Insurance Law Commons^™

Health Insurance And The Undocumented Immigrant, Anja Diercks

Honors Theses

The purpose of this thesis is to perform a comparative analysis on how seven different countries (USA, South Africa, Germany, England, Canada, France and Singapore) organize their healthcare system to cope with the issue of undocumented immigrants and whether or not these systems in place were “fair.” The thesis will also explore the possible ways the United States could change to be more inclusive and fairer in the world of healthcare and health insurance for the undocumented immigrant. A study on what fairness means both in ethical and economical terms is done to suggest a new basis of a fair …

Following The Money: The Aca’S Fiscal-Political Economy And Lessons For Future Health Care Reform, William M. Sage, Timothy M. Westmoreland

Faculty Scholarship

It is no exaggeration to say that American health policy is frequently subordinated to budgetary policies and procedures. The Affordable Care Act (ACA) was undeniably ambitious, reaching health care services and underlying health as well as health insurance. Yet fiscal politics determined the ACA’s design and guided its implementation, as well as sometimes assisting and sometimes constraining efforts to repeal or replace it. In particular, the ACA’s vulnerability to litigation has been the price its drafters paid in exchange for fiscal-political acceptability. Future health care reformers should consider whether the nation is well served by perpetuating such an artificial relationship …

Evidence Supporting The Value Of Surgical Procedures: Can We Do Better?, Christopher Robertson, Jonathan Darrow, Willard S. Kasoff

Faculty Scholarship

There is an acknowledged need for higher-quality evidence to quantify the benefit of surgical procedures, yet not enough has been done to improve the evidence base. This lack of evidence can prevent fully informed decision-making, lead to unnecessary or even harmful treatment, and contribute to wasteful expenditures of scare health care resources. Barriers to evidence generation include not only the long-recognized technical difficulties and ethical challenges of conducting randomized surgical trials, but also legal challenges that limit incentives to conduct surgical research as well as market-based challenges that make it difficult for those funding surgical research to recoup investment costs. …

Insurance, Maren R. Cave, Thomas D. Martin, Bradley S. Wolff

Mercer Law Review

During this Survey period, the courts in Georgia returned to the usual abundance of automobile and uninsured motorist (UM) cases, the summaries of which make up most of this annual update. The courts decided three cases involving UM coverage limits that were less than the policies’ liability limits and the claims of insureds that the carriers owed coverage equal to the liability limits. The insurers prevailed in all three cases. In a fourth case, the Georgia Court of Appeals determined that an insured could not sue a tortfeasor in the name of “John Doe,” where the person’s name was known …

“Waiving” Goodbye To Medicaid As We Know It: Modern State Attempts To Transform Medicaid Programs Through Section 1115 Waivers, Chandler Gray

Washington and Lee Law Review Online

This Note explores recent state efforts to reshape their respective Medicaid programs through Section 1115 waivers. Specifically, this Note looks at states that wish to convert their Medicaid program to a block grant through Section 1115 waivers. Examining the lawfulness of these waivers requires analyzing the language and application of both the Medicaid Act and the Administrative Procedure Act. This Note argues that any use of Section 1115 waivers to implement a block grant program would be a violation of the Medicaid Act and thus unlawful. Further, federal approval of such programs would be deemed arbitrary and capricious. To justify …

Notpetya, Not Warfare: Rethinking The Insurance War Exclusion In The Context Of International Cyberattacks, Katherine S. Wan

Washington Law Review

When an insurer wants to avoid coverage of a specific type of loss, it must explicitly exclude the loss in its policy. The war exclusion is a typical exclusion found in insurance policies that excuses insurers from covering losses caused by war or warlike actions. Courts interpreting the exclusion have traditionally held that war must consist of hostilities between sovereign nations. Despite the rise of state-sponsored cyberattacks, the United States has been hesitant to officially declare war in response. Even still, insurers argue that their war exclusions should apply to these new cyber losses. Courts are now tasked with reanalyzing …

