LexisNexis® Legal Newsroom
    Mealey's Insurance - Podiatrist Sentenced To 90 Months In Prison For Fraudulently Billing Medicare

    ST. LOUIS - A federal judge on Aug. 15 sentenced a podiatrist to 90 months in prison and ordered him to pay $6.9 million in restitution for fraudulently billing Medicare for services that were not rendered (United States v. Yev Gray, No. 15cr464, E.D. Mo.).

    Mealey's Insurance - Disability Insurer Did Not Misclassify Claimant's Own Occupation, Federal Judge Says

    KALAMAZOO, Mich. - A disability insurer did not act arbitrarily and capriciously when it classified a claimant's own occupation as sedentary because it relied on information from the claimant and the claimant's employer, a Michigan federal judge said Aug. 15 (Daniel Venier v. Liberty Life Assurance Company of Boston, No. 15-1016, W.D. Mich., 2017 U.S. Dist. LEXIS 129691).

    Mealey's Insurance - Judge Trims Some Of GEICO's Claims From Fraudulent Billing Suit

    BOSTON - A federal judge in Massachusetts on Aug. 16 trimmed some claims from a lawsuit brought by the Government Employees Insurance Co. (GEICO) against a chiropractic firm and its owners, finding that while the insurer's claims were timely and not barred by Massachusetts' Strategic Litigation Against Public Participation (anti-SLAPP) statute, the company's claims for civil conspiracy, money had and received, breach of contract and intentional interference with advantageous business relationships were not sufficiently pleaded (Government Employees Insurance Co. v. Barron Chiropractic & Rehabilitation, P.C., et al., No. 16-cv-10642-ADB, D. Mass., 2017 U.S. Dist. LEXIS 130278).

    Mealey's Insurance - Insurer Seeks Clarification On Discovery To Reinsurer In Breach Of Contract Suit

    PHILADELPHIA - In a breach of contract suit, an insurer moved for clarification on Aug. 11 with a Pennsylvania federal court to confirm that it is to produce only unredacted versions of documents previously produced with redactions based on proprietary material, reserves and "other reinsurance" information and additional documents reflecting the date when the insurer provided first notice of asbestos claims to other reinsurers of relevant policies (R&Q Reinsurance Co. v. St. Paul Fire & Marine Insurance Co., No. 16-1473, E.D. Pa.).

    Mealey's Insurance - Doctor Sentenced To 39 Months In Prison For Hospice Fraud Scheme

    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.).

    Mealey's Insurance - Reinsurer Appeals To 2nd Circuit Insurer's $18M Arbitration Award

    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.).

    Mealey's Insurance - Reinsurance Executives Say $50M RICO Suit With Insurers Should Be Sent To Arbitration

    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.).

    Mealey's Insurance - Florida Majority Reverses Ruling In Bad Faith Suit Over Sinkhole Damage

    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).

    Mealey's Insurance - Owner Of 2 Home Health Companies Found Guilty Of Health Care Fraud

    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).

    Mealey's Insurance - Washington Panel Affirms No Coverage Ruling In Intentional Act Dispute

    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).

    Mealey's Insurance - Parties Were Properly Aligned In Coverage Dispute, 6th Circuit Affirms

    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).

    Mealey's Insurance - Appeals Panel Says ERISA Preempts California Law Barring Discretionary Clauses

    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).

    Mealey's Insurance - Insurer Removes Suit Seeking Coverage For Water Damages To Federal Court

    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.).

    Mealey's Insurance - Judge Terminates Policy Coverage In SeniorSure Healthplan Receivership

    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.).

    Mealey's Insurance - Couple's Upgrades To Construction Project Are Not An Accident, Judge Says

    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).

    Mealey's Insurance - Tennessee Insurance Guaranty Association Seeks Remand Of Reimbursement Suit

    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.).

    Mealey's Insurance - Trust Bank Seeks Lift Of Stay In Insurer's Receivership, Seeks Preliminary Injunction

    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).

    Mealey's Insurance - 8th Circuit: Faulty Fire System Is Not An 'Accident' Under Insurance Policy

    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).

    Mealey's Insurance - Pollution Exclusion Bars Coverage For Carbon Monoxide Injuries, Appeals Panel Says

    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).

    Mealey's Insurance - Motion To Remand Pollution Dispute Denied; Claims Against Adjuster Fail, Judge Says

    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).

    Mealey's Insurance - Judge Approves Payment Of Reinsurance To Insured In Insurer's Liquidation

    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.).

    Mealey's Insurance - Judge: Fact Issues Preclude Summary Judgment In Professional Liability Dispute

    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).

    Mealey's Insurance - Appeals Court Affirms Man's Convictions For Setting Fire For Insurance Money

    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).

    Mealey's Insurance - Federal Judge Finds Questions Of Fact Exist On Amount Of Coverage Owed

    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).

    Mealey's Insurance - Panel Finds Error In Ruling That Reinsurance Agreement Is An Insurance Contract

    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).