Law Commons^™

Managed Care’S Crimea: Medical Necessity, Therapeutic Benefit, And The Goals Of Administrative Process In Health Insurance, William M. Sage

Faculty Scholarship

This Essay explores the concept of medical necessity as it has evolved in the judicial and administrative oversight of managed care. The goals of the Essay are to illustrate the range of plausible rationales for establishing administrative procedures to govern medical necessity disputes, and to demonstrate the difficulty of incorporating into those procedures the most important professional and social responsibilities of managed care in today’s health care system. Part I of the Essay explains the ideological and practical significance of medical necessity as managed care has evolved. Part II examines medical necessity as a legal problem, and questions whether current …

Insuring Against Terrorism And Crime, Saul Levmore, Kyle D. Logue

Law & Economics Working Papers Archive: 2003-2009

The attacks of September 11th produced staggering losses of life and property. They also brought forth substantial private insurance payouts, as well as federal relief for the City of New York and for the families of individuals who perished on that day. The losses suffered in and after the attacks, and the structure of the relief effort, have raised questions about the availability of insurance against terrorism, the role of government in providing for, subsidizing, or ensuring the presence of such insurance, and the interaction between relief and the incentives for future precaution taking. In response to such losses, and …

A Policy Overview, Stephen Utz

Faculty Articles and Papers

No abstract provided.

Holding Liability Insurers Accountable For Bad Faith Litigation Tactics With The Tort Of Abuse Of Process, Francis J. Mootz Iii

McGeorge School of Law Scholarly Articles

No abstract provided.

Obtaining Attorney Fees In Actions Against Insurers, Greg Munro

Faculty Journal Articles & Other Writings

This article reviews the law regarding awards of attorney fees in cases against insurance companies by insurance consumers or third-party claimants as developed by the Montana Supreme Court. The article outlines the Court's significant remedial body of law that can be used to obtain attorney fees and costs in cases where civil litigation has been necessary to secure the insurance benefit. The article concludes that the continued development of the remedy of attorney fees in such cases will help resolve the problem of insurers denying claims based on the simple economics of saving money by failing to pay claims and …

Exposing "Illusory" Underinsured Motorist Coverage, Greg Munro

Faculty Journal Articles & Other Writings

This article addresses auto insurers that use the "narrow" Underinsured Motorist Vehicle definition and couples it with a "reducing clause." The article discusses the conflict between what the declarations page promises and the UIM benefit the policy will actually pay and argues that the definition and reducing clause violate the consumer's expectations and defeat the very purpose of UIM coverage causing an injustice to the insured who has been prudent enough to purchase UIM coverage to guard against the tortfeasor who carries minimum limits. The article urges attorneys to persuade the courts in Montana to invalidate the narrow definition and …

Is Civil Authority Business Interruption Coverage A Soft Risk In The Post-9/11 World, Robert H. Jerry Ii

Faculty Publications

Tthe question whether 9/11 has changed the insurance world cannot be answered simply In some respects, nothing is different, but it is difficult to be sanguine about this assessment. Terrorism is less predictable in terms of magnitude and frequency of loss, and this raises doubts about the capacity of the industry with respect to future events. Until the uncertainty with respect to the terrorism risk abates and markets stabilize, problems of cost and availability will persist. This, of course, has been true in other insurance sectors in the past, and temporary dislocations do not necessarily justify government intervention. If, however, …

Obtaining Separate Limits Of Auto Coverage For Each "Occurrence" Or "Accident", Greg Munro

Faculty Journal Articles & Other Writings

This article examines the issue of what constitutes an "accident" or "occurrence" in auto liability policies that limit the insurer's liability for indemnity, defense, or other benefits to a set amount per "accident" or "occurrence." The article reviews a selection of cases from other jurisdictions because there is little Montana law delineating single "accidents" or "occurrences" for purposes of auto insurance. The article concludes with a list of factors that may be determinative and should be argued on the issue of whether there are multiple "accidents" or "occurrences" for purposes of triggering additional limits of auto insurance coverage.

