For more than a decade, medical providers have tried to limit the discretion of automobile insurers to pay less than the billed amount for services and equipment offered to injured insureds. Most of these efforts involve challenges to the use of automated bill review systems. But in Freedom Medical Supply Inc. v. State Farm Fire & Cas. Co., No. 14-1628 (3rd Cir. June 8, 2016), a company charging 1,000% mark-ups on equipment it bought at Bed Bath & Beyond argued ... Keep Reading »
Step-Up, Insurer! Your Step-Down Provision Is Not Triggered
“Sometimes nothin' can be a real cool hand.” -- Frank Pierson Where an automobile policy covers someone other than the named insured, a “step-down” provision may subject the amount of available coverage to the limit on “similar coverage” that is imposed by the injured person’s own policy. Sometimes, however, that second policy does not cover a particular risk at all. Last month, in Rivera v. McCray, No. A-2337-14T1 (N.J. App. Div. May 2, 2016), a New Jersey appellate ... Keep Reading »
Alabama Puts The Mystery Back Into All-Risk Coverage
“There is, one knows not what sweet mystery about this sea …” -- Moby-Dick Insuring property against loss creates an unavoidable moral hazard: policyholders often have an incentive to cause or allow their property to disappear. Early efforts to limit insurers’ exposure to that risk—such as requiring the insured to prove the cause of a loss by “direct and affirmative evidence”—proved unsustainable. Eventually, the problem gave rise to express exclusions for losses ... Keep Reading »
Eighth Circuit Orders Coverage For Hackers’ Fraudulent Wire Transfer
Financial institution bonds come in various forms, depending on the nature of the insured business (e.g. bank, broker, insurance company). Common forms are fidelity bonds and commercial crime policies. These policies provide first party coverage against losses caused by employee dishonesty, forgery, kidnap, ransom & extortion, computer fraud and other specified financial frauds. These policies are common, and in some cases required by law, for banks, insurers, and ... Keep Reading »
Colorado Takes A Stand Against Unauthorized Settlements
The “notice-prejudice” rule gives a pass to policyholders who breach the notice or cooperation provisions of their policies, if the breach is found not to have prejudiced the insurer. Sometimes, the late notice does not arrive until after the policyholder has settled an underlying claim; even in those cases—and even where the policy contains a “no voluntary payments” or a “consent-to-settle” clause—dozens of cases have found that the notice-prejudice rule applies. Last ... Keep Reading »
NY Appellate Court Rules “Blanket Ordinance or Law Coverage” not as Blanket as Insured Hoped
In 1947, some Bedouin shepherd boys were tending their sheep and goats near the ancient settlement of Qumran, near the Dead Sea. One of the boys threw a rock into an opening on the side of a cliff and heard something break. Curious, they entered what was a small cave. Inside, they discovered a large clay vessel that had been broken by the thrown rock. It contained several scrolls. This led to the discovery of more clay jars and more scrolls, what would later be come ... Keep Reading »
Insuring Cyber Exposure Through a Captive Insurer
Cyber risks have been confounding insurers and policyholders alike as those risks have evolved and expanded in recent years. Indeed, the risks have effectively outgrown the confines of standard commercial insurance coverage, and numerous insurers have developed new products, creating a market for cyber-specific coverages and policies. While predictions about growth in this market have generally been bullish, there are some signs it may be flattening. One recent survey ... Keep Reading »
Grateful Marijuana Grower Scores Coverage Victory in Colorado Federal Court
The refusal of the Senate to fill a Supreme Court vacancy has put gridlock back on the front page, as it leaves important questions about immigration and clean energy unresolved. Uncertainty about federal policy is also affecting other areas of American life, including one of our most popular pastimes. Recently, in The Green Earth Wellness Center, LLC v. Atain Specialty Ins. Co., No. 13-cv-03452-MSK-NYW (D. Colo. Feb. 17, 2016), a federal court in Colorado held that the ... Keep Reading »
Ninth Circuit Leaves it to Policyholder to Pay Eddie Haskell’s Attorneys’ Fees
Eddie: Well, look, there's nothin' to be so shook about. Lumpy's insurance'll take care of it. Moral hazard lurks around the edges of many disputes about liability coverage. Everyone agrees in principle that insurance shouldn’t help bad actors benefit from their wrongdoing, but parties often clash over where the principle applies. Some courts have addressed the problem by asking if the insured has suffered an insurable “loss.” E.g., Ryerson Inc. v. Federal Ins. Co., ... Keep Reading »
None Of Your Business: Eleventh Circuit Enters A Gray Area For Contract Liability Exclusions
Businesses have responsibilities; they buy liability insurance to cover losses that arise if they fail to perform them all. Businesses also “assume” responsibilities under contracts; those responsibilities are typically excluded from coverage. Sometimes the two kinds of responsibility overlap. Last month, in Payroll Management, Inc. v. Lexington Ins. Co., No. 15-10314 (11th Cir. March 1, 2016), the U.S. Court of Appeals rejected an insured’s attempt to exploit that ... Keep Reading »
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