Insurance Law Commons^™

The Coming Health Insurance Transition, Brendan S. Maher

Faculty Scholarship

For decades, the dominant form of private health insurance in the United States—by far—has been employment-based group health insurance. Somewhere in the range of 175 million employees and their families receive health care coverage through a system in which employers serve as financiers, procurers, administrators, and fiduciaries of the health insurance promise. An overwhelming percentage of those health insurance arrangements are governed by ERISA, with little room for state law.

That is going to change.

This Article explains—for the first time anywhere—why and how. Because of the tremendous and as-yet unrecognized power of an obscure-sounding funding arrangement called the Individual …

A New Framework For Drug Pricing Law And Policy, Rachel E. Sachs

Indiana Law Journal

Scholars and policymakers have expressed concern about the impact of high prescription drug costs on patients and healthcare budgets. This Article presents a new theoretical framework for evaluating both the problem to be addressed by drug pricing reforms as well as the efficacy of potential solutions. In seeking to solve “the drug pricing problem,” our legal system has given primacy to competition rather than regulation to drive down drug prices. This Article disaggregates the broader concept of drug competition into four steps, each of which must be addressed and each of which elevates different institutional actors to key roles. In …

Artificial Intelligence, Judicial Evolution, And Insurance, Renee Henson

Faculty Publications

AI-driven platforms have the potential to inflict traditional injuries in new ways. Proprietary algorithms trained on large volumes of personal data can cause mental, emotional, and sometimes physical injuries via conversational exchanges, harmful content recommendations, and the promotion of extremist content. This "algorithmic liability" fundamentally challenges existing legal doctrines and statutory protections, thereby exposing deficiencies in current insurance coverage frameworks. 

Historically, courts dismissed algorithmic liability claims early in litigation, invoking Section 230 immunity and First Amendment protections, and resisted classifying algorithmic tools as "products" for the purposes of products liability law. Recent jurisprudence, however, signals a critical turning point. On …

Maritime Personal Injury In The New England Fishery, Ralph J. Gillis

Maine Law Review

Commercial fishing, as carried on by the "down east" fisherman, is an industry fast succumbing to the economic inequities of vessel operation. Over the past two decades, the prices for fish boats have not increased as rapidly as the operating costs involved in fitting and maintaining the fishing vessel. Today, this situation has been compounded by the economic inability of the individual trawler owner to obtain protection and indemnity insurance to compensate crew members for injuries received during the course of maritime employment. The present consequence of these developments is that, although judicial and legislative regulatory guidelines have been set …

The Dilemma Of Concurrent Coverage: Carriers Insurance Co. V. American Policyholders Insurance Co., Joanne F. Cole

Maine Law Review

Insurance draftsmen responding to consumers' demands for comprehensive automobile liability protection have attempted to create precise, extensive coverage for the insured while at the same time limiting the insurer's liability if possible. One consequence of this effort is that when two or more policies cover the same risk and person and concurrent coverage results, the insurers may attempt to reduce their liability on the grounds that other insurance is available. Insurers achieve this contingent coverage through the device of "other insurance" clauses—a judicially approved means of reducing or avoiding liability if other valid and collectible insurance exists. These clauses originated …

Barriers To Insurance Innovation, Peter Molk

UF Law Faculty Publications

In exchange for a payment, insurance companies assume risks from policyholders. Because of their ability to aggregate and diversify many risks, insurers can offer this service at a price that is attractive to policyholders. Yet there are risks that insurers refuse to cover, even though the insurer appears to be in at least as favorable a risk-bearing position as is the policyholder. Property insurance contracts, for example, place on policyholders the risk that rebuilding costs will be greater than expected, or that a home will be destroyed by flood or nuclear damage, or that exposure to natural hazards will change …

The Unethical Practices Of Force-Placed Insurance: How To Protect And Indemnify The Forgotten Investors Of Mortgage-Backed Securities, Devin Moore

St. Thomas Law Review

In the United States, the media has been attempting to inform homeowners of an abusive insurance policy: force-placed insurance. Force-placed insurance is a type of policy that only protects the interest of the mortgage lender or mortgage servicer, and not the homeowner. While federal and state governments have restricted force-placed insurance policies for homeowners, the laws do not protect investors of mortgage-backed securities with force-placed insurance policies. These investors have an extensive impact on the general population since their investments are funded by retirement savings plans. As a result, the investors could lose the retirement savings of millions without proper …

