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Full-Text Articles in Insurance Law
Health Care Fraud Means Never Having To Say You're Sorry, Jacob T. Elberg
Health Care Fraud Means Never Having To Say You're Sorry, Jacob T. Elberg
Washington Law Review
For decades, the Department of Justice (DOJ) has issued a steady flood of press releases announcing False Claims Act (FCA) settlements against health care entities and extolling the purportedly sharp message sent to the industry through these settlements about the consequences of engaging in wrongdoing. The FCA is the primary mechanism for government enforcement against health care entities engaged in wrongdoing, and it is expected to be DOJ’s key tool for addressing fraud arising out of government programs in response to the COVID-19 pandemic. DOJ has pointed to three key goals of its enforcement efforts (deterrence, incentivizing cooperation, and building …
Notpetya, Not Warfare: Rethinking The Insurance War Exclusion In The Context Of International Cyberattacks, Katherine S. Wan
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 …
Does Small Group Health Insurance Deliver Group Benefits? An Argument In Favor Of Allowing The Small Group Market To Die, John Aloysius Cogan Jr.
Does Small Group Health Insurance Deliver Group Benefits? An Argument In Favor Of Allowing The Small Group Market To Die, John Aloysius Cogan Jr.
Washington Law Review
The small group health insurance market is failing. Today, fewer than one-third of small firms now offer health insurance and the number of people covered by small group insurance continues to drop. These problems invite the obvious question: What should be done about the small group market? Past scholarship on the small group market has largely focused on documenting the market’s problems, evaluating the effectiveness of prior reform efforts, and proposing regulatory changes to stabilize the market. This Article takes a different approach to the small group problem by asking a previously unasked question: Does the small group market deliver …
"A Nuanced Approach": How Washington Courts Should Apply The Filed Rate Doctrine, Kaleigh Powell
"A Nuanced Approach": How Washington Courts Should Apply The Filed Rate Doctrine, Kaleigh Powell
Washington Law Review
As of 2015, the vast majority of the American public had some form of health insurance, mostly provided by private companies. While some customers might, at some point, contemplate suing their insurance provider—for breach of contract, consumer protection statute violation, or some other cause—these potential plaintiffs are not likely to get far in many cases. The reason is the little-known “filed rate doctrine,” a court-created rule that bars lawsuits against many agency-regulated entities. The filed rate doctrine is based on the fact that many states, including Washington, require health insurers to file their rates with a regulatory agency—and have those …
Slayers And Soldiers: The Validity And Scope Of The Slayer's Rule Under The Family Servicemembers' Group Life Insurance Act, Rebecca Blasco
Slayers And Soldiers: The Validity And Scope Of The Slayer's Rule Under The Family Servicemembers' Group Life Insurance Act, Rebecca Blasco
Washington Law Review
The "slayer's rule"—a common law doctrine—precludes a murderer from financially benefiting from the victim's death by denying him or her the right to proceeds from the victim's life insurance policy. Some jurisdictions have extended this rule to disqualify the slayer's exclusive family members from receiving the victim's insurance proceeds as beneficiaries. Exclusive family members are those either not related to the victim or related to the victim only by marriage. The slayer's rule applies to federal group life insurance policies, such as the Servicemembers' Group Life Insurance Act (SGLI), which provides life insurance to servicemembers. Spouses and dependent children of …
First Things First: Federal Courts Should Determine The Legal Status Of Lloyd's Of London Syndicate Before Deciding The Syndicate's Citizenship For Diversity Purposes, John M. Brust
Washington Law Review
Lloyd's of London provides a marketplace where groups of underwriters form syndicates to insure risk. The United States Circuit Courts of Appeals have split on the question of how to determine whether a federal court has diversity jurisdiction over a controversy involving Lloyd's syndicates. In a diversity action, each party must have diverse citizenship from all opposing parties. Circuit courts disagree about which diversity of citizenship test applies to suits involving Lloyd's syndicates. The Second, Third, and Sixth Circuits have applied the real party in interest test. This test looks only to the citizenship of the parties that have a …
In The Litigation Business: Insurance Company Liability For Acts Occurring In The Course Of Litigation Under The Washington Consumer Protection Act, Kasey D. Huebner
In The Litigation Business: Insurance Company Liability For Acts Occurring In The Course Of Litigation Under The Washington Consumer Protection Act, Kasey D. Huebner
Washington Law Review
