Insurance Law Commons^™

Rejecting Word Worship: An Integrative Approach To Judicial Construction Of Insurance Policies, Jeffrey W. Stempel, Erik S. Knutsen

University of Cincinnati Law Review

Insurance coverage litigation is a quest for discerning meaning: Does the insurance policy cover the loss at issue? Construing the insurance policy, courts attempt to give legal effect to what the document purports to command. But what were the intentions and expectations of insurer and insured? Do those intentions even matter? Or is only the written text of the policy relevant to the coverage result? Courts addressing these questions typically frame the interpretative choice as one of strict textualism versus contextual functionalism.

In many, perhaps even most situations, text and context align to create an “easy” case. If a factory …

Health Insurance And Bankruptcy Risk: Examining The Impact Of The Affordable Care Act, Philip M. Pendergast, Michael D. Sousa, Tim Wadsworth

Brooklyn Law Review

The passage of the Patient Protection and Affordable Care Act (“ACA”) in 2010 represented a watershed moment for healthcare in the United States. As is well-noted, the federal courts are still wrangling over the constitutionality of the law, and there is significant uncertainty regarding the extent to which the ACA will survive these legal battles. Unquestionably, the ACA has expanded access to health insurance for many millions of Americans. Prior to the advent of the ACA, Medicaid income eligibility for adults without dependents was approximately 61 percent of the Federal Poverty Line. Empirical studies since the advent of the ACA …

The Patient Assistance Problem, Daniel O’Brien Lichtenauer

Journal of Law and Policy

Implemented in January 2006 as a voluntary enrollment supplement to standard Medicare plans, Medicare Part D coverage subsidizes the cost of prescription drugs for participants. However, significant gaps in coverage exist for those suffering from rare diseases that require costly drugs. Pharmaceutical companies seek to remove the powerful market force of patient price sensitivity by directly sponsoring or substantially funding “patient assistance programs” that help cover out-of-pocket costs. While pharmaceutical donors insist that their goal is strictly altruistic, the reality is that many of these programs offer a financial windfall for drug makers because they help funnel patients towards new …

Development Of A Topics Course For Construction Law, Julia C. Hoever

Construction Management

The Cal Poly Construction Management program is designed to prepare students heading into the construction industry for daily management tasks. With construction comes many legal aspects integrated into a project’s operations. Though the curriculum includes a contract law course, a gap exists with a minimal number of classes that address the array of legal matters the construction industry must be versed in. Working with faculty member, Thomas Kommer, J.D., there is a need for a course that expands on these varying legal topics. In order to determine the specific topics that would impactfully benefit and educate Cal Poly Construction Management …

What The Pandemic Taught Us: The Health Care System We Have Is Not The System We Hoped We Had, William M. Sage

Faculty Scholarship

The United States spends nearly twice as much per capita on medical care as any other country. The United States has the world’s most advanced biomedical technologies, sophisticated hospitals, and skilled health professionals. The United States has a national public health body, the Centers for Disease Control and Prevention (CDC), that is generally considered the world’s leader in infectious disease detection and response. Nonetheless, the United States suffered among the world’s worst COVID-19 disease burdens and outcomes, inflicting largely avoidable harm on patients, health professionals, and the broader community.

Why this happened is clearly important. But that it happened is …

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

Mercer Law Review

During this Survey period, the courts in Georgia remained active despite the pandemic. In the property arena, the Survey disclosed only a few decisions from the Georgia Court of Appeals but several from the district courts in Georgia as parties grappled with coverage disputes relating to policy time limits, bad faith, and the effects of COVID-19 on business losses. In the automobile arena, the Georgia Court of Appeals addressed sovereign immunity, and the Georgia Supreme Court refined the “cause test” for evaluating a series of collisions. In the uninsured motorist (UM) arena, the court of appeals weighed in on various …

Proof Of Objective Falsehood: Liability Under The False Claims Act For Hospice Providers, Sebastian West

University of Cincinnati Law Review

No abstract provided.