American Home Assurance Co. V. Ingeneri: Misrepresentations In Insurance Applications, Richard P. Bennett

Maine Law Review

In American Home Assurance Co. v. Ingeneri, the Maine Supreme Judicial Court, sitting as the Law Court, addressed the issue of when an incorrect response to a question on an insurance application constitutes a sufficient misrepresentation to render the policy voidable under Maine law. Reversing the trial court, the Law Court held that to render the policy voidable, the applicable statutory provision required the insurer to prove that the insured's misrepresentation was fraudulent, material to the insured risk, and actually relied upon by the insurer. The Law Court determined that the word "or" in the misrepresentation statute should be read …

Choice Of Law Issues In Eleventh Circuit Insurance Cases Arising From Lex Loci Contractus, Tom Schulte, Andrea Defield, Jorge Aviles

University of Miami Law Review

A growing number of cases have emerged from the Eleventh Circuit struggling with the application of lex loci contractus to choice-of-law issues in the insurance context. And while the federal courts continue to struggle, the state courts in the Eleventh Circuit have not yet offered definitive guidance on when to apply lex loci contractus, and when to depart from it. In light of this choice-of-law issue, which can be and often is outcome determinative, this Article offers practical guidance on how policyholders can avoid application of an unfavorable state’s law to their insurance dispute, both before and after litigation …

Florida's Homeowners Insurance Problems, Peter Molk

UF Law Faculty Publications

Floridians have seen dramatically rising homeowners insurance premium increases over the past several years, with year-over-year increases of forty percent or more over multiple years. The problem grew so severe that the State legislature convened a special session in 2022 to address the problem, ultimately passing several efforts designed to moderate rates. This Article reviews the evidence of Florida’s experience to interrogate why the State has suffered disparately high homeowners insurance premium increases. In light of this interrogation, I critically assess the prospects for the recent legislative efforts and other suggestions to address the underlying problems. Reform efforts predominantly address …

Disability Benefits And Administrative Vulnerability: Lessons For Canada From The Us's Social Security System, Neil H. Buchanan

UF Law Faculty Publications

The United States federal government's disability insurance system is a leading example of the problems that arise when a social program combines subjective eligibility criteria with an administrative apparatus that cannot handle the inevitable expenses and delays that such criteria create and that are expensive to reverse. In particular, Black, female, and non-English speaking individuals are most likely to be improperly denied benefits under that program. By contrast, Canada is moving in the right direction with its recent enactment of the Canada Disability Benefit Act. That Act, while obviously not perfect, importantly improves access to social support for people …

Insuring Judgements And The Disclosure Gap, Jonathan Stroud, Sam Korte

American University Law Review

Judgment preservation insurance (“JPI”) is a newer, under-the-radar financial innovation upending the litigation landscape today. By insuring plaintiffs' trial victories on appeal, these policies neutralize the risk of reversal, but have been criticized for preventing settlement and extending disputes. Despite JPI's growing use, a regulatory blind spot allows these policies to remain concealed from the courts throughout the appellate process. We spotlight JPI, contrast it with widely used litigation insurance products, and propose appellate disclosure requirements in line with existing insurance disclosure rules. These simple changes would close the disclosure gap on appeal.

Twisted Machines: Police Pursuit Policy And Accountability, Madeline Hedrick

Journal of the National Association of Administrative Law Judiciary

Part I of this comment will examine the cultural and legal approach to high-speed pursuits exemplified in Los Angeles—the national center of televised car chases. Part II will unpack the thorny judicial doctrine of qualified immunity and evaluate how it impacts the incentives and accountability of police pursuits. Part III will examine who pays for the lawsuits that survive qualified immunity and the role insurance companies have in the facilitation of police reform. In Part IV, this comment will examine the qualified immunity bills in New Mexico and Colorado, the nationwide example they set, and the pushback they have received. …

Modelling Climate Litigation Risk For (Re)Insurers, Martin Lockman

Sabin Center for Climate Change Law

In response to the growing threat of climate change, the insurance industry has made significant investments in modelling and quantifying physical climate risks. However, the emerging risk of climate litigation has proven particularly difficult to model. In 2015 Mark Carney, then-Governor of the Bank of England and Chairman of the Financial Stability Board, warned that climate litigation poses “long-tail risks” for insurers that may be “significant, uncertain and non-linear.” Since that warning, the number of climate-related cases has more than doubled, and the scope and financial significance of climate litigation has become increasingly clear. However, insurers and regulators still struggle …

The United States Should Take A Page Out Of Canadian Law When It Comes To Privacy, Genetic And Otherwise, Ashley Rahaim

University of Miami Inter-American Law Review

Genetic information is intimate and telling data warranting privacy in public and private realms. The privacy protections offered in the United States and Canada vastly differ when it comes to genetic privacy. Search and seizure law mirrors the privacy gap in the countries, as well as their treatment of DNA database information.