Insurance companies generally have much greater bargaining power and resources than individual insureds When a claim by an insured against an insurance company fails to settle amicably and is followed by a lawsuit, the insured has few options should the insurance company behave unfairly or deceptively in the course of the litigation. The Washington Consumer Protection Act protects consumers from deceptive and bad faith acts by businesses, including insurance companies Although Washington courts have created a general exception disallowing CPA suits for acts occurring in the course of litigation, Washington case law has not directly or clearly addressed whether this …
Strict Compliance With Marine Insurance Contracts: Conflicting Rules In The Ninth Circuit, Rhea D. Pappas-Ward
Strict Compliance With Marine Insurance Contracts: Conflicting Rules In The Ninth Circuit, Rhea D. Pappas-Ward
Washington Law Review
Under the federal admiralty "strict compliance rule," a policy of marine insurance is voided by an insured vessel owner's failure to comply with express policy terms or "warranties." Although recognized and applied by a majority of the federal circuits, the strict compliance rule has been improperly ignored by a handful of district courts within the Ninth Circuit. Instead, by misapplying the holding of Wilburn Boat v. Fireman's Fund Insurance Co., a 1955 Supreme Court case, and by ignoring the Ninth Circuit's interpretation of Wilburn Boat in Bohemia, Inc. v. Home Insurance Co., these district courts have turned to …
Washington's Judicial Invalidation Of Unambiguous Exclusion Clauses In Multiple Causation Insurance Cases, Lawrence Alan Wans
Washington's Judicial Invalidation Of Unambiguous Exclusion Clauses In Multiple Causation Insurance Cases, Lawrence Alan Wans
Washington Law Review
The Washington Supreme Court has restricted the use of unambiguous exclusion clauses that limit homeowners' insurance coverage in multiple causation cases. This Comment discusses the court's "proximate cause" analysis, judicial treatment of policy exclusions, and the insured's expectations of coverage. The Comment argues that the Washington approach to multiple causation cases should be narrowly construed in Washington and rejected in other jurisdictions, because its consequences may harm insurers and insureds alike.
Undefined Experimental Treatment Exclusions In Health Insurance Contracts: A Proposal For Judicial Response, Jennifer Belk
Undefined Experimental Treatment Exclusions In Health Insurance Contracts: A Proposal For Judicial Response, Jennifer Belk
Washington Law Review
Health insurance contracts often exclude coverage for experimental treatments. No accepted definition of experimental treatment exists, however, and insurance contracts rarely define the term. Although experimental treatment exclusions are necessary and desirable, insurers may easily manipulate undefined exclusions to exclude treatments on inappropriate bases such as cost. Thus, courts should construe the term "experimental" narrowly and find treatments non-experimental if there is any demonstrated likelihood of their success.
Discoverability Of An Insured's Post-Accident Statement To Insurer In Washington—Heidebrink V. Moriwaki, 104 Wn. 2d 392, 706 P.2d 212 (1985), Ronald S. Dinning
Discoverability Of An Insured's Post-Accident Statement To Insurer In Washington—Heidebrink V. Moriwaki, 104 Wn. 2d 392, 706 P.2d 212 (1985), Ronald S. Dinning
Washington Law Review
Courts have struggled, under both a privilege theory and pure work product doctrine analysis, with the difficulties of reconciling a broad discovery policy with the needs of an insured for confidentiality. Facing this difficulty, the Heidebrink court blurred the distinctions between privilege and work product immunity, potentially impeding the application of either. The Heidebrink court could have focused on the events triggering the insurance investigation, rather than on the insured-insurer relationship. This focus would provide meaningful guidance to lower courts, and would avoid undesirable consequences stemming from integration of privilege considerations with work product analysis.
Autopsy Of A Plain English Insurance Contract: Can Plain English Survive Proximate Cause?—Graham V. Public Employees Mut. Ins. Co., 98 Wn. 2d 533, 656 P.2d 1077 (1983), Lynn B. Squires
Washington Law Review
This Note first analyzes the majority's introduction of a tort concept of proximate cause for deciding insurance cases-and for covertly making public policy. Second, the Note analyzes the dissent's failure to modify its traditional contract analysis to meet the needs of consumers who purchase standard form contracts. The Note recommends the use of an adhesion contract analysis and a common sense test of causation for deciding consumer insurance cases. The Note considers the insurance industry's dilemma as it attempts to respond to plain language legislation while still controlling its exposure to liability. The Note considers as well the public in …
Washington's Underinsured Motorist Statute: Balancing The Interests Of Insurers And Insureds, Bertha Baranko Fitzer
Washington's Underinsured Motorist Statute: Balancing The Interests Of Insurers And Insureds, Bertha Baranko Fitzer
Washington Law Review
This comment will distinguish the uninsured/underinsured motorist problem and coverages, and will outline the 1980 amendment to Washington's uninsured motorist statute. The comment will then discuss some areas of the law likely to cause controversy and suggest resolutions to these issues. The proposed resolutions follow the approach taken by the legislature, balancing the conflicting interests of insureds and insurers.
