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Mealey's Insurance - Federal Judge Orders Production Of Reinsurers' General Ledger Info

ATLANTA - A Georgia federal judge on July 19 ordered the production of general ledger information from reinsurers in an insurer's case over alleged fraudulent transfers of reinsurance funds to avoid paying proceeds to the insurer (Canal Insurance Co., et al. v. Golden Isles Reinsurance Company Ltd...

Mealey's Insurance - Government Says Failed ACA Insurer Should File Case In Federal Claims Court

COLUMBIA, S.C. - A failed Patient Protection and Affordable Care Act (ACA) co-operative insurer's liquidator should file his lawsuit challenging a federal loan repayment demand in the U.S. Court of Federal Claims, the government says in a July 19 motion filed in South Carolina federal court (Raymond...

Mealey's Insurance - Liquidator Applies For Direct Payment Of Reinsurance To Insured

HARRISBURG, Pa. - Reliance Insurance Co.'s liquidator on July 20 sought the approval of a Pennsylvania court for 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 - Administrators Cannot Violate Anti-Kickback Law, 3rd Circuit Finds

PHILADELPHIA - A Third Circuit U.S. Court of Appeals panel ruled July 19 that administrators of an outpatient surgical facility cannot be found liable for violating Pennsylvania's insurance fraud statute because the anti-kickback provision of the statute applies only to health care providers (Aetna...

Mealey's Insurance - Judge: Insurer's Denial Of Coverage For Wilderness Programs Permissible

MIAMI - An insurer's exclusion of wilderness treatment programs is not a blanket bar, but is based on the frequent failure of those facilities to meet certain general coverage criteria, and thus does not violate federal law by treating mental health coverage differently from more general treatments...

Mealey's Insurance - Maryland Federal Judge: Denial Of Disability Benefits Was Arbitrary, Capricious

BALTIMORE - A Maryland federal judge on July 21 granted a disability claimant's motion for summary judgment after determining that a disability insurer's denial of benefits was arbitrary and capricious because substantial evidence does not support the denial (Wiley Joseph Smith v. The PNC Financial...

Mealey's Insurance - Nebraska High Court: Insurer Has No Right To Assert Breach Of Reinsurance Agreement

LINCOLN, Neb. - A workers' compensation insurer and a reinsurer's billing agent have no standing to bring a claim for breach of a "Reinsurance Participation Agreement" (RPA), the Nebraska Supreme Court ruled July 21, dismissing their case (Applied Underwriters Inc., et al. v. S.E.B...

Mealey's Insurance - Federal Judge Dismisses All Claims Against Insurer In Texas Flood Coverage Dispute

SAN ANTONIO - A Texas federal judge held on July 19 that an insured's state law tort causes of action as to how her federal flood insurer handled her claim are preempted by federal law, further concluding that it is undisputed that the insured failed to file an adequate proof of loss to support her...

Mealey's Insurance - Insurer Did Not Breach Contract By Failing To Pay $306,808 Post-Judgment Interest

DETROIT - A Michigan federal judge on July 20 granted a commercial excess insurer's motion for summary judgment in an insured's breach of contract lawsuit seeking to recover $306,808.46 in post-judgment interest that was awarded against the insured in an underlying product liability dispute ...

Mealey's Insurance - Federal Judge Enters $3.6M Judgment In Favor Of Professional Liability Insurer

GREENBELT, Md. - Following remand from the Fourth Circuit U.S. Court of Appeals, a Maryland federal judge on July 21 entered a $3,591,847.28 judgment plus post-judgment interest in favor of a professional liability insurer in its equitable contribution lawsuit arising from a medical malpractice claim...

Mealey's Insurance - Health Plan's Claim Over Reinsurance Contributions Under ACA Fails, Judge Says

BALTIMORE - A self-funded, self-administered group health plan failed to allege a claim over which jurisdiction would exist under the Patient Protection and Affordable Care Act's (ACA) "internal revenue tax" or "any sum" provisions, a Maryland federal judge ruled July 21, dismissing...

Mealey's Insurance - Kentucky Panel Affirms Dismissal Of Third-Party Bad Faith Claim In Malpractice Suit

FRANKFORT, Ky. - A Kentucky appeals panel on July 21 affirmed a lower court's grant of summary judgment in favor of a professional liability insurer in a lawsuit alleging that the insurer breached its duty to deal in good faith with a third party who sued its doctor insured for medical malpractice...

Mealey's Insurance - Michigan Panel Affirms Exclusion Does Not Apply To Insured's Water Damage

GRAND RAPIDS, Mich. - A Michigan appeals panel on July 20 affirmed a lower court's ruling in favor of an insured in a coverage dispute arising from water damage to the insured's Ann Arbor, Mich., property (Cincinnati Insurance Co. v Thomas Kaeding II, No. 332559, Mich. App., 2017 Mich. App. LEXIS...

Mealey's Insurance - Judge Finds Damage To Welds Is Covered, Reserves Indemnity Ruling

TACOMA, Wash. - A Washington federal judge on July 20 partially granted a motion for summary judgment filed by insurers to the extent that it sought declaratory judgment that only property damage to welds was covered under an insurance policy, but found that an underlying complaint could impose liability...

Mealey's Insurance - Wire Transfer Theft Covered Under Computer Fraud Policy Clause, Judge Rules

NEW YORK - A firm's loss due to a fraudulent wire transfer scheme constituted computer fraud even though the thief used email spoofing rather than hacking into the company's system, a New York federal judge ruled July 21, finding that coverage for the multimillion dollar loss existed under the...

Mealey's Insurance - Disability Claimant Met Burden Of Proving She Was Disabled Under Plan

SAN FRANCISCO - A California federal judge on July 24 determined that a disability claimant is entitled to long-term disability benefits because the claimant met her burden of proving that she was disabled according to the terms of the plan at issue (Hadar Meiri v. Hartford Life and Accident Insurance...

Mealey's Insurance - Federal Judge Substitutes Class Representative In Dispute Over Insurance Practices

JEFFERSON CITY, Mo. - A Missouri federal judge on July 24 granted an insured's motion to intervene as the representative of a class action alleging that a homeowners insurer committed breach of contract when it unlawfully applied a policy's $1,000 deductible to an actual cash value (ACV) payment...

Mealey's Insurance - Judge Approves Reinsurer's Direct Payment To Insured In Reliance's Liquidation

HARRISBURG, Pa. - A Pennsylvania judge on July 25 approved a direct payment of reinsurance by a reinsurer to an insured in the liquidation of Reliance Insurance Co. (In re: Reliance Insurance Co. in liquidation, No. 1 REL 2001, Pa. Cmwlth.).

Mealey's Insurance - Insured Failed To Raise Fact Issue As To Why Appraisal Award Should Be Set Aside

DALLAS - A Texas appeals panel on July 24 affirmed a lower court's summary judgment ruling in favor of an insurer in a breach of contract lawsuit arising from a $73,000 appraisal award for the insured's hailstorm damage (Floyd Circle Partners LLC v. Republic Lloyds, No. 05-16-00224, Texas App...

Mealey's Insurance - Legal Malpractice Claim Not Timely Reported, Wisconsin Panel Affirms

WAUSAU, Wis. - A Wisconsin appeals panel on July 25 affirmed a lower court's ruling that a legal malpractice claim against a law firm insured was not reported within a professional liability insurance policy's two-year extended reporting period (ERP) (Michael J. Sheffield v. Darwin National Assurance...