CLEVELAND - An Ohio dentist was sentenced to 12 months in prison by a federal judge on Sept. 6 and ordered to pay $343,665.68 in restitution for fraudulently billing Medicare for services that were not provided (United States of America v. Robert Rouzaud, No. 16-cr-127, N.D. Ohio).
MILWAUKEE - A federal judge in Wisconsin on Sept. 2 denied an insurer's motion to dismiss in an insurance bad faith lawsuit, ruling that the insureds' inclusion of a letter in their amended complaint that properly spelled out the terms of their bad faith claim does not "inherently" contradict the bad faith allegations made by the insureds in their amended complaint (Elizabeth Baires, et al. v. State Farm Mutual Automobile Insurance Co., No. 16-402, E.D. Wis.; 2016 U.S. Dist. LEXIS 119155).
CINCINNATI - The Sixth Circuit U.S. Court of Appeals on Sept. 7 reversed and remanded a district court's ruling that a disability claimant is not entitled to long-term disability benefits beyond the plan's one-year limitation for mental disorders because the plan administrator's decision was arbitrary and capricious (Patti Okuno v. Reliance Standard Life Insurance Co., No. 15-4043, 6th Cir.; 2016 U.S. App. LEXIS 16423).
MADISON, Wis. - A federal judge in Wisconsin on Sept. 1 dismissed a woman's lawsuit against the federal government over ownership of property that may be used to satisfy her husband's restitution obligations after being found guilty for insurance fraud, holding that the government is immune from the proceedings (Catherine Henricks v. United States of America, No. 16-cv-101, W.D. Wis.; 2016 U.S. Dist. LEXIS 118005).
AUSTIN, Texas - The Texas Supreme Court in a Sept. 2 pronouncement granted relators' petition to review a lower court's ruling compelling them to respond to discovery requests concerning their attorney fees in a multidistrict litigation hailstorm property damage coverage dispute (In Re National Lloyds Insurance Co., Wardlaw Claims Service Inc. and Ideal Adjusting Inc., No. 15-0591, Texas Sup.).
DES MOINES, Iowa - An Iowa federal judge on Sept. 2 denied an insured's request for the Iowa Supreme Court to consider whether comprehensive general liability policies provide coverage for underlying product liability claims when the damages arise from the insured's faulty work (Pella Corp., et al. v. Liberty Mutual Insurance Co., No. 11-00273, S.D. Iowa).
NEW YORK - A federal judge in New York on Sept. 6 remanded a reinsurance dispute, holding that the claims in a first amended complaint did not make allegations different enough from the original complaint to justify granting removal more than a year after the case was initially filed (R&Q Reinsurance Company v. Allianz Insurance Company, No. 16-cv-00794, S.D. N.Y.).
CHICAGO - A federal judge in Illinois on Sept. 6 dismissed a man's counterclaim against State Auto Property and Casualty Insurance Co. seeking attorney fees under Section 155 of the Illinois Insurance Code, ruling that the company's delay in making a payment under the policy was not vexatious and unreasonable since a dispute exists as to the cause of a fire that destroyed the man's home (State Auto Property and Casualty Insurance Company v. Anthony Blair Jr., No. 15 C 8026, N.D. Ill.; 2016 U.S. Dist. LEXIS 119885).
ST. LOUIS - Subrogated insurers who paid out water damage claims to insured tenants did not suffer the same damages as uninsured tenants of the same building, the Eighth Circuit U.S. Court of Appeals affirmed Sept. 6, affirming summary judgment for the City of Minneapolis on the insurers' equal protection clause claim (American Family Insurance Co. and Liberty Mutual Insurance Co. v. City of Minneapolis, No. 15-3216, 8th Cir.; 2016 U.S. App. LEXIS 16336).
SAN DIEGO - A California federal judge on Sept. 1 denied insureds' motion to amend their complaint to add insurance brokers as defendants in a directors and officers liability coverage dispute (Scott G. Kelly, et al. v. Starr Indemnity & Liability Co., No. 15-2900, S.D. Calif.; 2016 U.S. Dist. LEXIS 118415).
CHICAGO - A Seventh Circuit U.S. Court of Appeals panel on Sept. 1 affirmed a remand order from a lower court, noting that the reinsurance agreements at issue in the case have service of suit clauses that leave forum selection up to the reinsured (Pine Top Receivables of Illinois, LLC v. Transfercom, Ltd., No. 16-1073, 7th Cir.; 2016 U.S. App. LEXIS 16225).
AUSTIN, Texas - The Texas Supreme Court granted a directors and officers liability insurer's petition to review an appeals court's finding that an insured vs. insured policy exclusion is inapplicable, according to its orders pronounced Sept. 2 (Great American Insurance Co. v. Robert Primo, No. 15-0317, Texas Sup.).
DETROIT - An expert for three insured golf courses may testify that the weight of ice killed the turfgrass by prohibiting a gaseous exchange by the turfgrass, leading to anoxia, a Michigan federal judge held Aug. 30, declining to exclude the testimony because the expert provided documentation (Bloomfield Hills Country Club, et al. v. The Travelers Property Casualty Company of America, et al., No. 15-11290, E.D. Mich.; 2016 U.S. Dist. LEXIS 116172).
