CMS Proposed Rule and Administrator Ruling Affecting RAC Appeals
On March 13, 2013, CMS released a proposed rule (CMS-1455-P) to revise Medicare Part B billing policies when a Part A claim for an inpatient admission is denied for lack of medical necessity. CMS will...
View ArticleFifth Circuit Affirms Subrogation Verdict for Insurer Holding Replacement...
The U.S. Fifth Circuit Court of Appeals recently upheld a subrogation verdict for a property insurer based on replacement cost as a determination of the fair market value of destroyed property. Factory...
View ArticleOklahoma Supreme Court Affirms Validity of Properly Issued Reservation of...
The Oklahoma Supreme Court found an insurer has no obligation to indemnify for damages arising out of a condemnation claim despite providing a defense because the insurer properly reserved its rights...
View ArticleFederal Court in North Carolina Holds Supplemental Extended Reporting Period...
A federal court in North Carolina recently held that a 12-month supplemental extended reporting period purchased by an insured ran from the termination of the policy’s 60-day basic extended...
View ArticleFederal Court in Georgia Finds Lessor’s Liability Policy Does Not Cover...
A federal court in Georgia held that lessees were not “insureds” under a lessor’s liability policy because they did not meet the policy’s definition of...
View ArticleTexas Supreme Court Considers Certified Questions Concerning Coverage for...
The Texas Supreme Court has heard oral argument in Ewing Construction Co., Inc. v. Amerisure Insurance Co. on a certified question from the U.S. Fifth Circuit Court of Appeals regarding coverage for a...
View ArticleFlorida Appellate Court Holds Insurer Owes Separate Defense Counsel to...
A Florida appellate court has held that an insurer is required for the insurance carrier to appoint separate independent defense counsel for a named insured and an additional insured. University of...
View ArticleFederal Court in Arkansas Finds Insurer Entitled To Reformation
A federal district court in Arkansas has held an insurer entitled to reform a policy that was erroneously issued without a law enforcement exclusion. Harleysville Worchester Ins. Co. v. Diamondhead...
View ArticleTexas Appellate Court Threatens Mandamus If Trial Court Does Not Vacate...
An appellate court in Texas recently granted a conditional writ of mandamus ordering the trial court to vacate an order denying an insurer’s motion to compel appraisal prior to the scheduled...
View ArticleFederal Court in Kentucky Concludes That Defense Costs Incurred By Insurers...
A federal district court in Kentucky has held that two liability insurers providing insurance over multiple policy periods for a continuous exposure claim must allocate defense costs based on...
View ArticleAlabama Supreme Court Affirms Assault And Battery Exclusion Does Not Apply To...
The Alabama Supreme Court has held that a college fraternity’s general liability policy covers damages sustained by an assault victim as a result of the local chapter’s...
View ArticleUnder Kentucky Law, Policy Excluding Coverage for Damages Covered by Other...
The U.S. Sixth Circuit Court of Appeals has held that a general liability policy with an exclusion for damages covered by other insurance is primary to a professional liability policy containing an...
View ArticleFederal Court in Alabama Finds No Duty to Defend In Motion for Default...
A federal district court in Alabama has held in a motion for default judgment that an insurer has no duty to defend coverage for Chinese drywall claims. Penn. National Mut. Cas. Ins. Co. v. Snead Door,...
View ArticleFederal Court in Virginia Holds Insurer Has No Duty to Defend or Indemnify...
A federal court in Virginia recently held that an insurer has no duty to defend or indemnify its insured after the insured failed to give the insurer notice of an accident for almost three years on the...
View ArticleFifth Circuit Holds under Texas Law That Scope of Coverage for Additional...
The U.S. Fifth Circuit Court of Appeals, applying Texas law, held that when a named insured agrees to indemnify and secure insurance for an additional insured, the terms of the policy—not the...
View ArticleArkansas Supreme Court Holds Insurer Entitled To Pursue Subrogation Action to...
The Arkansas Supreme Court, reversing a lower court, has held that an auto insurer is entitled to pursue subrogation claims against a tortfeasor for no-fault medical benefits paid to its insured....
View ArticleFourth Circuit Holds Improper Storage of Elevator Fluid, Leading to Multiple...
The U.S. Fourth Circuit Court of Appeals upheld a lower court’s ruling that an insurer has no further duty to defend or indemnify its insured after paying its per occurrence limit for claims...
View ArticleFifth Circuit Upholds Policy’s Claims-Reporting Requirement against...
The U.S. Fifth Circuit Court of Appeals has held that a Louisiana direct action plaintiff has no right to proceed against an insurer that issued a claims-made and reported policy which did not receive...
View ArticleFlorida Supreme Court Holds "Economic Loss" Rule Applies Only To Product...
The Florida Supreme Court has held that the application of the “economic loss” rule is limited to products liability cases. Tiara Condo. Assoc., Inc. v. Marsh & McLennan...
View ArticleMississippi Supreme Court Holds Insured's Failure to Read Policy Does Not...
The Mississippi Supreme Court affirmed summary judgment that an insured is bound by the stated policy deductible, despite the insured’s claim that it was unaware of the policy deductible....
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