This note explores the foreshadowing of the creation of genetic privacy laws and their varying levels of protection based on the way private information was treated by state actors through search and seizure caselaw, the creation of legal precedent, and the treatment of intimate personal data in the …

Caremark'S Butterfly Effect, Angela N. Aneiros, Karen E. Woody

Scholarly Articles

In 1996, the Delaware Court of Chancery detailed the minimum standard for corporate boards of directors (“board”) with regard to corporate compliance programs and monitoring protocols. The landmark Caremark decision held that directors would not face liability for a breach of fiduciary duties unless they failed to implement a system of controls and compliance, or knowingly failed to monitor that system. In order to bring a successful Caremark claim, plaintiffs must prove that the board operated in bad faith by failing to exercise oversight in a sustained or systemic way. The Delaware Court of Chancery opinion noted that the theory …

The Case For Pausing Any Immediate Embrace Of The Social Inflation Argument For Legal System Reforms, Kenneth S. Klein

Faculty Scholarship

This paper brings a critical eye to the current conversation about "social inflation," reaching the conclusion that the current calls for legal system reform--whether that be controls on attorney advertising, clamping down on litigation financing, revisiting of fee recovery rules, or other similar reform proposals--currently lack the empirical support and analytical comprehensiveness for. regulators and legislators to act with confidence that the requested reforms will do more good than harm. In a variety of States, insurance premiums are rising faster than general inflation, some insurers are becoming insolvent, and some insurers are leaving markets entirely. Insurers are pointing to social …

Changemakers: Master Of Studies In Law: 'Something New And Different...': Monique Kuester, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.

Status Quo Kewenangan Perusahaan Asuransi Dalam Menerbitkan Produk Penjaminan Pasca Berlaku Efektifnya Undang-Undang No. 1 Tahun 2016 Tentang Penjaminan, Kalih Krisnareindra

"Dharmasisya” Jurnal Program Magister Hukum FHUI

Risk is something that is always exist in various type of business. Risk management commonly used the assistance of insurance companies to manage its risk by risk transfer. The current prevailing law allows the insurance industry to develop its products wider than the explicitly defined business lines in the regulation. Historically, the guarantee/surety business has been marketed jointly between insurance companies and guarantee/surety companies. This can be traced through laws and regulations that provide the authority to both type of companies to issue guarantee/surety products. But with the enactment of Law No. 1 of 2016 concerning Guarantees, there is an …

Pertanggungjawaban Otoritas Jasa Keuangan Terhadap Kasus Gagal Bayar Perusahaan Asuransi, Tumbur Halomoan

"Dharmasisya” Jurnal Program Magister Hukum FHUI

The development of the financial industry accompanied by close supervision in order to maintain stability in the financial industry. Financial Services Authority is an independent institution have special authority by the Law to overseen the financial industry. The financial industry is divided into two parts first the bank financial industry and the non-bank financial industry. One non-bank financial industry that is overseen by OJK. OJK in overseeing insurance is quite large starting from the granting of a company establishment license to the company's activities which are reported regularly by the insurance company. OJK not necessarily make the insurance industry run …

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

مجلة جامعة الإمارات للبحوث القانونية 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. …

Recent Development: Arkansas Insurance Dep't. Final Rule 126: "Insurance Business Transfers", Silas Heffley

Arkansas Law Review

Pursuant to Act 1018 of 2021, “An Act to Establish the Arkansas Business Transfer Act,” the Arkansas Insurance Department has promulgated Final Rule 126 “to provide standards and procedures for the transfer and novation of insurance policies from a transferring insurer to an assuming insurer through a transaction known as an ‘insurance business transfer.’” The Rule requires that the applicant submit an Insurance Business Transfer Plan—along with a nonrefundable $10,000 fee—to the Department detailing the transaction. One critical element of this Plan is the Independent Expert Opinion Report. An independent expert will produce a written report to be included in …

Insuring Contraceptive Equity, Jennifer Hickey

Northwestern Journal of Law & Social Policy

The United States is in the midst of a family planning crisis. Approximately half of all pregnancies nationwide are unintended. In recognition of the social importance of family planning, the Affordable Care Act (ACA) includes a “contraceptive mandate” that requires insurers to cover contraception at no cost. Yet, a decade after its enactment, the ACA’s promise of universal contraceptive access for insured women remains unfulfilled, with as many as one-third of U.S. women unable to access their preferred contraceptive without cost.