Community And Separate Property Interests In Life Insurance Proceeds: The Risk Payment Doctrine In State Courts And Its Federal Estate Tax Consequences, James M. Higbee
Community And Separate Property Interests In Life Insurance Proceeds: The Risk Payment Doctrine In State Courts And Its Federal Estate Tax Consequences, James M. Higbee
Washington Law Review
This comment will first examine the decisions of the Louisiana, Texas, Arizona, Idaho, and New Mexico courts in which the risk payment doctrine has been approved for use with term insurance in order to determine how well established the doctrine is in each state. The status of the risk payment doctrine in state courts is important because "state property rules control the estate taxation of community property life insurance." The estate tax consequences of the risk payment doctrine will then be considered.
Community And Separate Property Interests In Life Insurance Proceeds: A Fresh Look, James M. Higbee
Community And Separate Property Interests In Life Insurance Proceeds: A Fresh Look, James M. Higbee
Washington Law Review
This comment examines the difficult problem of characterizing the proceeds of a life insurance policy as separate or community property where the policy insures the life of a spouse and premiums have been paid with both separate and community funds. The problem commonly arises when a person takes out a life insurance policy while single, pays the first few premiums from separate funds, and then maintains the policy with community funds following marriage. Upon death of the insured spouse, the characterization of the proceeds as separate or community or partially both is significant for two reasons. Not only may such …
Insurance—Disability Insurer's Refusal To Pay Gives Rise To Action In Tort—Fletcher V. Western National Life Insurance Co., 10 Cal. App. 3d 376, 89 Cal. Rptr. 78 (1970), Anon
Washington Law Review
Plaintiff suffered a totally disabling back injury in an industrial accident. His insurance policy with the defendant company provided for benefits of $150 per month for thirty years for total disability due to injury. But if the disability were due to sickness, the benefits were to continue for only two years. The defendant had received extensive medical information confirming the accidental cause of the disablement. To avoid full payment, however, it attempted to pay under the limited two-year sickness provision, then stopped payments altogether, fabricated a story about a previously existing condition and demanded return of the payments it had …
Group Insurance: Agency Characterization Of The Master Policy-Holder, Stephen K. Eugster
Group Insurance: Agency Characterization Of The Master Policy-Holder, Stephen K. Eugster
Washington Law Review
One of the major issues in connection with group life insurance is whether the master policy holder, the person who takes out the insurance, is the agent of the insurance company. This comment describes the general characteristics of group insurance and discusses the factors courts consider in finding an agency relationship between the master policyholder and the insurance company. Arguments are presented that the most equitable results are reached when the insurer is held responsible for the acts of the master policyholder under an agency theory.
Crisci's Dicta Of Strict Liability For Insurer's Failure To Settle: A Move Toward Rational Settlement Behavior, Jonathan A. Eddy
Crisci's Dicta Of Strict Liability For Insurer's Failure To Settle: A Move Toward Rational Settlement Behavior, Jonathan A. Eddy
Washington Law Review
This comment attempts to explore the interests of the insurer and insured under the insurance contract, to differentiate between different tests applied by the courts, and to determine what effect these different tests will have on insurer's conduct. Finally, the comment examines what courts have actually done in their process of defining insurer duties and presses for a more conscious exercise of their role in facilitating rational settlement behavior. Adoption of a rule of strict liability is advocated.
Crisci's Dicta Of Strict Liability For Insurer's Failure To Settle: A Move Toward Rational Settlement Behavior, Jonathan A. Eddy
Crisci's Dicta Of Strict Liability For Insurer's Failure To Settle: A Move Toward Rational Settlement Behavior, Jonathan A. Eddy
Washington Law Review
This comment attempts to explore the interests of the insurer and insured under the insurance contract, to differentiate between different tests applied by the courts, and to determine what effect these different tests will have on insurer's conduct. Finally, the comment examines what courts have actually done in their process of defining insurer duties and presses for a more conscious exercise of their role in facilitating rational settlement behavior. Adoption of a rule of strict liability is advocated.
