Insurance Law Commons^™

The Affordable Care Act’S Preventive Services Mandate: Breaking Down The Barriers To Nationwide Access To Preventive Services, John Aloysius Cogan, Jr.

Faculty Articles and Papers

No abstract provided.

Erisa Subrogation And The Controversy Over Sereboff: Silencing The Critics, The Divided Bench Is A Legitimate Standard, Ashley A. P. Frazier

Georgia Law Review

ERISA protects employees in the administration of
employer-sponsored benefit plans. When a party is injured
by third parties and a health and welfare benefit plan
governed by ERISA pays benefits, conflicts have arisen
between insurers seeking subrogation and individuals
seeking full recovery. Injured parties claim they should
not have to reimburse insurers while insurers deny
responsibility for damage caused by third parties. The
Supreme Court set the standard for plan fiduciary rights
to ERISA subrogation in Sereboff v. Mid Atlantic Medical
Services, Inc. Sereboff held that the plain wording of 29
U.S.C. § 1132(a)(3) means equitable relief available under
the …

Constitutionality Of The Patient Protection And Affordable Care Act Under The Commerce Clause And The Necessary And Proper Clause, Wilson Huhn

Akron Law Faculty Publications

The Patient Protection and Affordable Care Act is a comprehensive federal statute that attempts to extend health insurance coverage to tens of millions of Americans and to expand health insurance coverage by eliminating exclusions for preexisting conditions, increase medical loss ratios, abolish annual and lifetime limits, and other reforms. A necessary provision of this law (the individual mandate) requires most individuals to maintain health insurance coverage. The individual mandate has been challenged in a number of lawsuits on the ground that Congress lacks the power under the Constitution to require individuals to purchase health insurance. The power of Congress to …

Some Misleading Influences On The Reading Of Reinsurance Contracts: A Plea For Express Intent, Graydon S. Staring

Graydon S. Staring

Reinsurance is a business of transactions that cross national and state boundaries in great numbers and great values measured by premiums, risks and recoveries. It has very old roots as an innovative market free of control by any single nation, responsive to the intentions of parties and governed by the usages and ethical understandings of its principals inherited as part of international commercial practice. It is important that the intentions represented in its contracts be understood in whatever venue they are questioned to the same effect as they were to those who negotiated them. Although this laudable aim will occasionally …

Credit Arrangements, Angelo Giampietro Avv.

Angelo Giampietro Avv.

International trade transactions can be regulated for their payment in various ways: by means of letters of credit or by cash and kind. Therefore, credit arrangements are a common and protection against risk solution. One of the most important challenges for traders involved in a transaction is to secure financing so that the transaction may actually take place. The faster and easier is the process of financing an international transaction, the more trade will be facilitated. The method of payment is crucial for the decision about the opportunity of the trading. Therefore, the arrangements for credit in international trade, play …

Revenue-Cycle Management And Reimbursement: The Impact Of Health Law And Health Reform On Providers, Timothy D. Martin

Timothy D Martin

Healthcare payment systems are complex and difficult to administer. Over the years, providers have developed a complex process, called revenue-cycle management, for administering their interactions with payers operating under various payment systems. The Patient Protection and Affordable Care Act of 2010 will have a significant impact on payment systems—as will other recent reform measures. This paper contains primers on revenue-cycle management, health insurance systems, medical claims, claim coding, electronic-data interchange (EDI), claims processing, and public and private reimbursement methods for hospitals and physicians. But its focus is on the impact recent healthcare reform initiatives have had and are likely to …

Religion And The Alien Tort Statute, Chad G. Marzen

Chad G. Marzen

The paper generally discusses the relationship between religion and the Alien Tort Statute.

The Wrap Up Of Wrap-Ups? Owner Controlled Insurance Programs And The Exclusive Remedy Defense, Chad G. Marzen

Chad G. Marzen

Large scale, complex commercial construction projects today often utilize Owner-Controlled Insurance Programs (OCIPS, also referred to as “Wrap-Up” programs), which streamline various insurance coverages into a single consolidated program (the OCIP), where the owner, through the OCIP, establishes and administers insurance coverage for the general contractor and all the subcontractors on the project.

OCIPs have been lauded for several reasons – efficient claims management, efficient coordination of the program, and potentially significant cost savings for the owner. Although the benefits of OCIPs have been cited in court decisions throughout the country, at least two courts have held that an owner, …

Energy Revolution And Disaster Response In The Face Of Climate Change, Prof. Elizabeth Burleson

Prof. Elizabeth Burleson

Nuclear meltdown in Japan and civil society strife across the Middle East highlight the degree to which resilience is core to international peace and security. This article considers the means by which communities can become increasingly resilient through shared best practices across a range of climate change measures.

