Open Access. Powered by Scholars. Published by Universities.®

Law Commons

Open Access. Powered by Scholars. Published by Universities.®

Articles 1 - 30 of 48

Full-Text Articles in Law

Health Care Fraud Means Never Having To Say You're Sorry, Jacob T. Elberg Jun 2021

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 Oct 2020

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. Oct 2018

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 Mar 2017

"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 …


Petition For A Writ Of Certiorari. Rochow V. Life Insurance Company Of North America, 136 S. Ct. 480 (2015) (No. 15-163), 2015 U.S. S. Ct. Briefs Lexis 2657, Eric Schnapper, Erik W. Scharf, John J. Cooper Aug 2015

Petition For A Writ Of Certiorari. Rochow V. Life Insurance Company Of North America, 136 S. Ct. 480 (2015) (No. 15-163), 2015 U.S. S. Ct. Briefs Lexis 2657, Eric Schnapper, Erik W. Scharf, John J. Cooper

Court Briefs

QUESTION PRESENTED When a benefit plan, in violation of ERISA, wrongfully denies or delays payment of a benefit, the court may award relief because of the improper delay in the payment of that benefit. The question presented is: Should 'the amount of a remedy based on the improper delay in the payment of a benefit be based on: (1) only the amount needed to redress the loss that the beneficiary sustained as a result of the wrongful delay (the rule in the Sixth Circuit), (2) either the amount needed to redress the loss that the beneficiary sustained as a result …


Race, Sex And Genes At Work: Uncovering The Lessons Of Norman-Bloodsaw, Elizabeth Pendo Jan 2010

Race, Sex And Genes At Work: Uncovering The Lessons Of Norman-Bloodsaw, Elizabeth Pendo

Articles

The Genetic Information Nondiscrimination Act of 20081 ("GINA") is the first federal, uniform protection against the use of genetic information in both the workplace and health insurance. Signed into law on May 21, 2008, GINA prohibits an employer or health insurer from acquiring or using an individual's genetic information, with some exceptions.

One of the goals of GINA is to eradicate actual, or perceived, discrimination based on genetic information in the workplace and in health insurance. Although the threat of genetic discrimination is often discussed in universal terms - as something that could happen to any of us -the use …


Book Review - Uninsured In America: Life And Death In The Land Of Opportunity, Elizabeth Pendo Jan 2008

Book Review - Uninsured In America: Life And Death In The Land Of Opportunity, Elizabeth Pendo

Book Reviews

Health care reform tops our national policy agenda, ranking second only behind Iraq as the issue that the public wants the 2008 Presidential candidates to address. This is no surprise, as health care spending represents nearly one out of every six dollars spent in the national economy, costs continue to climb, and health insurance is increasingly hard to get, keep, and afford. The numbers are staggering, and numbing. Most of us have heard that 46.5 million people were without insurance for the entire year in 2006, and nearly 89.6 million people were without insurance for some period during 2006 or …


Slayers And Soldiers: The Validity And Scope Of The Slayer's Rule Under The Family Servicemembers' Group Life Insurance Act, Rebecca Blasco Nov 2007

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 …


The Health Care Choice Act: The Individual Insurance Market And The Politics Of "Choice", Elizabeth Pendo Jan 2007

The Health Care Choice Act: The Individual Insurance Market And The Politics Of "Choice", Elizabeth Pendo

Articles

The Health Care Choice Act of 2005 (HCCA) aims to reform perceived problems in the individual market, and is touted as part of the solution to the problem of the uninsured. It purports to allow individuals who are not eligible for or cannot afford group coverage to purchase an individual policy in and from any state. If passed, the HCCA would allow health insurers to offer individual policies of insurance from any state without being required to comply with the laws of the insured's own state. Its proponents claim that it would lower the cost of individual health insurance by …


Tangible Cash For An Intangible Loss? Insurance Coverage For Damage Or Loss Or Third-Party Data, Kendall Bodden Feb 2005

Tangible Cash For An Intangible Loss? Insurance Coverage For Damage Or Loss Or Third-Party Data, Kendall Bodden

Washington Journal of Law, Technology & Arts

Will general business insurance cover liability for electronic data loss? A recent change to Commercial General Liability language specifies that data is not “tangible property” for CGL coverage. However, many companies may still be covered by older policies that do not contain this express exclusion. Case law interpreting the older policy language tends to deny coverage for the lost data itself, but successful claims have been made based on the loss of use of hardware caused by a data loss.