Table Of Contents, Seattle University Law Review

Seattle University Law Review

Table of Contents

Private Insurance Limits And Responses, Elizabeth Weeks

Scholarly Works

The COVID-19 pandemic exposed a number of existing flaws in the United States’ patchwork approach to paying for and providing access to medical care. Shelter-in-place orders, social distancing, and other public health strategies employed to address the pandemic spawned a global recession, causing rapid and high unemployment rates in many countries. The U.S. unemployment rate peaked in April 2020 at 14.7%, higher than in any previous period since World War II. The United States has long hewed an anachronistic policy of relying heavily on private employers to provide health insurance to a substantial portion of the population. Those who are …

Which Law Is Supreme? The Interplay Between The New York Convention And The Mccarran-Ferguson Act, Brian A. Briz, César Mejía-Dueñas

University of Miami Law Review

The McCarran-Ferguson Act was enacted in 1945 to safeguard the rights of the states to regulate the business of insurance. It provides that acts of Congress not specifically related to the business of insurance are superseded by state laws that regulate the business of insurance. In 1970, the United States ratified the Convention on the Recognition and Enforcement of Foreign Arbitral Awards (the New York Convention). Congress enacted Chapter 2 of the Federal Arbitration Act to implement the New York Convention. The New York Convention requires courts to recognize and enforce both private agreements to arbitrate and arbitration awards made …

Saving Small Business From The Big Impact Of Data Breach: A Tiered Federal Approach To Data Protection Law, Nadia Udeshi

Brooklyn Journal of Corporate, Financial & Commercial Law

Small businesses provide a significant positive impact on the American economy. However, the current fragmented federal and state data protection and breach notification legal scheme puts the viability of small businesses at risk. While the probability of data breaches occurring continues to increase, small businesses lack the financial and technological resources to contend with the various state and federal laws that impose different monetary penalties and remedial requirements in the event of such breaches. To preserve the viability of small businesses, Congress should enact a centralized, multi-tiered federal data protection and breach notification framework that preempts state laws, imposes minimum …

Reflections On Covid-19, Insurance, Business Interruption, Systemic Risk, And The Future, Robert H. Jerry Ii

Faculty Publications

The COVID-19 pandemic is a major loss event for the insurance industry. This chapter begins with an overview of the pandemic’s most significant insurance implications. Because business interruption has been the most prominently discussed of these impacts, the second part of this chapter takes a closer look at business interruption insurance. This part describes how markets for this coverage are structured in the U.S., and then undertakes a detailed analysis of one of the most common business interruption policy forms, demonstrating that some aspects of this form, insofar as pandemic-caused business interruption is concerned, were not drafted with utmost precision. …

Investigating Healthcare Fraud: Its Scope, Applicable Laws, And Regulations, Nicole Forbes Stowell, Carl Pacini, Nathan Wadlinger, Jaqueline M. Crain, Martina Schmidt

William & Mary Business Law Review

Healthcare costs are not only an enormous strain on the U.S. economy but are expected to increase in the foreseeable future. Not surprisingly, clever fraudsters view the healthcare industry as a lucrative and attractive hotspot for illegal activity. Although federal and state governments have increased their funding and prosecution efforts relating to healthcare fraud, this fraud continues to be a major threat to the U.S. economy and every patient and consumer. The impact of healthcare fraud is substantial and far-reaching. Healthcare fraud in the U.S. affects not only the government, but also insurance companies, patients, healthcare providers, and consumers. This …

States Should Quickly Reform Unemployment Insurance, Brian Galle, David Gamage, Erin Scharff, Darien Shanske

Articles by Maurer Faculty

COVID-19 is causing mass layoffs and related economic hardship, as well as budget crises for state and local governments. This article is part of Project SAFE (State Action in Fiscal Emergencies), an academic effort to help states weather the fiscal crisis by providing policy recommendations backed by research. This article will focus on how state governments should reform unemployment insurance (UI) eligibility and benefits and the taxes funding these programs.

Workplace Wellness Programs: Empirical Doubt, Legal Ambiguity, And Conceptual Confusion, Camila Strassle, Benjamin E. Berkman

William & Mary Law Review

Federal laws that protect workers from insurance discrimination and infringement of health privacy include exceptions for wellness programs that are “voluntary” and “reasonably designed” to improve health. Initially, these exceptions were intended to give employers the flexibility to create innovative wellness programs that would appeal to workers, increase productivity, and protect the workforce from preventable health conditions.

