CLEVELAND - The U.S. Department of Justice has announced that three workers at a Cleveland home health care company were sentenced Dec. 8 by a federal judge in Ohio for their roles in a $3 million Medicare fraud scheme that lasted from 2009 to 2013 (United States of America v. Amir Ahmed, et al., No. 15cr223, N.D. Ohio).
NEW YORK - ExxonMobil Oil Corp. on Dec. 9 filed a petition to compel arbitration in New York federal court, seeking an order that its excess insurer is required to arbitrate a coverage dispute arising out of underlying claims for groundwater contamination (ExxonMobil Oil Corp. v. TIG Insurance Co., No. 16-9527, S.D. N.Y.).
SYRACUSE, N.Y. - An insurer and its reinsurer jointly asked a federal court in Massachusetts on Dec. 12 stay their breach of contract dispute so they can have time to convert their agreement in principle into a written settlement agreement (OneBeacon America Insurance Company v. Transatlantic Reinsurance Company, No. 14-cv-14067, D. Mass.).
SAN FRANCISCO - A California federal judge on Dec. 9 scheduled a bench trial in a disability benefits dispute after determining that it is not clear from the available evidence whether a claimant's prior disability claims factored into the insurer's decision to deny a third disability claim (Robert Bosley v. Metropolitan Life Insurance Co., No. 16-139, N.D. Calif.; 2016 U.S. Dist. LEXIS 170872).
BALTIMORE - A Maryland federal judge on Dec. 9 partially granted an insured's motion to dismiss after determining that the court cannot exercise admiralty jurisdiction over a coverage dispute arising out of a collapsed pier because the policy at issue does not provide coverage for traditional marine risks (The Hartford Fire Insurance Co. v. The Harborview Marina & Yacht Club Community Association Inc., No. 16-769, D. Md.; 2016 U.S. Dist. LEXIS 170438).
SYRACUSE, N.Y. - A federal magistrate judge in New York on Dec. 8 granted in part an insurer's and a reinsurer's motions to compel discovery information from each other regarding alleged obligations under certain reinsurance agreements (Utica Mutual Insurance Company v. Century Indemnity Company, No. 13-cv-00995, N.D. N.Y.).
SYRACUSE, N.Y. - The Second Circuit U.S. Court of Appeals on Dec. 8 certified a question to the New York Court of Appeals regarding reinsurance contract limits that the panel said presents an important question of New York law (Global Reinsurance of America v. Century Indemnity Company, No. 15-2164, 2nd Cir.).
BOSTON - Six former executives and managers of drug maker Insys Therapeutics Inc. were indicted Dec. 6 for racketeering, mail fraud and wire fraud conspiracy for allegedly bribing medical practitioners to prescribe Subsys, a fentanyl-containing pain drug, and for defrauding medical insurers, according to a criminal information unsealed Dec. 8 (United States of America v. Michael L. Babich, et al., No. 16-cr-10343, D. Mass.).
BOSTON - The First Circuit U.S. Court of Appeals on Dec. 7 found that a homeowners insurance policy draws a clear distinction between an insurer's duty to defend that applies to suits alone and the insurer's right to investigate that applies to both suits and claims, affirming a lower federal court's ruling that the insurer has no duty to defend its insured (Harry Sanders, executor of the Estate of Nancy A. Andersen and assignee of John Doe, v. The Phoenix Insurance Co., et al., No. 15-2539, 1st Cir.; 2016 U.S. App. LEXIS 21773).
ALBUQUERQUE, N.M. - A federal judge in New Mexico on Dec. 6 ordered a woman who pleaded guilty to disability insurance fraud and wire fraud to pay two beneficiaries of an estate more than $100,000 in restitution, finding that the contingency fees charged by a research firm and a law firm they hired to research where funds from their deceased father's estate were located were acceptable under the Mandatory Victim Restitution Act (MVRA) (United States of America v. Juanita Roibal-Bradley, No. CR 15-3253, D. N.M.; 2016 U.S. Dist. LEXIS 168259).
JACKSON, Miss. - Transfer of a suit filed by the United States seeking damages for oil spill removal costs from Mississippi federal court to Louisiana federal court where an insurance coverage action is pending is not warranted because the United States' suit does not overlap with the coverage suit in Louisiana, a Mississippi federal judge said Dec. 5 (United States of American v. Third Coast Towing LLC, et al., No. 16-34, S.D. Miss.; 2016 U.S. Dist. LEXIS 167441).
BEAUMONT, Texas - A federal magistrate judge correctly found that a disability insurer's termination of disability benefits was not an abuse of discretion, a Texas federal judge said Dec. 6, noting that the evidence clearly supports the insurer's decision (Troy Arrington v. Unum Life Insurance Company of America, et al., No. 14-549, E.D. Texas; 2016 U.S. Dist. LEXIS 168120).
ATLANTA - The 11th Circuit U.S. Court of Appeals on Dec. 5 affirmed a lower court's dismissal of an insured's federal conspiracy claims against his homeowners insurer, a claims investigator and a deputy sheriff arising from the insured's claim that $496,641 was stolen from his home (Windham Todd Pittman v. State Farm Fire & Casualty Co., et al., No. 16-10144, 11th Cir.; 2016 U.S. App. LEXIS 21610).