Insuring The "Uninsurable": Business Interruption Insurance Coverage & Covid-19, Natalie E. Delatour

Georgia State University Law Review

The COVID-19 pandemic has impacted virtually every facet of life in the United States, including the insurance industry. In particular, the number of business interruption insurance coverage lawsuits has continued to climb since March 2020, as insurers are denying coverage for pandemic-related losses and policyholders are seeking indemnification. Courts across the country are faced with answering difficult, novel questions about the interpretation and scope of business interruption insurance policies. Collectively, the conclusions the courts reach are critically important because they will determine the fate of policyholders and the insurance industry, respectively. This Note explores business interruption insurance coverage during COVID-19 …

Call For Action: Provinces And Territories Must Protect Our Genetic Information, Leah Hutt, Elaine Gibson, Erin Kennedy

Dalhousie Law Journal

The Genetic Non-Discrimination Act (GNDA), passed by Parliament in 2017, seeks to protect Canadians’ genetic information. The GNDA establishes certain criminal prohibitions to the use of genetic information and also amends federal employment and human rights legislation to protect against genetic discrimination. However, we argue that the GNDA alone is insufficient to protect Canadians given constitutional limitations on the powers of the federal government. Areas of profound importance relating to genetic discrimination are governed by the provinces and territories. We identify three key areas of provincial/territorial jurisdiction relevant to protection against genetic discrimination and outline the applicable legislative environments. We …

The Case For Banning (And Mandating) Ransomware Insurance, Kyle D. Logue, Adam B. Shniderman

Law & Economics Working Papers

Ransomware attacks are becoming increasingly pervasive and disruptive. Not only are they shutting down (or at least “holding up”) businesses and local governments all around the country, they are disrupting institutions in many sectors of the U.S. economy — from school systems, to medical facilities, to critical elements of the U.S. energy infrastructure as well as the food supply chain. Ransomware attacks are also growing more frequent and the ransom demands more exorbitant. Those ransom payments are increasingly being covered by insurance. That insurance offers coverage for a variety of cyber-related losses, including many of the costs arising out of …

Legal Evaluation Of The Regulation Of The Unified Motor Vehicle Insurance Policy: A Comparative Study, Dr. Issa Ghassan Al-Rabdi

UAEU Law Journal

The need Settlement of disputes arising from bank credit between national and Vehicle accidents pose a great danger to people's lives and property, which is why, decades ago, the United Arab Emirates turned towards the path followed by the vast majority of Arab and foreign countries, which is the regulation of compulsory insurance on the civil liability of vehicle accidents.

The Board of Directors of the Insurance Authority issued the unified vehicle insurance policy issued under the system of unification of vehicle insurance policies under Resolution No. (25) Of 2016. This document is a legal system, amending Ministerial Resolution No. …

Law School News: Rwu Law Acquires Top Marine Law Journal 08-19-2021, Michael M. Bowden

Life of the Law School (1993- )

No abstract provided.

Frivolous Defenses, Thomas D. Russell

Cleveland State Law Review

This Article is about civil procedure, torts, insurance, litigation, and professional ethics. The Article is the opening article in a conversation with Stanford Law Professor Nora Freeman Engstrom, who has written about the plaintiffs’ bar and settlement mill attorneys. The empirical center of this piece examines 356 answers to 298 car crash personal injury cases in Colorado’s district courts. The Article situates these cases within dispute pyramid elements, including the total number of miles-traveled within Colorado and the volume of civil litigation. The Article then analyzes the defense attorneys’ departures from the Colorado Rules of Civil Procedure, especially Rule 8. …

Business Interruption Insurance In The Time Of Covid-19: Who Should Foot The Bill?, Paul Mchugh

Journal of Law and Policy

COVID-19-related business closures led to thousands of business interruption insurance claims and lawsuits across the country. However, throughout the history of business interruption policies, obstacles such as virus exclusions and “physical damage” requirements have been added in response to prior pandemics and catastrophic losses. These exclusions and requirements have led to many hurdles and outright denials for those seeking payment on their policies. So, then, can business owners still find some economic refuge in these policies? Despite outright denials in many courts, at least a handful of federal judges as well as a number of members of Congress seem to …