Yet a detailed look at the scientific literature reveals that wellness program efficacy is quite disputed, and even highly touted examples of program success have been shown to be unreliable. Meanwhile, the latest administrative regulations on wellness programs were vacated by a district …

Comprehensive General Liability Policies Under Maine's Ground Water Protection Act: The Law Court's Extraordinary Definition Of Ordinary Intelligence, Andrew M. Strongin

Maine Law Review

In Patrons Oxford Mutual Insurance Co. v. Marios, the Supreme Judicial Court of Maine, sitting as the Law Court, joined the current debate in the state and federal judiciaries as to whether comprehensive general liability (CGL) insurance policies obligate the insurer to indemnify the insured for cleanup costs incurred pursuant to governmentally mandated cleanup of hazardous substances. In that decision, the court held that cleanup costs incurred pursuant to court order authorized by the Maine Underground Oil Storage Facilities and Ground Water Protection Act are not covered by such policies. The explicit basis of the court's decision was that the …

Comprehensive General Liability Policies Under Maine's Ground Water Protection Act: The Law Court's Extraordinary Definition Of Ordinary Intelligence, Andrew M. Strongin

Maine Law Review

In Patrons Oxford Mutual Insurance Co. v. Marios, the Supreme Judicial Court of Maine, sitting as the Law Court, joined the current debate in the state and federal judiciaries as to whether comprehensive general liability (CGL) insurance policies obligate the insurer to indemnify the insured for cleanup costs incurred pursuant to governmentally mandated cleanup of hazardous substances. In that decision, the court held that cleanup costs incurred pursuant to court order authorized by the Maine Underground Oil Storage Facilities and Ground Water Protection Act are not covered by such policies. The explicit basis of the court's decision was that the …

Telemedicine And Malpractice: Creating Uniformity At The National Level, Tyler D. Wolf

William & Mary Law Review

Picture this: an elderly gentleman living alone, isolated in a rural, midwestern locale. One day, this elderly gentleman awakes to find a distinct rash forming on his chest. The nearest doctor capable of performing an examination is located over a hundred miles away, and this man has not driven more than ten miles in twenty years. Shambling into his living room, the elderly man logs onto his computer and begins typing. Within twenty minutes he is videoconferencing with a doctor who examines the rash remotely and makes a diagnosis.

Through advances in telemedicine, the scenario described above is becoming an …

Reflections On The Effects Of Federalism On Opioid Policy, Matthew B. Lawrence

Dickinson Law Review (2017-Present)

No abstract provided.

Mhpaea & Marble Cake: Parity & The Forgotten Frame Of Federalism, Taleed El-Sabawi

Dickinson Law Review (2017-Present)

No abstract provided.

The Cost Of Legal Restrictions On Experience Rating, Levon Barseghyan, Francesca Molinari, Darcy Steeg Morris, Joshua C. Teitelbaum

Georgetown Law Faculty Publications and Other Works

We investigate the cost of legal restrictions on experience rating in auto and home insurance. The cost is an opportunity cost as experience rating can mitigate the problems associated with unobserved heterogeneity in claim risk, including mispriced coverage and resulting demand distortions. We assess this cost through a counterfactual analysis in which we explore how risk predictions, premiums, and demand in home insurance and two lines of auto insurance would respond to unrestricted multiline experience rating. Using claims data from a large sample of households, we first estimate the variance-covariance matrix of unobserved heterogeneity in claim risk. We then show …

The Paradox Of Insurance, Gideon Parchomovsky, Peter Siegelman

All Faculty Scholarship

In this Article, we uncover a paradoxical phenomenon that has hitherto largely escaped the attention of legal scholars and economists, yet it has far-reaching implications for insurance law: loss-creation by uninsured parties caused by the presence of insurance. Contrary to the conventional wisdom, we show that insurance can create significant negative externalities by inducing third parties to engage in antisocial, illegal and unethical activities in order to extract money from insureds or insurers. Moreover, as the amount and scope of insurance grows, so does its distortionary effect on third parties. We term this phenomenon the paradox of insurance. The risk …

The Current System Of Resolving Insurance Disputes In Saudi Arabia: Its Weaknesses And Ways Of Developing It, Saleh Alsheha

