LexisNexis® Legal Newsroom
Mealey's Insurance - Judge Allows Portions Of ACA Lactation Coverage Suit To Proceed

DES MOINES, Iowa - A pair of women may continue with their class action lawsuit claiming that their insurer violated the Patient Protection and Affordable Care Act (ACA) by charging for lactation consultation services, but nothing in the Employee Retirement Income Security Act requires insurers to list...

Mealey's Insurance - Judge Trims RICO Claims From Insurers' Fraud Suit, Finds No Enterprise

MINNEAPOLIS - A federal judge in Minnesota on Sept. 7 dismissed with prejudice claims asserted by four insurance companies that two chiropractors, their firms and individuals who allegedly recruited patients for the doctors violated the Racketeer Influenced and Corrupt Organizations Act, finding that...

Mealey's Insurance - Panel Affirms Dismissal Of Law Firm's Suit Seeking Legal Fees From Clients' Insurer

CHICAGO - An Illinois appeals panel on Sept. 7 affirmed a lower court's ruling that a law firm's amended complaint against its clients' professional liability insurer fails to adequately plead claims for account stated and fraudulent misrepresentation (Law Offices of Arnold Landis, P.C.,...

Mealey's Insurance - Judge: Qui Tam Plaintiff's Insurance Fraud Claims Barred By Public Disclosure

SAVANNAH, Ga. - A federal judge in Georgia on Sept. 6 dismissed without prejudice a relator's claims under the qui tam provision of the False Claims Act (FCA) accusing two health care clinics and their providers of failing to submit reimbursements to Medicare, Medicaid and private insurers in 14...

Mealey's Insurance - Judge: Dermatologist Convicted On Fraud Charges Does Not Deserve New Trial

CHICAGO - A federal judge in Illinois on Sept. 11 ruled that a dermatologist who was found guilty of eight counts of health care fraud and eight counts of making false statements related to health care matters is not entitled to a new trial, finding that the evidence presented by the government supported...

Mealey's Insurance - Judge Dismisses Defect Coverage Dispute For Lack Of Jurisdiction

LAS VEGAS - An insured contractor failed to adequately allege complete diversity between itself and the relevant names of an insurance syndicate, a Nevada federal judge ruled Sept. 11, dismissing the dispute over coverage for an underlying construction defect case (Centex Homes v. Navigators Specialty...

Mealey's Insurance - Panel Says Trial Court Erred In Striking Expert Testimony In Water, Mold Damage Suit

BATON ROUGE, La. - A trial court erred in granting an insurer's motion for summary judgment in a dispute over coverage for water and mold damage because the expert testimony proffered by the insureds was improperly excluded by the trial court, the First Circuit Louisiana Court of Appeal said Sept...

Mealey's Insurance - Personal Profit Or Advantage Exclusion Bars Coverage, Panel Says On Remand

LANSING, Mich. - A Michigan appeals panel on Sept. 7 held that an insurance policy's personal profit or advantage exclusion applies to bar coverage for an underlying consent judgment arising from an alleged "conduit financing scheme" between charter schools (Employers Mutual Casualty Co...

Mealey's Insurance - Maryland Appeals Court Finds Woman Waived Continuing Objection Over Fraud Evidence

ANAPOLIS, Md. - A Maryland appeals court panel on Sept. 11 ruled that a trial court did not err when admitting evidence related to a woman's fraudulent insurance claim for jewelry that was allegedly stolen, finding that she waived her right to appellate review because her attorney did not renew the...

Mealey's Insurance - Judge Finds Anti-Assignment Clause Puts Health Care Insurance Spat Outside ERISA

NEWARK, N.J. - A health insurance plan's provision barring insureds from assigning rights leaves a provider pursuing its individual right to payment under state law and precludes removal and preemption under the Employee Retirement Income Security Act of 1974, a federal judge in New Jersey held Sept...

Mealey's Insurance - Judge: Insureds Sufficiently Allege Insurer Considered Higher Reinsurance Costs

PHILADELPHIA - A class of owners of life insurance policies adequately alleged that a life insurer's admitted consideration of lower investment income and higher reinsurance costs constituted breaches of the policies, a Pennsylvania federal judge ruled Sept. 11 (In re: Lincoln National Co. Litigation...

Mealey's Insurance - Judge Refuses To Transfer Dispute Under Reinsurance Agreement's Forum Clause

BRIDGEPORT, Conn. - In a dispute over a series of insurance and reinsurance contracts, a Connecticut federal judge on Sept. 12 declined to enforce a forum selection clause in a reinsurance participation agreement (RPA) because it does not apply to the bulk of an insured's claims against its workers'...

Mealey's Insurance - 5th Circuit Finds Woman Was Deliberately Ignorant Of Medicare Fraud Scheme

NEW ORLEANS - A woman was properly convicted and sentenced to 140 months in prison for illegally billing Medicare more than $250,000 for medical equipment for beneficiaries that was not medically necessary, a Fifth Circuit U.S. Court of Appeals panel ruled Sept. 13, finding that she was deliberately...

