A business that transferred thousands of dollars – based on a fraudulent email it believed was coming from the company’s president – failed to demonstrate its loss was covered by insurance. Instead, the loss was barred by the voluntary parting ...

Tagged with: Insurance Judge John A. Gibney Jr. U.S. District Court - Eastern District

Aetna did not abuse its discretion in denying an employee’s request for long-term disability benefits following a car accident. Although the employee initially received short-term benefits, subsequent examinations by both treating and independent medical professionals concluded she was capable of ...

Tagged with: Insurance Judge Claude M. Hilton U.S. District Court - Eastern District

A healthcare provider has a private right of action under a statute that requires medical insurers to pay for emergency care without prior authorization regardless of whether the provided emergency services are in-network or out-of-network. The insurer’s demurrer to the ...

Tagged with: Fairfax Circuit Court Insurance Judge Richard E. Gardiner Virginia Circuit Courts

Doctors who billed nearly $250,000 but were paid less than $15,000 can sue their patient’s health plan under a Virginia statute setting pay rates for out-of-network emergency care, a circuit judge has ruled. A statute establishing what’s known as the ...

Tagged with: Fairfax Circuit Court Insurance Insurance Claims Judge Richard E. Gardiner Medical Costs

Where the sponsor of a PGA tournament accepted the terms of a policy that insured payouts for a hole-in-one at least 170 yards in distance, its claims that the insurer breached duties by failing to obtain a policy covering holes-in-one ...

Tagged with: 4th U.S. Circuit Court of Appeals Insurance Per Curiam Opinion

Although Nationwide argued it had no duty to satisfy a judgment arising from an automobile accident because it was not provided timely notice or because the injuries were incurred as a result of an intentional act, these arguments were contrary ...

Tagged with: Insurance Judge John A. Gibney Jr. U.S. District Court - Eastern District

In a case stemming from a wrongful death settlement, one carrier argued the “other insurance” language in two policies rendered both true excess policies, thereby requiring pro rata sharing of the burden. But one policy was found to be a ...

Tagged with: Insurance Judge M. Hannah Lauck U.S. District Court - Eastern District

Although the plaintiff was the victim of an email fraud in which it transferred money to the fraudsters, disputed issues over the location of the sender and the number of occurrences will need to be resolved at the bench trial. ...

Tagged with: Insurance Judge M. Hannah Lauck U.S. District Court - Eastern District

Where the son was staying at a house owned by his mother that was her tem­porary residence when his dog bit a 15-month old child, Liberty Insurance was not required to make payments to the minor because the son was ...

Tagged with: Insurance Judge David J. Novak U.S. District Court - Eastern District

Where Progressive’s policy did not cov­er the tractor or trailer involved in the fa­tal motor vehicle accident and the driv­er was not acting in pursuit of his own trucking business at the time of the acci­dent, there was no coverage. ...

Tagged with: Insurance Judge James P. Jones U.S. District Court - Western District