Which Chance Was Lost?, Jonathan Koehler

Faculty Working Papers

The loss of chance doctrine in medical malpractice cases holds that when a doctor is responsible for reducing a patient's chance of survival by some percentage, the patient (or the patient's estate) should be compensated by the doctor for that percentage loss. Compensation is often determined by multiplying the value of a patient's life by the lost chance. This paper investigates psychological factors that my affect a legal decision maker's evaluation of damage awards in loss of chance cases. A paper and pencil experiment and a large-scale mock jury study (the latter using videotaped trials) are conducted to investigate the …

Holding Liability Insurers Accountable For Bad Faith Litigation Tactics With The Tort Of Abuse Of Process, Francis J. Mootz Iii

Scholarly Works

Liability insurers generally do not owe any common law duties to injured third-party claimants who sue their insureds. After establishing (as a conceptual backdrop) the important and recognized public policies favoring prompt and fair payments by liability insurers to injured third-party claimants, this article analyzes whether claimants can effectively use the tort of abuse of process to hold liability insurers accountable when they engage in bad faith litigation tactics. The article identifies the problems that claimants may face in alleging abuse of process in the liability insurance setting, but also indicates that recent trends in this area of law suggest …

Containing The Promise Of Insurance: Adverse Selection And Risk Classification, Tom Baker

All Faculty Scholarship

Insurance law, risk pools, adverse selection

The Antitrust Implications Of Collaborative Standard Setting By Insurers Regarding The Use Of Genetic Information In Life Insurance Underwriting, Robert H. Jerry Ii

Faculty Publications

The discussion in this Article is divided into four parts. Part I summarizes the landscape, past and present, with respect to insurer collaboration in underwriting. Part II considers whether, absent an antitrust exemption, multiinsurer agreements and collaborative insurer standard-setting with respect to underwriting violate federal antitrust law. This Part also evaluates whether insurers, to the extent potential federal liability exists, enjoy any kind of statutory or judicial exemption from federal law for such activities. Part III considers the same questions addressed in Part II but in the context of state antitrust laws. Because antitrust law, including the law of antitrust …

Insurance, Terrorism, And 9/11, Robert H. Jerry Ii

Faculty Publications

The question of whether 9/11 has changed the insurance world cannot be answered simply. In some respects, nothing is different, but it is difficult to be sanguine about this assessment. Terrorism is less predictable in terms of magnitude and frequency of loss, and this raises doubts about the capacity of the industry with respect to future events. Until the uncertainty with respect to the terrorism risk abates and markets stabilize, problems of cost and availability will persist. This, of course, has been true in other insurance sectors in the past, and temporary dislocations do not necessarily justify government intervention. If, …

The Antitrust Implications Of Collaborative Standard Setting By Insurers Regarding The Use Of Genetic Information In Life Insurance Underwriting, Robert H. Jerry Ii

UF Law Faculty Publications

Whenever two or more market participants collaborate to restrain trade, the potential applicability of federal and state antitrust laws must be considered. When the collaborating parties are insurance companies, a further layer of analysis may be necessary to determine whether the activity is exempt from federal antitrust regulation. Even if the activity enjoys an exemption, state antitrust law may have different things to say about the activity. Embedded in each of these levels of analysis are many difficult and complex subsidiary questions. In short, the law of insurance antitrust is not a subject for the faint of heart.

Antitrust law …

Redistributing Optimally: Of Tax Rules, Legal Rules, And Insurance, Kyle D. Logue, Ronen Avraham

Articles

From the beginning of the law and economics movement, normative legal economists have focused almost exclusively on evaluating the efficiency of alternative legal rules. The distributional consequences of legal rules, therefore, have largely been ignored. It is tempting to conclude that legal economists are hostile or indifferent to concerns of distributional fairness. In fact, however, the discipline of economics has a great deal to say about distributional policy. The normative branch of economics, known as welfare economics, has always been deeply concerned with distributional issues. It is not that welfare economists purport to know a priori the "right" or "optimal" …

Insuring Against Terrorism -- And Crime, Saul Levmore, Kyle D. Logue

Articles

The attacks of September 11th produced staggering losses of life and property. They also brought forth substantial private-insurance payouts, as well as federal relief for the City of New York and for the families of individuals who perished on that day. The losses suffered during and after the attacks, and the structure of the relief effort, have raised questions about the availability of insurance against terrorism, the role of government in providing for, subsidizing, or ensuring the presence of such insurance, as well as the interaction between relief and the incentives for taking precautions against similar losses in the future. …

The Genie And The Bottle: Collateral Sources Under The September 11th Victim Compensation Fund, Kenneth S. Abraham, Kyle D. Logue

Articles

The September 11th Victim Compensation Fund of 2001 (the Fund) was part of legislation enacted just eleven days after the terrorist attacks of September 11th in the wake of extraordinary national loss. It is possible, therefore, that the Fund will always be considered an urgent and unique response to the unprecedented events of September 11th. On that view, the character of the Fund will have little longterm policy significance. It is equally possible, however, that the enactment of the Fund will prove to be a seminal moment in the history of tort and compensation law. The Fund adopts a new …