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 …

Predictors Of Fraudulent Monday Effect Workers Compensation Claims Filing, Sharla St. Rose

FIU Electronic Theses and Dissertations

Monday Effect Claims refer to workers compensation claims filed on Mondays for easy to conceal injuries such as strains, sprains, and back injuries. Researchers and industry experts have long believed that there is an element of fraud in these claims, resulting from individuals who were injured during the weekend, while not at work, looking to take advantage of the medical benefits available through workers compensation insurance. Fraudulent Monday Effect Claims (FMEC), as presented in this study, specifically refer to workers compensation claims filed for injuries that occurred while an individual was not at work, presumably during the weekend.

A study …

Making A Declaration: The Rise Of Declaratory Judgment Actions And The Insurer As Regulator In The Fight To End Sex Trafficking In The Hotel Industry, Lori N. Ross

Loyola of Los Angeles Law Review

“Let it not be said that I was silent when they needed me.”

– William Wilberforce

Potential For Unseaworthiness Claims Based On Covid-19 Transmission, Blaine Payer, Read Porter

Sea Grant Law Fellow Publications

No abstract provided.

Appraising Problems, Not Stuff, Chad J. Pomeroy

St. Mary's Law Journal

Abstract forthcoming.

070— Mental Health Parity: What It Is And Why It Matters, Lauren Klein

GREAT Day Posters

While stigma around mental health, as well as treatment options have been drastically improved within the last decade, people who need help still are not getting it. The ultimate issue is the lack of mental health parity, which is defined by the equal treatment and benefits of other health conditions in insurance plans. Benefits such as inpatient in-network & out-of-network, co-pays, deductibles, max limit for out of pocket costs, reimbursement rates, geographic care, and coverage for any type of hospitalization. The lack of these advantages force people into difficult situations in order to receive these services. Paying abundant amounts of …

Hard Battles Over Soft Law: The Troubling Implications Of Insurance Industry Attacks On The American Law Institute Restatement Of The Law Of Liability Insurance, Jeffrey W. Stempel

Cleveland State Law Review

ALI Restatements of the Law have traditionally exerted significant influence over court decisions and the development of the common law. During the past two decades, however, the ALI has seen an upsurge in interest group activity designed to shape or even thwart aspects of the Institute’s work. Most recently, the Restatement of the Law of Liability Insurance (RLLI) has been the focus of not only criticism of particular provisions but a concerted effort by members of the insurance industry to demonize the project as a whole and bar use of the document by courts.

The vehemence of insurer opposition seems …

"Sudden And Accidental" Pollution Exclusions: The Battle Between Insurance Carriers And Insureds Continues, Penny R. Warren

Journal of Natural Resources & Environmental Law

No abstract provided.

Views On The Position Of The Contemporary Islamic Jurisprudence On The Question Of Insurance B Y Prof. Mustafa El-Gammel

UAEU Law Journal

This article analyzes and evaluates the positions of the contemporary Islamic jurisprudence regarding the question of insurance. The practice in this respect is to present the views of those who consider insurance as a legitimate activity, and the views of those who consider it as illegal one, and deal with the arguments and replies offered in support of such views. This article, however, has adopted a different approach, based on tracing or examining the fundamental. Conceptions from which the different positions on insurance flow, and evaluate them in the light of their understanding of the system of insurance. There are …

أ.د. فتحي عبد الرحيم عبد الله - نظام التأمين في دولة الإمارات العربية المتحدة

UAEU Law Journal

يعد نظام التأمين حديث النشأن وذلك رغم ذيوعه وانتشاره في التجارة والصناعة وغيرها من وجوه النشاط الاقتصادي وهو أكثر حداثة في دولة الإمارات العربيةالمتحدة، إذ بدأ ينتشر فيها قبيل الاستقلال مع ظهور الاكتافات النفطية عام 1960 ويميز فقهاء القانون بين التأمين من ناحية تنظيمه الداخلي باعتباره فكرة وطريقة ذات أثر اقتصادي واجتماعي ترتكز على نظرية عامة ذات قواعد وأسس فنية، وبين عقد التأمين باعتباره تصرفاً قانونياً ينشئ حقوقاً بين طرفين متعاقدين وتطبيقاً عملياً لذلك النظام.