Maurer Theses and Dissertations

Insurance industry generally revolves around financial risks, and the business of insurance companies is reliant on the resolution of claims that arise from these risks associated with insurance policies. In fact, insurance companies routinely adjust claims and provide indemnities to the insureds or beneficiaries. In some cases, however, the resolution of claims may falter, resulting in disputes that involve conflicting views between the insurer and insured on the eligibility of indemnity. Hence, this requires the existence of an effective and smooth mechanism that guarantees the end of such conflicts and protects the rights of the parties involved in insurance contracts. …

Private Equity Value Creation In Finance: Evidence From Life Insurance, Divya Kirti, Natasha Sarin

All Faculty Scholarship

This paper studies how private equity buyouts create value in the insurance industry, where decentralized regulation creates opportunities for aggressive tax and capital management. Using novel data on 57 large private equity deals in the insurance industry, we show that buyouts create value by decreasing insurers' tax liabilities; and by reaching-for-yield: PE firms tilt their subsidiaries' bond portfolios toward junk bonds while avoiding corresponding capital charges. Previous work on affiliated or "shadow" reinsurance and capital management misses the important role that private equity buyouts play as recent drivers of these phenomenon. The trend we document is of growing importance in …

Forum Shopping Covid-19 Business Interruption Insurance Claims, Chris French

Journal Articles

Insurance disputes are typically governed by state law, and state insurance laws vary considerably, with some states being favorable to policyholders and others being unfavorable. With forum shopping, a plaintiff often has many choices regarding where it can bring a lawsuit, including multiple states in which to bring the case and whether to bring the case in federal or state court. Of the over 1000 COVID-19 business interruption insurance lawsuits filed thus far, more than 700 of them have been filed in, or removed to, federal court, with more than 250 of the cases filed as class actions. Many of …

America On Fire: Climate Change, Wildfires & Insuring Natural Catastrophes, Christopher French

Journal Articles

America is on fire. The damage, destruction, and loss of life caused by wildfires have exploded over the past few decades. Nine of the ten worst fire seasons have occurred in the past fifteen years, with 2017 and 2018 being the worst years ever. Despite spending approximately $3.7 billion annually on fire suppression, more than 35,000 structures were lost to wildfires in 2017 and 2018, approximately $32 billion in property losses occurred, and more than 100 people were killed. More than forty million homes worth approximately $187 billion in the U.S. are currently at a high risk of destruction due …

Cyber Insurance Today: Saving It Before It Needs Saving, Angela Nieves

Catholic University Journal of Law and Technology

Cyber insurance, which covers a company’s losses and costs stemming from a cyberattack, represents a nearly $5 billion global market. But have stakeholders shaped a sustainable model? This article analyzes contrasting claims about the viability of cyber insurance. It proposes measures to ensure the survival of the cyber insurance market, which should be immediately addressed given the current state of the world and the fact that even pre-COVID-19, businesses worldwide stood to lose over $5.2 trillion over the next five years due to cybercrimes. Unless action is taken to mitigate the fallout from cyber events, the cyber insurance market will …

Bacon Construction Co. V. Arbella Protection Insurance Co., 208 A.3d 595 (R.I. 2019), Lucas A. Sylvia

Roger Williams University Law Review

No abstract provided.

Shook: Litigation, Regulation, And Legislation Strategies To Better Protect Oklahoma’S Earthquake Insurance Policyholders, Nick A. Marr

Oklahoma Law Review

No abstract provided.

Insurance Law, J. Price Collins, Janet Tolbert, Ashley Gilmore

SMU Annual Texas Survey

No abstract provided.

Trust, Contribution And Equitable Accounting: Analysing Imbalances In Contribution Towards Mortgage Payments, Sing Yong Lim, Hang Wu Tang

Research Collection Yong Pung How School Of Law

A frequently litigated issue across the Commonwealth is determining the beneficial interest of property in light of a breakdown of close relationships such as domestic relationships or family members or friends who may have jointly bought property together. These cases are frequently complicated by the fact that there may be imbalances in contributions of the mortgage repayments by one party. How are parties’ beneficial entitlement determined using legal or equitable doctrines? Unfortunately, the current case law has not been entirely clear and judges have used a myriad of doctrines in relation to such a fact pattern which has resulted in …