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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 - 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...

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...

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...

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...

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...

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...

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"...

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...

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...

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"...

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...

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...

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 - 5th Circuit Affirms Doctor's Convictions For Health Care Fraud, Kickbacks

NEW ORLEANS - A Fifth Circuit U.S. Court of Appeals panel on Aug. 17 affirmed a jury's verdict convicting a man of committing health care fraud and paying and receiving kickbacks for approving patients for home health care when they did not need such treatment (United States v. Warren Dailey, No...

Mealey's Insurance - Punitive Damages Award Upheld; Award Justified Based On Insurer's Deceit

ST. LOUIS - A jury's award of $2.75 million in favor of a plaintiff who was injured while a passenger in an insured vehicle was not excessive and was justified based on the jury's finding that the insurer deceived the passenger regarding coverage on the insured vehicle, the Eighth Circuit U.S...

Mealey's Insurance - Judge Declines To Stay Coverage Action Pending Insurer's Liquidation

ST. LOUIS - A Missouri federal judge on Aug. 16 refused to stay a professional liability insurer's dispute against an insolvent insurer over wrongful act claims submitted by the insolvent insurer because she found that the contractual issues are not pivotal to the underlying state court liquidation...

Mealey's Insurance - Federal Judge Dismisses Coverage Dispute Over Damage To Texas Motel

DALLAS - A Texas federal judge on Aug. 15 granted an insured's motion to dismiss its commercial insurer's declaratory judgment lawsuit disputing coverage for alleged storm damage to the insured's motel, finding that the majority of the factors in Brillhart v. Excess Ins. Co. of Am., 316 U...

Mealey's Insurance - New York Insured Sues FEMA, Administrators, Insurer In Superstorm Sandy Dispute

CENTRAL ISLIP, N.Y. - An insured sued the Federal Emergency Management Agency, its administrators and Wright National Flood Insurance Co. on Aug. 17 in a New York federal court, alleging that he was wrongfully denied $141,274.50 in insurance proceeds for Superstorm Sandy damage to his Long Beach, N.Y...

Mealey's Insurance - Rapid-American Protests Insurers' Subpoenas To Claims-Processing Facilities

NEW YORK - Chapter 11 debtor Rapid-American Corp. and the asbestos claimants in its case asked a New York federal bankruptcy judge on Aug. 15 to stop the debtor's insurers from enforcing subpoenas they issued to six asbestos claims-processing facilities, saying the subpoenas are "facially overbroad...