PHILADELPHIA - Dismissal an insured's bad faith claim against his insurer for failure to pay uninsured motorist benefits pursuant to an automobile insurance policy is proper because the insured failed to state any factual allegations to support his bad faith claim, a federal judge in Pennsylvania ruled Dec. 5 (Vincent Talotta v. State Farm Mutual Automobile Insurance Co., No. 16-5557, E.D. Pa.; 2016 U.S. Dist. LEXIS 167248).
OKLAHOMA CITY - An insured's insurance bad faith counterclaim was dismissed Dec. 5 after a federal judge in Oklahoma ruled that the insured failed to plead its counterclaim with any facts to support it (Employers Mutual Casualty Co. v. W-W Trailer Manufacturers, d/b/a W.W. Trailer Manufacturing, No. 16-995, W.D. Okla.; 2016 U.S. Dist. LEXIS 167362).
LOS ANGELES - Summary judgment is warranted against insureds in an insurance breach of contract and bad faith lawsuit because the insureds have failed to show that their insurer breached its contract in failing to pay their claims for benefits or denied their requests for a defense or indemnification, a federal judge in California ruled Dec. 6 (Julie Sohn, et al. v. Allstate Indemnity Co., et al., No. 15-8841, C.D. Calif.; 2016 U.S. Dist. LEXIS 168555).
LAFAYETTE, La. - A disability insurer did not abuse its discretion in denying a claim for long-term disability benefits because the insurer was not required to complete an independent medical exam of the claimant and was not required to give greater weight to the opinions of the claimant's treating physicians, a Louisiana federal judge said Dec. 5 (Linda Bellard v. Unum Life Insurance Company of America, No. 15-0428, W.D. La.; 2016 U.S. Dist. LEXIS 167714).
FRANKFORT, Ky. - The Kentucky Court of Appeals on Dec. 2 affirmed the dismissal of two disability claimants' amended complaints after finding that the claimants could not assert their claims against the trust that administered their employer's disability plan because the trust did not possess the authority to determine a claimant's eligibility for benefits (Vera Furtula v. PNC Bank et al., Nos. 2015-518, 2015-525, Ky. App.; 2016 Ky. App. Unpub. LEXIS 801).
SCRANTON, Pa. - A federal judge in Pennsylvania on Dec. 5 granted an insurer's motion for summary judgment on an insured's claim for insurance bad faith in a homeowners insurance dispute, ruling that the insured failed to show that the insurer's actions during the investigation and subsequent issuance of an estimate and revised estimates rise to the level of bad faith under Pennsylvania law (Joan Yatsonsky v. State Farm Fire & Casualty Co., No. 15-1777, M.D. Pa.; 2016 U.S. Dist. LEXIS 167224).
PORTLAND, Ore. - The Ninth Circuit U.S. Court of Appeals on Dec. 5 held that a lower federal court did not err in disregarding the heat-related portions of an affidavit from an expert witness in a dispute over coverage for a building collapse (Tarleton LLC v. State Farm Fire and Casualty Co., No. 14-35540, 9th Cir.; 2016 U.S. App. LEXIS 21636).
RICHMOND, Va. - The Fourth Circuit U.S. Court of Appeals on Dec. 6 held that a nurse who was employed by a staffing agency and assigned to work at a hospital qualifies as a hospital "employee" under its insurance policy, vacating and remanding an equitable contribution lawsuit arising from a medical malpractice claim (Interstate Fire and Casualty Co. v. Dimensions Assurance Ltd., No. 15-1801, 4th Cir.; 2016 U.S. App. LEXIS 21710).
WASHINGTON, D.C. - In a unanimous ruling, the U.S. Supreme Court on Dec. 6 held that the False Claims Act (FCA) "does not enact so harsh a rule" as mandating dismissal of a relator's lawsuit under the act for a violation of the statute's requirement that the relator's complaint remain sealed, affirming a ruling of the Fifth Circuit U.S. Court of Appeals (State Farm Fire & Casualty Co. v. United States, ex rel. Cori Rigsby, et al., No. 15-513, U.S. Sup.; 2016 U.S. LEXIS 7420).
NEW YORK - A judgment debtor told a federal court in New York on Dec. 2 that it is appealing a $7.8 million judgment against it related to a reinsurance participation agreement that the judgment debtor claimed it was not a party to (AmTrust North America, Inc. and Technology Insurance Company, Inc., as judgment creditors of Pacific Re, Inc. on behalf of its protected cell Pac Re 5-AT v. Safebuilt Insurance Services Inc., No. 16-cv-06033, S.D. N.Y.).
SAN FRANCISCO - An insurer involved in an environmental contamination coverage dispute claims in a Dec. 1 motion for partial summary judgment filed in California federal court that it is entitled to reimbursement of the deductible it paid on behalf of its insured because the policy at issue specifically states that the deductible includes claim expenses such as defense costs (American Guarantee and Liability Insurance Co., et al. v. Technichem Inc., et al., No. 15-03611, N.D. Calif.).
CHICAGO - An Illinois appeals panel held Dec. 5 that it lacks jurisdiction to hear a claimant's appeal in a dispute over insurance coverage for an underlying $8,414,374.50 judgment arising from unsolicited fax advertisements in violation of the Telephone Consumer Protection Act (TCPA), rejecting the claimant's argument that its certificate of service was timely under the "mailbox rule" (Targin Sign Systems, Inc. v. Illinois Casualty Co., No. 1-15-3538, Ill. App., 1st Dist., 1st Div.; 2016 Ill. App. Unpub. LEXIS 2562).