Category Archives: Insurance

Early Fraud Warning

Our very first substantive post (way back in January of Aught Five) was about folks who thought they could cheat their way to big time insurance bucks. As one can imagine, they were not exactly successful in these endeavors, although they may have earned an "A" for effort.But that was then, and this is now, and it appears that bad actors get early starts:[Hat Tip: Bits & Pieces via FoIB MisHum]Original content copyright © InsureBlog.. To continue reading this legal news please click Read full information...

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NY Insurance Department D&O Opinion

The New York Insurance Department has issued an opinion (see here) requiring admitted Directors and Officers liability (D&O) insurance policies not have a provision placing a duty to defend on the insured. A D&O liability policy may not include a provision that places the duty to defend upon the insured, rather than the insurer Two D&O experts, Kevin LaCroix of The D&O Diary and Carrie Cope of the Tressler, Soderstrom Maloney & Preiss law firm, have pointed out flaws in….. To continue reading this legal news please click Read full information...

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ERISA Regulations

The Employee Retirement Income Security Act (ERISA) is governed by federal statutes. The claims procedures originate from 29 U.S.C., Section 1133 and 1135.  Section 1133(1) requires that a carrier or claims administrator provide adequate notice of the reasons for denial that can be readily understood by the claimant.  Section  1133(2) requires ERISA plans to afford claimants a full and fair review, usually called an appeal, of a denied claim by a claim fiduciary.  The full and fair review is usually conducted by the same entity that issued the denial, typically an insurance carrier or third-party administrator, but must be conducted by someone other than the adjuster who denied the claim. Section 1135 grants the power to the Secretary of the U.S. Department of Labor (DOL) to establish claims regulations that comply with ERISA. Continue reading.. To continue reading this legal news please click Read full information...

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The Sentinel Strike: The Hartford’s Gift to New York Insurers in the War to Stop Policyholder Experts from Claiming Ambiguities Exist in Clear Policy Exclusions

In this age of exponentially increasing technology, we can rely on one certainty in property casualty jurisprudence – that is, bold policyholder assertions supported by even bolder “expert” opinions. In BF Advance, LLC v. Sentinel Insurance Company, No. 16-cv-5931 (E.D.N.Y. Mar. 20, 2018), decided in New York federal court this past March, the policyholder argued […].. To continue reading this legal news please click Read full information...

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Ninth Circuit Interprets the Health Parity Act in Favor of Insureds Seeking Health Insurance Benefits

Insurance companies often attempt to provide different levels of benefits for the treatment of physical injuries and mental health issues in the same policy.  Mental health parity describes the equal treatment of mental health conditions and non-mental health conditions in … The post Ninth Circuit Interprets the Health Parity Act in Favor of Insureds Seeking Health Insurance Benefits appeared first on McKennon Law Group PC... To continue reading this legal news please click Read full information...

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