Competition And Regulation In The Insurance Sector: Reassessing The Mccarran-Ferguson Act, Susan Beth Farmer

Journal Articles

This article was presented at a symposium entitled “Public and Private: Are the Boundaries in Transition?” sponsored by the American Antitrust Institute on June 24, 2010. It proposes a different paradigm, which more precisely describes regulation and competition in the insurance sector. This relationship is the shifting boundary between state and federal regulation instead of a boundary between the public and private sectors. The McCarran-Ferguson Act was adopted to protect firms acting in the business of insurance from federal antitrust scrutiny, but its language and impact goes far beyond federal competition law. So broad is the exemption that the modern …

Construction Defects: Are They “Occurrences”?, Chris French

Journal Articles

An issue in the area of insurance law that has been litigated frequently in recent years is whether construction defects are “occurrences” under Commercial General Liability (“CGL”) insurance policies. The courts have been divided in deciding the issue and in their approaches to analyzing the issue. This article addresses how the issue should be analyzed and concludes that construction defects are “occurrences”. The relevant rules of insurance policy interpretation dictate that construction defects are “occurrences”. Policy language should be interpreted in such a way as to fulfill the reasonable expectations of the policyholder when the policy is construed as a …

The “Non-Cumulation Clause”: An “Other Insurance” Clause By Another Name, Chris French

Journal Articles

How long-tail liability claims such as asbestos bodily injury claims and environmental property damage claims are allocated among multiple triggered policy years can result in the shifting of tens or hundreds of millions of dollars from one party to another. In recent years, insurers have argued that clauses commonly titled, “Prior Insurance and Non-Cumulation of Liability” (referred to herein as “Non-Cumulation Clauses”), which are found in commercial liability policies, should be applied to reduce or eliminate their coverage responsibilities for long-tail liability claims by shifting their coverage responsibilities to insurers that issued policies in earlier policy years. The insurers’ argument …

From Coverture To Contract: Engendering Insurance On Lives, Mary L. Heen

Law Faculty Publications

In the 1840s, state legislatures began modifying the law of marital status to ease the economic distress of widows and children at the family breadwinner's death. Insurance-related exceptions to the common law doctrine of "marital unity" under coverture permitted married women to enter into insurance contracts and protected life insurance proceeds from their husbands' creditors. These early insurance-related statutory exceptions to coverture introduced an important theoretical question that persisted for the rest of the nineteenth century-and into the next-as broader legal and social reforms took hold. How could equality of contract for married women be reconciled with the traditional dependencies …

Liability Insurance Coverage For Clergy Sexual Abuse Claims, Peter N. Swisher

Law Faculty Publications

This article addresses issues that arise when a policyholder under a standard general liability insurance policy, not containing an express sexual abuse coverage endorsement (or an express sexual abuse exclusion), seeks insurance coverage for sexual abuse claims. Such cases continue to increase in frequency as the legacy of sexual abuse and molestation generates an unrelenting deluge of insurance coverage claims.

The purpose of this article is to explore and analyze the case law and various legal theories supporting and rejecting liability insurance coverage claims involving institutional sexual abuse allegations. This article concludes by recommending a better-reasoned objective concurrent causation legal …

Stolen Art, Looted Antiquities, And The Insurable Interest Requirement, Robert L. Tucker

Robert L Tucker

Trafficking in stolen art and looted antiquities is a multi-billion dollar enterprise. Stolen art and looted antiquities are ultimately sold to museums or private collectors. Sometimes the purchasers acquire them in good faith. But other times, the purchasers know, suspect, or willfully blind themselves to the possibility that the piece was stolen or illegally excavated and exported up the chain of title.

This problem is compounded by customs and course of dealing in the art and antiquities trade. Dealers generally decline to provide meaningful information to prospective purchasers about the provenance of a piece, and sophisticated purchasers customarily acquiesce in …

Constitutionality Of The Patient Protection And Affordable Care Act Under The Commerce Clause And The Necessary And Proper Clause, Wilson Huhn

Wilson R. Huhn

The Patient Protection and Affordable Care Act is a comprehensive federal statute that attempts to extend health insurance coverage to tens of millions of Americans and to expand health insurance coverage by eliminating exclusions for preexisting conditions, increase medical loss ratios, abolish annual and lifetime limits, and other reforms. A necessary provision of this law (the individual mandate) requires most individuals to maintain health insurance coverage. The individual mandate has been challenged in a number of lawsuits on the ground that Congress lacks the power under the Constitution to require individuals to purchase health insurance. The power of Congress to …

Claims And Coverage In Montana For Damage To A Victim's Family Members, Greg Munro

Faculty Journal Articles & Other Writings

This article explores those situations in which Montana tort law now recognizes secondary injuries to family members resulting from primary severe injuries or death of another family member, which recognition may invoke additional auto insurance coverage. The article first makes a short survey of the development of Montana tort law insofar as it has come to take cognizance of family injuries. The article then looks at the application of insurance law to those claims with special emphasis on recent cases.

The Future Of Climate Change Litigation After Aep V. Connecticut, Amanda Leiter, Rick Faulk, Eric Lasker, Mike Myers

Articles in Law Reviews & Other Academic Journals

No abstract provided.

Managing The Next Deluge: A Tax System Approach To Flood Insurance, Charlene Luke, Aviva Abramovsky

Journal Articles

This Article critiques the National Flood Insurance Program and proposes an alternative insurance plan that would use the strengths of the federal tax system to address the complexities of flood loss and provide basic coverage for all individuals. The Article also discusses the current tax rules applicable to flood loss and proposes methods for harmonizing such rules with the proposed program.

Using Payroll Deduction To Shelter Individual Health Insurance From Income Tax, David Orentlicher

Scholarly Works

In this article, Professor Orentlicher and his colleagues assess the impact of state laws requiring or encouraging employers to establish ‘‘section 125’’ cafeteria plans that shelter employees’ premium contributions from tax.