وقد ظهر أول تنظيم تشريعي لشركات ووكلاء التأمين بالدولة بصدور القانون الاتحادي رقم 9 لسنة 1984 وكان قد صدر من قبل التنظيم القانوني لعقد التأمين …

مدى خضوع التأمين التجاري لأحكام عقد التأمين في قانون المعاملات المدنية

UAEU Law Journal

تعليق على أحكام محكمة تمييز دبي في شأن القانون الواجب التطبيق على التأمين التجاري

بشان القانون الواجب التطبيق على التأمين التجاري

تعليق على حكم محكمة (غير محكم)

End Of Life Uncertainty: Terminal Illness, Medicare Hospice Reimbursement, And The "Falsity" Of Physicians' Clinical Judgments, Jameson Steffel

University of Cincinnati Law Review

No abstract provided.

Public Policy And The Insurability Of Cyber Risk, Asaf Lubin

Articles by Maurer Faculty

In June 2017, the food and beverage conglomerate Mondelez International became a victim of the NotPetya ransomware attack. Around 1,700 of its servers and 24,000 of the company’s laptops were suddenly and permanently unusable. Commercial supply and distribution disruptions, theft of credentials from many users, and unfulfilled customer orders soon followed, leading to losses that totaled more than $100 million. Unfortunately, Zurich, which had sold the company a property insurance policy that included a variety of coverages, informed Mondelez in 2018 that cyber coverage would be denied under the policy based on the “war exclusion clause.” This case, now pending, …

Penerapan Prinsip Kontribusi Dan Prinsip Subrogasi Dalam Asuransi Pengangkutan Laut (Studi Kasus Pt. Asuransi Axa Indonesia Dengan Pt. Asuransi Buana Independent), Luthfiana Arumsari

"Dharmasisya” Jurnal Program Magister Hukum FHUI

In insurance, for the same object can be insured to more than 1 (one) insurance company, which means it is possible for an insured to receive profits from 2 (two) or more insurers, to avoid this, in the insurance law in Indonesia known indemnity principle , which serves to avoid the benefits received by the insured that exceeds the losses suffered. The author conducted research at PT. AXA Insurance Indonesia (hereinafter referred to as PT. AXA) and PT. Buana Independent Insurance (hereinafter referred to as PT. ABI), each of which is an Insurance company that has equally guaranteed a cargo …

When Justice Should Precede Generosity: The Case Against Charitable Immunity In Arkansas, Courtney Jane Baltz

Arkansas Law Notes

This Comment discusses various aspects of the modern hospital and examines charitable immunity’s incompatibility with modern law.

First, Part II explains the historical justifications for immunity and presents the doctrine’s landscape in the United States. Part III examines the role precedent plays in continuing to adhere to the rule of immunity. Part IV takes an in-depth approach of the big business of hospitals by evaluating various financial aspects of charitable hospitals. Part V explores the reality of charitable immunity falling out of touch with concepts of modern law. Part VI takes a more specific look at the application of the …

The Extent Of Compulsory Car Insurance Coverage For Injuries Caused By Cars' Accidents: A Comparative Study Between The Jordanian Laws And, Uae Laws, Ghazi Abu Orabi

UAEU Law Journal

Car accidents are one of the main causes which endangers human life in addition to causing materialand moraldamage. The aim of the study is to shed light on the adequacy of compulsory car insurance in providing satisfactory legalprotection for injured persons, whether these injuries are fatalor non-fatal.

It is suggested in the study, that, this can be achieved via establishing legalmeans which enable the injured party to directly claim damages from the insuring company.

The study focuses on compulsory car insurance laws in the Jordanians and UAE laws. And it also attempts to explore the influence of Islamic Jurisprudence on …