SAN FRANCISCO - A California statute voiding discretionary clauses in disability and life insurance policies does not apply to a claim for medical expenses under a health insurance policy because New York law applies to the dispute and because health insurance is not a form of disability insurance, a California federal judge said Aug. 30 (David Bain et al., v. United Healthcare Inc., No. 15-3305, N.D. Calif.; 2016 U.S. Dist. LEXIS 116805).
CHARLESTON, W.Va. - Ruling on a topic not yet decided by the West Virginia Supreme Court of Appeals, a federal judge in West Virginia on Aug. 30 determined that insureds are entitled to summary judgment on their breach of contract claim in a bad faith lawsuit because an insurer breached its contract with insureds by inserting an "unlawfully more restrictive" residence premises provision into a homeowners insurance policy (William Shank v. Safeco Insurance Company of America, No. 15-9033, S.D. W.Va.; 2016 U.S. Dist. LEXIS 116367).
LAS VEGAS - An insurer's removal of an insurance breach of contract and bad faith lawsuit to federal court was timely, and the insurer proved that the amount in controversy exceeded statutory limits, a federal judge in Nevada ruled Aug. 30 in denying an insured's motion to remand (Susan R. Montoya v. State Farm Mutual Automobile Insurance Co., No. 16-1530, D. Nev.; 2016 U.S. Dist. LEXIS 116434).
BOSTON - Massachusetts law must be applied in an environmental contamination coverage suit for several Rhode Island sites because Massachusetts is the state where the insurance contracts were negotiated, the Massachusetts Appeals Court said Aug. 31 in reversing a number of rulings in favor of the insured (OneBeacon America Insurance Co. v. Narragansett Electric Co., et al., No. 13-1240, Mass. App.; 2016 Mass. App. LEXIS 113).
PHILADELPHIA - A majority of a Third Circuit U.S. Court of Appeals panel on Sept. 1 affirmed a federal court's ruling that an insurer has no duty to defend or indemnify a $2 million judgment entered against its insured as part of a class action settlement arising from unsolicited fax advertisements (Auto-Owners Insurance Co. v. Stevens & Ricci Inc., et al., No. 15-2080, 3rd Cir.; 2016 U.S. App. LEXIS 16182).
NEWARK, N.J. - A New Jersey judge on Aug. 30 granted an insured's motion for summary judgment after determining that a general notice letter issued by the U.S. Environmental Protection Agency constitutes a suit under the terms of insurance policies at issue and triggers the insurer's duty to defend (Cooper Industries LLC v. Employers Insurance of Wausau et al., No. L-9284-11, N.J. Super., Essex Co., Law Div.; 2016 N.J. Super. Unpub. LEXIS 2003).
AUSTIN, Texas - The Third District Texas Court of Appeals on Aug. 30 reversed and remanded a lower court decision dismissing the claims of a woman who was involved in an auto accident against a woman insured by an insolvent insurer, finding that the lower court had abused its discretion by dismissing the claims based on a discovery noncompliance (Crystal Bingham Hernandez v. Tiffany Polley, No. 03-15-00384-CV, Texas App., 3rd Dist.; 2016 Tex. App. LEXIS 9526).
WILLIAMSPORT, Pa. - Although an insured has properly pleaded his claim for insurance bad faith, he has failed to do so with regard to claims made under the Pennsylvania Unfair Insurance Practices Act (UIPA) because Pennsylvania does not provide for recovery for such claims, a federal judge in Pennsylvania ruled Aug. 29 (Ronald E. Long v. Hartford Life and Accident Insurance Co., No. 16-0138, M.D. Pa.; 2016 U.S. Dist. LEXIS 115328).
WILLIAMSPORT, Pa. - A federal judge in Pennsylvania on Aug. 29 granted in part and denied in part an insurer's motion to dismiss in an insurance breach of contract and bad faith lawsuit, ruling that Pennsylvania does not provide for recovery for bad faith claims made pursuant to the Pennsylvania Unfair Insurance Practices Act (UIPA) (Ronald E. Long v. Stonebridge Life Insurance Co., No. 16-0139, C.D. Pa.; 2016 U.S. Dist. LEXIS 115324).
NEW YORK - The Second Circuit U.S. Court of Appeals on Aug. 31 found that a lower court erred when it prematurely granted summary judgment in favor of insurers on whether Amtrak was entitled to coverage under the Demolition and Increased Cost of Construction (DICC) clause in its insurance policies, vacating and remanding the Superstorm Sandy dispute in part (National Railroad Passenger Corp. v. Aspen Specialty Insurance Co., et al., No. 15-2358, 2nd Cir.; 2016 U.S. App. LEXIS 16074).
SAN JOSE, Calif. - A California federal judge on Aug. 29 held that a commercial general liability insurer has alleged that some of the claims in an underlying lawsuit against the San Francisco Forty Niners Football Co. and others are potentially covered by a second insurance policy (First Mercury Insurance Co. v. Great Divide Insurance Co., No. 16-02114, N.D. Calif.; 2016 U.S. Dist. LEXIS 115872).
OWENSBORO, Ky. - A disability insurer must produce information related to its disability medical claims reviewers, a Kentucky federal magistrate judge said Aug. 26, rejecting the insurer's argument in its motion for reconsideration that producing the information would create an undue burden on the insurer (Paulette Owes v. Liberty Life Assurance Company of Boston, No. 15-71, W.D. Ky.; 2016 U.S. Dist. LEXIS 114470