Mealey's Insurance - Repopulation Of Bird Flock Lost In Avian Flu Outbreak Is Covered Under Policy

MINNEAPOLIS - A Minnesota federal judge on Sept. 12 determined that an insured is entitled to reimbursement for the costs of repopulating its bird flock after an outbreak of the avian flu virus required the flock to be destroyed because the destruction of the birds qualifies as a remediation expense...

Mealey's Insurance - Reinsurer Opposes Motion To Bar Employee's Testimony In Asbestos Coverage Dispute

UTICA, N.Y. - In a dispute over an underlying $325 million settlement of asbestos claims, a reinsurer responds in a Sept. 13 opposition brief to an insurer's motion to exclude testimony from the reinsurer's former employee, arguing to a New York federal court that the former employee has extensive...

Mealey's Insurance - 3rd Circuit Affirms Dismissal Of Insurer's Fraud Suit Against Attorneys, Firm

PHILADELPHIA - A federal judge in Pennsylvania did not err when dismissing an insurance company's claims that two attorneys and their law firm conspired to submit two fraudulent insurance claims for damage at a church, a Third Circuit U.S. Court of Appeals ruled Sept. 15, finding that the insurer's...

Mealey's Insurance - Appeals Panel Addresses Defamation Claims Against Former N.Y. Attorney General

NEW YORK - American International Group Inc.'s (AIG) former chief executive officer sufficiently alleged a defamation claim based on several public statements made by New York's former attorney general, a New York appeals panel affirmed Sept. 13 (Maurice R. Greenberg v. Eliot L. Spitzer, No....

Mealey's Insurance - 1st Circuit Allows Negligence Claims Against U.S. In Oil Spill Coverage Dispute

BOSTON - The First Circuit U.S. Court of Appeals on Sept. 15 reversed a district court's dismissal of admiralty and maritime negligence claims filed against the United States in an oil spill dispute after determining that the negligence claims are viable under the Suits in Admiralty Act (Ironshore...

Mealey's Insurance - Pediatric Firm Can Pursue Federal, State False Claims Act Allegations, Judge Says

NEWARK, N.J. - A firm of pediatric doctors can pursue allegations that a skilled nursing and rehabilitation facility violated the False Claims Act, the New Jersey False Claims Act (NJFCA) and the New York False Claims Act (NYFCA) for unlawfully billing Medicare and Medicaid as primary payers rather than...

Mealey's Insurance - Award Of Attorney Fees Warranted As Disability Claimant Achieved Some Success

SAN FRANCISCO - A California federal judge on Sept. 14 awarded a disability claimant more than $100,000 in attorney fees after determining that the award was warranted because the claimant achieved "some degree" of success on the merits (Robert Bosley v. Metropolitan Life Insurance Co., No...

Mealey's Insurance - Illinois Federal Judge Says Disability Insurer Reasonably Terminated Benefits

CHICAGO - A disability insurer did not breach its contract or act unreasonably by terminating a claimant's total disability benefits because the evidence shows that the claimant was able to undertake a number of mentally and physically demanding activities, an Illinois federal judge said Sept. 14...

Mealey's Insurance - Nevada Federal Judge Says Bad Faith Claim, Unfair Practices Claim Can Stand

LAS VEGAS - A Nevada federal judge on Sept. 19 denied an insurer's motion for summary judgment as it pertained to a plaintiff's claims for unfair settlement practices and bad faith because the plaintiff provided sufficient evidence to support the claims (Melinda Booth Dogra et al., v. Liberty...

Mealey's Insurance - Judge Adjourns Fraud Trial So Defendant Can Review Recorded Sales Calls

NASHVILLE, Tenn. - A federal judge in Tennessee on Sept. 19 granted a motion filed by a man accused of orchestrating a telemarketing scheme to sell insurance products that were not major medical health insurance, finding that he should be allowed to review recordings of approximately 100,000 sales calls...

Mealey's Insurance - Bifurcation Of Bad Faith Claim Is Not Warranted, Pennsylvania Federal Judge Says

WILLIAMSPORT, Pa. - A Pennsylvania federal judge on Sept. 18 denied an automobile insurer's motion to sever and stay its insureds' bad faith claim after determining that bifurcation would not promote judicial economy and that the insurer would not be prejudiced if the claims are tried together...

Mealey's Insurance - Breach Of Fiduciary Duty Claim Dismissed In Dispute Over Sham Reinsurer Scheme

NEW YORK - In a dispute over two alleged schemes involving a "sham reinsurance company" and a "sham medical billing company," a New York justice on Sept. 15 dismissed claims by an investment fund for breach of fiduciary duty and aiding and abetting breach of fiduciary duty and unjust...