johns-Manville Broker Barred, Court Rules Again

    NEW YORK - An asbestosis sufferer "received due process in every possible respect" as a future claimant in the long-running Chapter 11 case of Johns-Manville Corp., so he cannot pursue in personam claims against the company's insurance broker, a New York federal bankruptcy judge held Jan. 24 on remand (In re Johns-Manville Corporation, et al., No. 82-11656, S.D. N.Y. Bkcy., 2018 Bankr. LEXIS 166).

    Mealey's Insurance - Insurer Paints Rehab Centers' Allegations As Vague, Wants Them Dismissed

    LOS ANGELES - Amended complaints from three drug rehabilitation centers contain the same insufficiently broad allegations regarding the formation of contracts and the services provided as a previously dismissed pleading, an insurer told a federal judge in California on Jan. 25 (Casa Bella Recovery International Inc. v. Humana Inc., et al., Nos. 17-1801, 17-1804, 17-1807, C.D. Calif.).

    Mealey's Insurance - No Coverage Owed Under Policy's Collapse Provision, Connecticut Federal Judge Says

    HARTFORD, Conn. - A Connecticut federal judge on Jan. 24 dismissed an insured's suit seeking coverage for the deterioration of a home's basement walls caused by a chemical reaction because the policy's collapse provision does not provide coverage for the loss as there has been no abrupt collapse of the walls (Gail M. Chernosky v. Amica Mutual Insurance Co., No. 17-1047, D. Conn., 2018 U.S. Dist. LEXIS 11285).

    Mealey's Insurance - Magistrate Judge Says Further Information On Claimant's Tenancy Is Necessary

    BALTIMORE - A Maryland federal magistrate judge on Jan. 24 determined that a third-party claimant in a lead-paint coverage suit must amend certain answers to a request for admission filed by the insurer and provide further information regarding his tenancy with his mother at the property where he was exposed to lead paint (CX Reinsurance Company Limited v. Devon S. Johnson, No. 15-3132, D. Md., 2018 U.S. Dist. LEXIS 11209).

    Mealey's Insurance - Judge: Coverage Barred For Suit Arising From Equity Interest Purchase Agreement

    SHERMAN, Texas - A Texas federal judge on Jan. 24 found that a profit management liability insurer has no duty to defend its insureds against underlying claims that they made false representations during negotiations of and in an equity interest purchase agreement (Tom Gleason, et al. v. Markel American Insurance Co., No. 17-00163, E.D. Texas, 2018 U.S. Dist. LEXIS 11608).

    Mealey's Insurance - Fraud Cross-Claims Dismissed In Coverage Suit Over Failed Business Relationship

    MOBILE, Ala. - An Alabama federal judge on Jan. 24 found that if an insured has a valid fraud claim to assert against an underlying claimant, it should do so in the pending state court lawsuit rather than via a cross-claim brought in its commercial general liability insurer's ancillary declaratory judgment action (Acadia Insurance Co. v. SouthernPointe Group, Inc., et al., No. 17-01368, N.D. Ala., 2018 U.S. Dist. LEXIS 11054).

    Mealey's Insurance - Judge: Reinsurer Is Liable For $5M Settlement Between Insurer, Steel Maker

    NEW YORK - A reinsurer is liable for an insurer's $5 million settlement with a steel maker, a New York federal judge ruled Jan. 23, granting the insurer's motion to enforce an arbitration award (National Indemnity Co. v. IRB Brasil Resseguros S.A., No. 15-3975, S.D. N.Y.).

    Mealey's Insurance - Judge: Cracks In Concrete Excluded Under Homeowners Policy's Collapse Provision

    NEW HAVEN, Conn. - Cracks in concrete for the foundation of a home do not qualify as a "collapse" under a homeowners insurance policy's collapse provision because an insured has not shown that the collapse was "abrupt" or that she is unable to occupy the home for its intended purpose, a federal judge in Connecticut ruled Jan. 24 in granting an insurer's motion to dismiss (Gail M. Chernosky v. Amica Mutual Insurance Co., No. 17-1047, D. Conn., 2018 U.S. Dist. LEXIS 11285).

    Mealey's Insurance - Insurer Has No Duty To Defend Additional Insured, Federal Judge Concludes

    CHARLOTTE, N.C. - Because an underlying lawsuit does not state claims for "personal injury" or "property damage," a North Carolina federal judge ruled Jan. 23 that an insurer has no duty to defend an additional insured (American Reliable Insurance Co. v. Five Brothers Mortgage Company and Securing Inc., No. 16-159, W.D. N.C., 2018 U.S. Dist. LEXIS 10546).

    Mealey's Insurance - 11th Circuit Upholds Couple's Conviction For $12M Insurance Fraud Scheme

    ATLANTA - An 11th Circuit U.S. Court of Appeals panel on Jan. 23 refused to vacate a couple's convictions and sentences for a $12 million insurance fraud scheme that involved their clinics overcharging Universal Health Care Insurance Co. for treatment of patients with HIV, finding that the judge did not err when admitting evidence and calculating the amount of loss sustained by the insurer (United States of America v. Gladys Fuertes, et al., No. 15-12928, 11th Cir., 2018 U.S. App. LEXIS 1900).