While much attention has been focused on religious exemptions granted to employers, the primary barrier to no-cost contraception is …

Is Fire Insurable?, Kenneth S. Klein

Faculty Scholarship

The focus of this chapter is on the extant data on the prevalence, causes, and depth of inadequate, unavailable, and/or unaffordable dwelling insurance for fire, and what might be done about it. Whether it is ‘bushfire’ in Australia or ‘wildfire’ in the United States, the frequency, intensity, and cost of fire is increasing, with no reason to expect the upward trend to dissipate any time soon. Most homeowners want to insure their homes for fire and think they both have done so and done so adequately. More often than not, they are wrong. And many are finding that insurance now …

The Color Of Property And Auto Insurance: Time For Change, Jennifer B. Wriggins

Faculty Publications

Insurance company executives issued statements condemning racism and urging change throughout society and in the insurance industry after the huge Black Lives Matter demonstrations in summer 2020. The time therefore is ripe for examining insurance as it relates to race and racism, including history and current regulation. Two of the most important types of personal insurance are property and automobile. Part I begins with history, focusing on property insurance, auto insurance, race, and racism in urban areas around the mid-twentieth century. Private insurers deemed large areas of cities where African Americans lived to be “blighted” and refused to insure all …

The Limits Of Regulation By Insurance, Kenneth S. Abraham, Daniel Benjamin Schwarcz

Indiana Law Journal

Insurance is an enormously powerful and beneficial method of spreading risk and compensating for loss. But even insurance has its limits. A new and misleading aspiration for insurance—that it also can and often does substitute for or significantly complement health and safety regulation—is increasingly in vogue. This vision starts from the uncontroversial recognition that insurers typically adopt measures designed to counteract “moral hazard,” the tendency of insurance to blunt policyholders’ incentives to take care. But proponents of this vision go on to contend that the risk-reducing potential of insurance is significantly more extensive than is traditionally imagined, because insurers are …

Federal Courts’ Recalcitrance In Refusing To Certify State Law Covid-19 Business Interruption Insurance Issues, Christopher French

Faculty Scholarship

Over 2,000 COVID-19 business interruption insurance cases have been filed in state and federal courts the past two years with most of the cases filed in or removed to federal courts. The cases are governed by state law. Rather than certify the novel state law issues presented in the cases to the respective state supreme courts that ultimately will determine the law applicable in the cases, each of the eight federal circuit courts to issue decisions on the merits in such cases to date has done so by making an Erie guess regarding how the controlling state supreme courts would …

Debunking The Standardized Nature Of Insurance Policies, Elizabeth Sousa

Fordham Journal of Corporate & Financial Law

This article discredits the conventional view of insurance policies as standardized contracts that do not vary across insurance companies and policyholders. Contrary to this view, there are wide variations in policy language in both the admitted and non-admitted insurance markets. These deviations reduce the perceived benefit of insurance policies as standardized contracts intended to promote predictability and lower transaction costs for policyholders by focusing only on the most salient terms. Nowhere is this deviation more apparent than with Commercial General Liability (CGL) policies defendants are turning to in the current opioid litigation.

The opioid epidemic has been plaguing the United …

The Promise And Peril Of Paternalistic Approaches To Flood Risk, Alexander B. Lemann

University of Colorado Law Review

Our country's ever-growing exposure to flood risk has been the target of policy reform for decades. To many experts, it is clear that we must stop subsidizing flood-prone development and begin the process of moving people away from flood-prone areas. And yet, despite the seemingly obvious benefits of abandoning areas that will be permanently underwater in a generation, flood-prone living has been a difficult habit to kick.

Examining the problem against the background of the philosophical literature on paternalism helps show why. Paternalism- government intervention in people's choices for the good of those same people-has long been controversial. The insistence …

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 …