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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 - Underlying Suit Fails To Trigger Professional Liability Coverage, Federal Judge Says

PHILADELPHIA - A senior federal judge in Pennsylvania on Sept. 12 granted two professional liability insurers' motions for judgment on the pleadings and/or summary judgment in a coverage dispute over an underlying negligence lawsuit brought against the insureds by a national title insurance underwriting...

Mealey's Insurance - Kansas Federal Judge Allows Insured To Add Breach Of Contract, Bad Faith Claims

WICHITA, Kan. - An insured seeking coverage for hailstorm damage to two commercial buildings is permitted to amend its complaint to add claims for breach of contract and bad faith because the addition of the claims would not be futile and the insurers will not be prejudiced as a result of the amendment...

Mealey's Insurance - Appellate Panel Refuses To Rehear Plan's Arguments In Disability Benefits Suit

WASHINGTON, D.C. - A District of Columbia Circuit U.S. Court of Appeals panel on Sept. 11 refused to reconsider its finding that a woman was totally disabled under the terms of her Employee Retirement Income Security Act-governed long-term disability plan and that the plan administrator did not satisfactorily...

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 - Federal Judge Says Amount In Controversy Could Exceed $75,000 If Bad Faith Is Proven

CAMDEN, N.J. - Although an insured's claim for breach of contract does not exceed the federal jurisdictional minimum amount in controversy of $75,000, a New Jersey federal judge on Sept. 12 refused to dismiss the insured's complaint, noting that if the insured is successful in proving that the...

Mealey's Insurance - Judge Refuses To Strike Class Allegations, Finds UCL Claims Are Representative

SAN FRANCISCO - Since a construction company seeks to assert claims for violation of California's unfair competition law (UCL) as representative claims under state law, rather than as class claims under federal law, a California federal judge on Sept. 12 denied an insurer's motion to strike parts...

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 - Bad Faith, Breach Of Contract Claims Dismissed; Policy Was Canceled Before Fire Loss

BIRMINGHAM, Ala. - An Alabama federal magistrate judge on Sept. 13 dismissed an insured's suit seeking coverage for fire damage to the insured's home after determining that the insured's claims for breach of contract and bad faith cannot stand because the evidence shows that the policy at...

Mealey's Insurance - Suit Involving Tenant Rights Triggered Insurer's Duty To Defend, Judge Rules

HOUSTON - A Texas federal judge on Sept. 13 found that an underlying lawsuit alleging that an insured failed to timely negotiate a commercial lease agreement triggered an insurer's duty to defend, granting the insured's motion for summary judgment in a coverage dispute (2200 West Alabama, Inc...

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 - No Professional Liability Coverage Owed For Harassment, Discrimination Claims

NEWARK, N.J. - A New Jersey federal magistrate on Sept. 14 found that professional liability insurance coverage was not triggered because underlying sexual harassment and discrimination claims do not arise out of the insured's performance of ambulance services, granting the insurer's motion for...

Mealey's Insurance - Federal Judge Refuses To Dismiss Diminished Value Suit Arising From Hail/Wind Damage

MACON, Ga. - A Georgia federal judge on Sept. 15 denied a homeowners insurer's motion to dismiss a lawsuit alleging that it committed breach of contract by refusing to assess and pay for the diminished value of the insureds' home caused by wind and/or hail damage (Tonya Long v. State Farm Fire...

Mealey's Insurance - Insurer Is Responsible For 25 Percent Of Lead-Paint Judgment, Federal Judge Says

BALTIMORE - A Maryland federal judge on Sept. 14 said an insurer is responsible for paying for 25 percent of a judgment entered against its insured in an underlying lead-paint injury case after determining that the allocation must be calculated based on the time period during which the tenant lived in...

Mealey's Insurance - Company Awarded Judgment After Expert For Insurer Seeking Subrogation Excluded

GREENBELT, Md. - A Maryland federal judge on Sept. 15 awarded summary judgment to a utility contractor on an insurance company's claim that the contractor's negligence caused a house fire, after excluding the insurer's expert from testifying about the standard of care for the work at issue...

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 - Ohio Couple Sentenced, Ordered To Turn Over Home For Insurance Fraud

COLUMBUS, Ohio - A federal judge in Ohio on Sept. 18 sentenced a couple who owned a home health care company for their roles in an insurance fraud scheme that involved submitting falsified training sheets for nurses and aides and required them to turn over the $1 million home they built with the proceeds...

Mealey's Insurance - Judge: No Directors, Officers Liability Coverage Owed For Overtime Pay Dispute

SHERMAN, Texas - A Texas federal judge on Sept. 18 adopted a magistrate's report that recommended granting an insurer's motion for summary judgment in a dispute over directors and officers liability coverage for underlying claims that the insured failed to pay overtime and improperly categorized...

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...