LOS ANGELES - A health insurer waived the right to deny coverage for vertebrate fusion surgery as experimental when it preauthorized the procedure, albeit with a different device, a federal judge in California held Dec. 12, entering judgment for the plaintiff on her Employee Retirement Income Security Act claims (Aubrey Cohorst v. Anthem Health Plans of Kentucky Inc., No. 16-7925, C.D. Calif., 2017 U.S. Dist. LEXIS 204362).
PITTSBURGH - An insured has failed to show that remand of his insurance breach of contract and bad faith lawsuit to state court is necessary since he asserts only claims under state law and, thus, a federal district court lacks jurisdiction over the claims because the insured does not seek a declaratory judgment and because he seeks damages in excess of the statutory limits, a federal magistrate judge in Pennsylvania ruled Dec. 12 in denying the insured's motion (Adam Carney v. GEICO, No. 17-1486, W.D. Pa., 2017 U.S. Dist. LEXIS 205042).
PHILADELPHIA - The Third Circuit U.S. Court of Appeals on Dec. 14 affirmed a New Jersey federal judge's ruling in favor of an insurer in an environmental contamination dispute after determining that the insurer's failure to exclude coverage to certain parties involved in the contamination dispute clearly was a mistake or scrivener's error (Indian Harbor Insurance Co. v. NL Environmental Management Services Inc., et al., Nos. 16-3262, 16-3293, 3rd Cir., 2017 U.S. App. LEXIS 25277).
MIAMI - A federal judge in Florida on Dec. 11 sentenced the former owner and operator of a health care agency to 115 months in prison and ordered him to pay $15.1 million in restitution for his role in a conspiracy to defraud Medicare (United States of America v. Yunesky Fornaris, No 17cr20163, S.D. Fla.).
NEW ORLEANS - A subcontractor's insurer had a duty to defend an additional insured in a construction defects lawsuit, the Fifth Circuit U.S. Courts of Appeals ruled Dec. 12, affirming in part and reversing in part awards issued in favor of the additional insured (Lyda Swinerton Builders Inc. v. Oklahoma Surety Co., No. 16-20195, 5th Cir., 2017 U.S. App. LEXIS 25048).
DENVER - A Colorado federal judge on Dec. 12 refused to dismiss an insured's statutory and common-law bad faith claims after determining that the insurer's conduct before, during and after an appraisal proceeding conducted to determine the value of the insured's claim for property damages caused by a hailstorm is relevant to the insured's allegations of bad faith conduct (Hometown Community Association Inc. v. Philadelphia Indemnity Insurance Co., No. 17-777, D. Col., 2017 U.S. Dist. LEXIS 203675).
BOWLING GREEN, Ky. - Evidence related to a man's prior acts of setting fire to three residences and one automobile to collect insurance proceeds should be admitted during his trial on similar claims, a federal judge in Kentucky ruled Dec. 13, finding that the information has probative value as to whether he committed the act as part of a common scheme or plan (United States of America v. Steven Allen Pritchard, No. 16-CR-00028, W. D. Ky., 2017 U.S. Dist. LEXIS 204958).
NEW ORLEANS - An insured's assignee whose lungs were damaged by the inhalation of an excess amount of chlorine in the insured hotel's hot tub waived the right to argue that Oklahoma law, rather than Texas law, should be applied because the assignee failed to argue that the application of Texas law was a manifest injustice, the Fifth Circuit U.S. Court of Appeals said Dec. 13 in affirming the district court's ruling in favor of the insurer (Wesley Howard v. Maxum Indemnity Co., No. 16-11746, 5th Cir.).
SAN FRANCISCO - A religious group told a federal judge in California on Dec. 11 that it should be allowed to intervene in an action challenging new rules governing exemptions to the Patient Protection and Affordable Care Act (ACA) contraceptive mandate, saying that while the states give lip service to protecting religious beliefs, the reality is much more stark (State of California, et al. v. Don J. Wright, et al., No. 17-5783, N.D. Calif.).
OKLAHOMA CITY - An Oklahoma federal judge on Dec. 12 denied an insurer's motion to dismiss an insured's claims for bad faith and breach of contract arising out of the handling of two auto claims after determining that the insured alleged sufficient facts in support of the claims and properly relied on Oklahoma's Unfair Claims Settlement Practices Act to support her claim for bad faith (Rachel Curtis, et al. v. Progressive Northern Insurance Co., No. 17-1076, W.D. Okla., 2017 U.S. Dist. LEXIS 203759).
COLUMBUS, Ga. - Genuine issues of fact preclude summary judgment on a bad faith failure-to-settle claim because a jury could find that the insurer did not act reasonably in responding to a settlement offer for the full limits of an auto policy, a Georgia federal judge said Dec. 12 in denying the insurer's and a trustee's motions for summary judgment (Fife M. Whiteside v. GEICO Indemnity Co., No. 16-313, M.D. Ga., 2017 U.S. Dist. LEXIS 203617).
ATLANTA - An 11th Circuit U.S. Court of Appeals panel on Dec. 12 upheld a man's conviction and sentence for his role in a health care fraud scheme, finding that the government presented "overwhelming evidence" to prove that he received illegal kickbacks and conspired with his co-defendants (United States of America v. Carlos Rodriguez Nerey, No. 16-13614, 11th Cir., 2017 U.S. App. LEXIS 25026).