Telling Stories About Health Insurance: Using New Films In The Classroom, Elizabeth Pendo Jan 2005

Telling Stories About Health Insurance: Using New Films In The Classroom, Elizabeth Pendo

Articles

In keeping with the theme of "The Mass Media's Influence on Health Law and Policy," this essay is designed to share my experience using clips from three recent popular films as a method of enhancing coverage and discussion of legal and policy issues surrounding the private health insurance system, and to provide some practical advice for others interested in doing the same. It builds upon a presentation that I gave along with Professors Timothy S. Hall and Ross D. Silverman at the 2004 Health Law Teachers Conference entitled "Health Law, Policy and Media," and was inspired by Professor Paul Bergman's …


Coverage Of Reproductive Technologies Under Employer-Sponsored Health Care Plans, Elizabeth Pendo Jan 2005

Coverage Of Reproductive Technologies Under Employer-Sponsored Health Care Plans, Elizabeth Pendo

Articles

The federal courts have issued two important decisions regarding non-discriminatory insurance coverage of conditions and treatments associated with sex, disability or both, such as prescription contraception and infertility treatment. Cases like Erickson and Saks are important because, as ERISA scholars know, state law mandates regarding coverage are unlikely to lead to uniform results due to the structure of ERISA's preemption provisions, and none of the federal proposals addressing infertility treatment or prescription contraception have been enacted to date.

What I would like to do is outline the impact of ERISA in this area, and offer some thoughts on one 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 Aug 2004

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 …


The Politics Of Infertility: Recognizing Coverage Exclusions As Discrimination, Elizabeth Pendo Jan 2004

The Politics Of Infertility: Recognizing Coverage Exclusions As Discrimination, Elizabeth Pendo

Articles

Infertility affects approximately ten percent of the reproductive-age population in the United States, and strikes people of every race, ethnicity and socio-economic level. It is recognized by the medical community as a disease, one with devastating physical, psychological, and financial effects. Nonetheless, comprehensive coverage of infertility treatments under employer-sponsored plans - where, like Jane, most Americans get health insurance - appears to be the exception rather than the rule. Can Jane sue for disability discrimination, sex discrimination, or both? While the answer - "it depends" - should not be surprising to anyone who has survived even a semester of law …


Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo Jan 2004

Images Of Health Insurance In Popular Film: The Dissolving Critique, Elizabeth Pendo

Articles

Several recent films have villainized the health insurance industry as central elements of their plots. This Article examines three of those films: Critical Care, The Rainmaker, and John Q. It analyzes these films through the context of the consumer backlash against managed care that began in the 1990s and shows how these films reflect the consumer sentiment regarding health insurance companies and the cost controlling strategies they employ. In addition, the Article identifies three key premises about health insurance in the films that, although exaggerated and incomplete, have significant factual support. Ultimately, the author argues that, despite their passionately critical …


In The Litigation Business: Insurance Company Liability For Acts Occurring In The Course Of Litigation Under The Washington Consumer Protection Act, Kasey D. Huebner Jul 2001

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 Apr 1995

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 Jan 1992

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 Jul 1991

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 Jul 1986

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 Jul 1984

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 Nov 1980

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 Nov 1976

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 Mar 1976

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 May 1972

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 Jan 1971

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 Apr 1968

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 Apr 1968

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 Jun 1966

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 Apr 1966

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 …