    Mealey's Insurance - Family Sues New Jersey Insurance Guaranty Association For Benefits

    NEWARK, N.J. - A New Jersey mother and her minor daughter filed a personal injury lawsuit on Jan. 22 against a driver and the state's insurance guaranty association, alleging that they are entitled to uninsured motorist benefits for the driver's negligence (Shamya Tillery, et al. v. Lynnes Nissan, et al., No. ESX-L-000497-18, N.J. Super., Essex Co.).

    Mealey's Insurance - Judge: Insured Complied With Policy In Dispute Over $81,317 In Stolen Bullion Coins

    DENVER - Ruling on dueling motions for summary judgment in a breach of contract and bad faith dispute, a Colorado federal judge on Jan. 23 found that a list of stolen property satisfies a retail coin and collectible store owner's obligations under the plain language of a commercial property insurance policy (TBL Collectibles, Inc., d/b/a Colorado Coins, Cards & Comics v. Owners Insurance Co., No. 16-01788, D. Colo., 2018 U.S. Dist. LEXIS 10538).

    Mealey's Insurance - Federal Judge Says Injured Claimant Has Standing To Bring Claims Against Insurer

    BATON ROUGE, La. - A third-party claimant who was assigned an insured's rights to pursue damages against an insurer has standing to maintain claims against the insurer for allegedly failing to act in good faith in defending its insured in an underlying suit arising out of an auto accident, a Louisiana federal judge said Jan. 22 (Brian Richard, et al. v. USAA Casualty Insurance Co., No. 17-175, M.D. La., 2018 U.S. Dist. LEXIS 9676).

    Mealey's Insurance - Question Of Fact Exists On Insurer's Initial Adjustment Of Property Damage Claim

    DENVER - A Colorado federal judge on Jan. 23 refused to dismiss an insured's bad faith claim alleging that an insurer unreasonably adjusted its claim for property damages caused by a hailstorm because a question of fact exists regarding the insurer's initial adjustment of the insured's claim (Provincetown Landing II Association LLC v. American Family Mutual Insurance Co., No. 16-1403, D. Col., 2018 U.S. Dist. LEXIS 10537).

    Mealey's Insurance - Judge Affirms Man's Conviction, Sentence For Auto Accident Scheme

    DALLAS - A federal judge in Texas on Jan. 23 denied a man's motion to vacate his conviction and sentence for conspiracy to commit health care fraud for orchestrating a scheme to submit false bills to insurers for injuries occurring from automobile accidents, finding that his right to due process was not violated (Frenchitt Su-Dell Collins v. United States of America, No. 16-cv-1472-K, N.D. Texas, 2018 U.S. Dist. LEXIS 10997).

    Mealey's Insurance - Panel Remands Disability Claim After Finding Questions Of Fact Exist Regarding Denial

    PHILADELPHIA - The Third Circuit U.S. Court of Appeals on Jan. 24 determined that a district court properly applied an abuse-of-discretion standard of review in a disability benefits dispute but remanded the suit after determining that questions of facts exist regarding the disability insurer's decision not to conduct an independent medical evaluation and disregard of the claimant's fatigue and pain complaints (Renee Killebrew v. The Prudential Insurance Company of America, No. 17-2137, 3rd Cir., 2018 U.S. App. LEXIS 1672).

    Mealey's Insurance - Disability Claimant Failed To Exhaust Administrative Remedies, 6th Circuit Says

    CINCINNATI - A claim alleging that a disability insurer violated the Employee Retirement Income Security Act when it offset a plan participant's disability benefits was properly dismissed because the claim arose under the disability plan and the claimant was required to administratively exhaust the plan's remedies or plead futility, neither of which the claimant did, the Sixth Circuit U.S. Court of Appeals said Jan. 23 (Oliver H. Barber III, et al. v. Lincoln National Life Insurance Co., No. 17-5588, 6th Cir., 2018 U.S. App. LEXIS 1560).

    Mealey's Insurance - Panel: Insurer Failed To Prove Causation, Notice In Dispute Over Roof Collapse

    CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Jan. 23 affirmed a lower federal court's findin0g that an insurer failed to prove that a developer breached its lease with a sporting goods retailer, concluding that the developer is not liable for the insurer' damages arising from a roof collapse during a rainstorm (Developers Diversified of Tennessee, Inc. v. Tokio Marine & Fire Insurance Co., 16-6615, 6th Cir., 2018 U.S. App. LEXIS 1552).

    Mealey's Insurance - Motion To Strike Health Care Provider's Pleading Remains After Briefing Vacated

    LOS ANGELES - A federal judge in California on Jan. 23 vacated briefing on a motion to dismiss an emergency health services provider's case against an insurer, but let stand a motion to strike the new filing, which the defendant claims ignores the court's order not to add defendants (Long Beach Memorial Medical Center v. Blue Cross and Blue Shield of South Carolina Inc., et al., No. 17-8181, C.D. Calif.).

    Mealey's Insurance - Health Plan Interpretation Plausible, ERISA Claims Fail, Insurer Argues

    SAN FRANCISCO - To prevail on their claims, plaintiffs must show that an insurer's interpretation of plan documents was implausible, a standard a class action challenging guidelines governing mental health and substance abuse coverage cannot meet, an insurer tells a federal judge in California in a Jan. 23 post-trial brief (David and Natasha Wit, et al. v. United Behavioral Health, No. 14-02346, Gary Alexander, et al. v. United Behavioral Health, No. 14-5337, N.D. Calif.).