RALEIGH, N.C. - After finding that a laboratory failed to show that it received a valid assignment of benefits under the Employee Retirement Income Security Act, a North Carolina federal judge on Dec. 7 dismissed its claims against a group of insurers in relation to allegedly unpaid amounts for services rendered (AvuTox LLC v. Cigna Health and Life Insurance Co., et al., No. 5:17-CV-250, E.D. N.C., 2017 U.S. Dist. LEXIS 201296).
WILMINGTON, Del. - Review of a Delaware judge's ruling that a number of excess insurance policies are not triggered by underlying asbestos claims filed against an insured is not warranted because the primary policies at issue were not exhausted, an insurer asserts in a Dec. 8 joinder brief filed in the Delaware Supreme Court (Motors Liquidation Co. DIP Lenders Trust v. Allstate Insurance Co., et al., No. 381, 2017, Del. Sup.).
CHICAGO - An insurance benefits company is entitled to a producer commission but not a marketer's fee for a health insurer's breach of an oral contract under a marketing agreement amended following the health insurer's termination of a reinsurance agreement, an Illinois appeals panel affirmed Dec. 7 (Insurance Benefit Group Inc. v. Guarantee Trust Life Insurance Co., No. 1-16-2808, Ill. App., 1st Dist., 4th Div., 2017 Ill. App. LEXIS 763).
CHICAGO - An Illinois federal judge on Dec. 7 denied an insurer's motion to dismiss after rejecting the insurer's argument that the potential indemnitor for underlying liabilities arising out of exposure to polychlorinated biphenyls should be named as the defendant pursuant to a 1999 settlement between the insurer and the potential indemnitor because the coverage dispute is based on the insured's contracts with the insurer (Magnetek Inc. v. The Travelers Indemnity Co., et al., No. 17-3173, N.D. Ill.).
MINNEAPOLIS - The filed-rate doctrine precludes employers' claims to recover assessments that Workers' Compensation Reinsurance Association (WCRA) levied against them, a Minnesota appeals panel affirmed Dec. 11 (Ambassador Press Inc., et al. v. Trifac Workers' Compensation Fund, et al., Nos. A17-0307 & A17-0323, Minn. App., 2017 Minn. App. Unpub. LEXIS 1016).
PITTSBURGH - A Pennsylvania federal judge on Dec. 7 granted and denied in part an insured's request to compel an insurer to produce redacted documents pertaining to mediation in an underlying case, as well as reinsurance information (Golon Inc. v. Selective Insurance Company of the Southeast, et al., No. 17-0819, W.D. Pa., 2017 U.S. Dist. LEXIS 201792).
AUGUSTA, Ga. - A Georgia federal judge on Dec. 6 denied an insurer's motion for summary judgment on a breach of contract claim but granted the insurer's motion on a bad faith claim after determining that the insurer had a reasonable basis to deny the insured's claim for coverage of mold and water damages incurred to her home as a result of a hailstorm (Carrie Finch v. Owners Insurance Co., No. 16-169, S.D. Ga., 2017 U.S. Dist. LEXIS 200934).
SALEM, Ore. - An insurer had a duty to defend an additional insured general contractor in an underlying construction defects case, an Oregon appeals panel ruled Dec. 6, reversing a trial court's entry of summary judgment in favor of the insurer (Security National Insurance Co. v. Sunset Presbyterian Church, No. 588, Ore. App., 2017 Ore. App. LEXIS 1501).
WASHINGTON, D.C. - The U.S. Supreme Court on Dec. 11 refused to review the Second Circuit U.S. Court of Appeals' ruling that a New York law barring the offset of a claimant's disability benefits with the proceeds of the claimant's settlement of a personal injury suit is not preempted by the Employee Retirement Income Security Act (Aetna Life Insurance Co. v. Salvatore Arnone, No. 17-416, U.S. Sup.).
CHICAGO - The First District Illinois Appellate Court on Dec. 5 affirmed a trial court's ruling that underlying asbestos bodily injury claims constitute only one occurrence under an insurer's policies because the underlying claims arose from the single cause of the insured's manufacturing of ash-handling conveyor systems for coal plants (United Conveyor Corp. v. Allstate Insurance Co., et al., No. 1-16-2314, Ill. App., 1st Dist., 2nd Div., 2017 Ill. App. LEXIS 744).
GOSHEN, N.Y. - A New York justice on Dec. 5 refused to compel arbitration of a dispute pursuant to a provision under a reinsurance participation agreement (RPA) because the provision is invalid under Nebraska law (Milmar Food Group II, LLC, et al. v. Applied Underwriters Inc., et al., No. EF003101-2017, N.Y. Sup., Orange Co., 2017 N.Y. Misc. LEXIS 4634).
MOUNT VERNON, Ill. - An Illinois appeals panel on Dec. 6 held that underlying claims against an attorney and his law firm can be rationally said to fall within coverage of a professional liability insurance policy, rejecting the insureds' argument that coverage is barred by the policy's' business enterprise exclusion (Bruce A. Wiley, et al. v. Minnesota Lawyers Mutual Insurance Co., et al., No. 14-144, Ill. App., 5th Dist.).
SEATTLE - Finding insufficient support for an insurer's claim that its consultants were engaged in advance of possible insurance fraud litigation, a Washington federal judge on Dec. 5 denied the insurer's motion to quash subpoenas served on them by the plaintiff in a coverage suit related to extreme weather events (Premier Harvest LLC, et al. v. AXIS Surplus Insurance Co., et al., No. 2:17-cv-00784, W.D. Wash., 2017 U.S. Dist. LEXIS 199910).