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2016

Blog Posts in 2016

  • Hurricane Matthew Presents Potential Recovery Headaches

    Hurricane Matthew was identified as a named tropical storm on September 28, 2016, and became a Category1 Hurricane on September 29, 2016. Matthew then grew in strength and blasted its way through the Caribbean, and along the United States’ Eastern seaboard impacting Florida, Georgia, South Carolina, and North Carolina. This single hurricane prompted two Emergency Declarations (EM-337 & EM-3380) by ...
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  • HHS Introduces Proposal for Medicaid Fraud Control Unit Program Changes

    In September 2016, a new rule was proposed that would codify statutory changes and amend several provisions of the Medicaid Fraud Control Unit (MFCU) program. MFCUs operate in 49 states, as well as the District of Columbia, and are designed to facilitate the integrity of the Medicaid program by combatting fraud and abuse. Only twice in its nearly forty-year history has the program itself been ...
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  • Are Broad Implications for Insurers Faced with Allegations of Bad Faith in Our Future?

    The Texas Supreme Court is primed to hear a case that could have broad implications for insurers faced with allegations of bad faith following a coverage determination averse to an insured. At issue is whether Texas law allows a plaintiff to recover policy benefits for an insurance company’s alleged “bad faith” in rejecting a claim when the insurer did not breach the insurance contract. Menchaca ...
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  • The Fifth Circuit May Expand a Relator's Ability to Bring Qui Tam Actions Even With Uncertainty of Damages

    The Fifth Circuit is currently hearing a case which, depending on the outcome, could greatly expand an individual’s ability to bring qui tam actions under the False Claims Act (“FCA”) by allowing a relator to sue a company for unassessed damages based solely on a statutory violation. The case currently pending before the Fifth Circuit is Simoneaux v. E.I. DuPont De Numours & Co. , No. 16-30141. ...
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  • Supreme Court Clarifies RICO's Extraterritorial Application

    In RJR Nabisco, Inc. v. European Community , the Supreme Court was asked to determine whether a private action under the Racketeer Influenced Corrupt Organization statute (“RICO”), 18 U.S.C. §§ 1961-1964, could extend to injuries that occurred outside the United States. The European Community (“EC”), on behalf of 26 of its member states, filed a civil suit against RJR Nabisco, Inc. (“RJR”) under § ...
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  • Recent Texas Decision Helps Define 'Prompt Notice' in Hail Claims

    Known for its mercurial nature and frequent severity, Texas weather has long been the subject of wry observation, but 2016’s Texas weather has been even more intense than usual. Freshest on our minds is the terrible flooding from May and June—even the seemingly all-night thunderstorms over the Fourth of July weekend, here in Tarrant County. Before that, though, were the hailstorms. March and April ...
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  • North Texas Chiropractors Convicted in Million Dollar Fraud

    U.S. District Judge Reed O’Conner and a federal jury convicted Drs. Abbas Zahedi and James Sterns of health care fraud in January 2015 in the Northern District of Texas. Dr. Zahedi of Carrolton, Texas was convicted of one count of conspiracy to commit health care fraud, five counts of health care fraud, and four counts of aggravated identity theft. Dr. Zahedi will serve 145 months in federal ...
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  • The Rise of Cyber Insurance

    As companies become wholly dependent on technology and the Internet for day-to-day business, the risk of cyber-attacks and data breaches are ever-present. These risks are largely unavoidable and are a part of doing business in today’s world. Companies are increasingly turning to insurance companies to obtain cyber insurance policies to protect against these mounting risks. KEY INDUSTRIES SEEKING ...
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  • Lying to an Insurer, Even if the Claim Has Been Denied, Can Land You in Jail

    State v. Goodwin , 129 A.3d 316 (N.J. 2016) In January of 2016, the Supreme Court of New Jersey upheld the guilty conviction of second-degree insurance fraud for defendant Robert Goodwin (“Goodwin”), even though the insurer had denied the claim. This claim was denied based on discovery of the fraud during an Examination Under Oath (“EUO”), ultimately leading to criminal charges and a felony ...
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  • CONSENT TO ASSIGNMENT CLAUSES IN CALIFORNIA

    Fluor Corp. v. Superior Court (2015) 61 Cal.4 th 1175. There is a long standing tradition that parties should be free to contract for and against various types of risks. This has formed the backbone of the insurance industry for over a century. But what happens to existing insurance policies when a company with several core operations decides to split its operations into new individual entities? ...
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  • PITFALLS AND IMPORTANT CONSIDERATIONS OF POST CLAIM FILED RESCISSION

    Dubeck v. California Physicians’ Service (2015) 234 Cal.App.4 th 1254. Despite intentionally misrepresenting material facts in her insurance application, a California court denies an insurer’s attempt to rescind the policy holding that the insurer had an opportunity to investigate prior to making payments on the claim. Dubeck v. California Physicians’ Service discusses an insurer’s waiver of right ...
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  • UNCERTAINTY HOVERING OVER UAS USE......ARE DRONES COVERED UNDER STANDARD HOMEOWNER'S INSURANCE POLICIES?

    Traditionally, drones, or unmanned aerial systems (UAS), bring to mind images of robotic aircraft armed with bombs or missiles patrolling some of the world’s deadliest regions. However, over the past few years, drone use has become increasingly recreational. So much so that drone sales were predicted to increase by approximately 50% from 2014 to 2015. The Consumer Electronic Association predicted ...
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  • Pennsylvania Federal Judge Overturns Heinz Jury Verdict, Rules in Favor of Insurer & $25 Million Policy Rescission

    H.J. Heinz Co. v. Starr Surplus Lines Ins. Co. – 2:15-cv-00631 On the first of February, 2016, federal Judge Arthur J. Schwab of the Western District of Pennsylvania overruled a jury verdict and held that Starr Surplus Lines Insurance (“Starr”) can rescind a $25 million policy the insurer had issued to H.J. Heinz Co. (“Heinz”). The policy would have provided coverage damages resulting from ...
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  • Texas Supreme Court Revamps Decades of Texas Precedent, Holds Loss-of-Use Damages Recoverable in Cases of Total Loss to Property

    J&D Towing, LLC v. Am. Alternative Ins. Company Corp. – No. 14-057 Shortly after the New Year, the Texas Supreme Court issued a significant opinion for the Texas insurance community in J&D Towing, LLC v. American Alternative Insurance Corporation, 2016 WL 91201 (Tex. Jan. 8, 2016) . The Court’s opinion overrules over 60 years of contrary, although inconsistent, Texas case law. Specifically, Texas’ ...
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