Effect Of Conflicting "Other Insurance" Claims, Anon
Effect Of Conflicting "Other Insurance" Claims, Anon
Washington Law Review
Plaintiff was seriously injured when an automobile in which she was a passenger collided with another vehicle driven by an uninsured operator. Plaintiff's automobile insurance policy, issued by defendant, included coverage for bodily injury caused by uninsured motorists. Excluded from this coverage, however, was injury sustained in an automobile not owned by plaintiff, if the owner had "similar insurance" which was available to plaintiff. The owner of the automobile in which plaintiff was injured also carried insurance containing uninsured motorist coverage. His policy, written by another company, contained a pro rata clause restricting coverage to a proportionate share of the …
Limiting Language In Unpurchased Policy Provision Does Not Apply To Purchased Coverage, Anon
Limiting Language In Unpurchased Policy Provision Does Not Apply To Purchased Coverage, Anon
Washington Law Review
Plaintiff's truck was hit by a tree felled by a logging contractor's employee. The truck was insured by defendant insurance company against damage due to collision, but plaintiff had not purchased coverage under the comprehensive clause. Plaintiff brought an action against defendant insurer for the loss. Relying upon the language of the unpurchased comprehensive clause, the trial court held that defendant's liability did not include loss caused by falling objects. On appeal, a divided Montana Supreme Court reversed. Held: When an insured does not purchase one form of insurance coverage, the insurer may not deny liability on the basis that …
Some Aspects Of The Omnibus Clause, David C. Lycette
Some Aspects Of The Omnibus Clause, David C. Lycette
Washington Law Review
The presence of an omnibus clause in automobile insurance policies can be attributed to the highly competitive nature of the insurance industry. Basically, the omnibus clause is designed to give insurance coverage to an un-named person who is driving the policyholder's automobile with the latter's consent. A standard clause reads, With respect to the insurance for bodily injury liability and for property damages liability the unqualified word "insured" includes the named insured and also includes any person while using the automobile and any organization legally responsible for the use thereof, provided the actual use is by the named insured or …
Insurance, Robert L. Taylor
Insurance, Robert L. Taylor
Washington Law Review
Covers recent laws on credit life, accident, and health insurance and on life insurance.
Insurance, Thomas B. Grahn
Insurance, Robert L. Taylor
Insurance, Robert L. Taylor
Washington Law Review
Covers mutual insurers, standard valuation law, investments, title insurers, and unfair practices and fraud.
Insurance, David H. Olwell
Insurance, David H. Olwell
Washington Law Review
Covers cases on accidents—determination of the number of accidents in one mishap.
Insurance, Irwin L. Treiger
Insurance, Irwin L. Treiger
Washington Law Review
Covers cases on insurance—effect of a divorce decree.
Insurance, Vincent L. Gadbow
Insurance, Vincent L. Gadbow
Washington Law Review
Covers cases on collateral estoppel and scope of the prior adjudication of facts.
Community Property—Life Insurance, Dale Riveland
Community Property—Life Insurance, Dale Riveland
Washington Law Review
The insurer interpleaded the insured's daughter as named beneficiary and the insured's wife to determine which was entitled to the proceeds of a group life insurance contract paid from wages. The jury found that the deceased and his wife had agreed that the earnings of each should be separate property. Thus the verdict was for the daughter because the insured had complete ownership of the policy and could select any beneficiary he saw fit. Held on Appeal, reversed and remanded with instructions to enter judgment in favor of the wife. There was insufficient evidence to establish the alleged separate property …
Insurance—Conflict Of Interests—Bad Faith Of Insurer, Myron J. Carlson
Insurance—Conflict Of Interests—Bad Faith Of Insurer, Myron J. Carlson
Washington Law Review
P, the insured under a public liability insurance policy with D, had been sued by an injured party; one of the grounds alleged for recovery was expressly excepted by the terms of the policy. D insisted on its policy right to control the defense and also to withdraw and disclaim all liability if at the trial the loss was found to be outside the policy coverage. P objected to the reservation of rights by D, pointing out that it would be to D's interest at the trial to allow proof of the loss on grounds outside the policy coverage and …