News & Analysis as of

Insurance Claims Compliance

WaterStreet Company

Certified Mail vs. Proof of Mail for Insurance

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Insurance carriers operate in one of the most regulated industries. Communication with policyholders is not only essential, but legally required. When sending cancellation notices, conditional renewals, or premium increases,...more

Dentons

Ep. 59 – Treating Medicare Beneficiaries as a Cash-Based Practice

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Cash-based practices, or providers who neither participate with nor bill insurers, are becoming increasingly common, especially in certain specialties such as primary care, women’s health, and mental health. While providers...more

J.S. Held

Inside the Healthcare Industry: The Critical Role of Medical Coding, Billing & Nurse Review

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In what is already a highly regulated industry, it is becoming increasingly difficult for healthcare organizations to navigate the growing volume, complexity and enforcement of laws, regulations and guidance that surround...more

K&L Gates LLP

Litigation Minute: Emerging Contaminants: Minimizing and Insuring Litigation Risk

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What You Need to Know in a Minute or Less - As the scientific and regulatory landscape surrounding various emerging contaminants shifts, so too do the options that companies can consider taking to minimize and insure against...more

Whiteford

Understanding Price Transparency Laws and Gag Clauses: A Guide for Healthcare Providers

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Providers continually struggle to get the fair reimbursement they deserve from payers and often feel powerless to negotiate better rates. However, regulatory changes aimed at increasing price transparency and prohibiting gag...more

Marshall Dennehey

Fourth District Court of Appeal: Noncompliance with Post-Loss Requirements Is a Contract Breach, No Prejudice to Insurer Needed

Marshall Dennehey on

Alton Forbes v. People’s Trust Ins. Co., Fla. 4th DCA, No. 4D2023-2375, January 8, 2025 - The Fourth District Court of Appeals ruled that the final judgment against the appellant stands because the appellant failed to comply...more

Goldberg Segalla

Georgia Court's Ruling on Rycroft Defense Signals Key Limitation for Employers

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Unfortunately, not everything is always peachy in the Peach State. Historically, the Rycroft defense has allowed employers to deny workers’ compensation benefits when a worker makes false representations about their physical...more

Goldberg Segalla

Fraud Doesn’t Pay in New York – February 2025 Update

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As a part of our Quarterly Practice Group Update, we are pleased to produce another installment with examples of our continued success in the area of fraud litigation. The New York State Workers’ Compensation Board has...more

Fennemore

Lessons Learned from ERISA Health Plan Representation and Recommendations for Plan Design and Oversight

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ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more

Goldberg Segalla

CMS Issues Alert & WCMSA User Guide Update; Positive Changes Expedite Allocation Practice

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Beginning April 7, the Centers for Medicare & Medicaid Services (CMS) will eliminate its one-year waiting period for Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Amended Review requests. Instead, CMS will...more

Rivkin Radler LLP

New York Insurance Coverage Law Update — Compilation 2024

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An owner, general contractor (GC) and subcontractor (Sub) were sued by injured workers at a construction site, and they were defended by the Sub’s insurer, U.S. Specialty Insurance Company. U.S. Specialty tendered their...more

Goldberg Segalla

Pennsylvania Department of Labor & Industry Bureau of Workers’ Compensation has created the Direct Deposit Payment Authorization...

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Following the signing of Senate Bill 1232 amending the Pennsylvania Workers’ Compensation Act to require that employers and insurers offer claimants the option to receive their Workers’ Compensation payments by way of direct...more

Saul Ewing LLP

The Friday Five: Five ERISA Litigation Highlights - January 2025

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This month’s Friday Five explores recent decisions including the standard of review for ERISA benefit denials, whether structural conflict entitles a claimant to conflict-of-interest discovery, whether a “relative value...more

Lowenstein Sandler LLP

Taking the Right Steps To Navigate the Consent To Settle Provision in an Insurance Policy and Maintaining the Right to Coverage...

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Insurers often try to withhold, or at least minimize, coverage by taking the position that a policyholder has failed to keep the insurer sufficiently informed throughout the defense of an underlying matter or has failed to...more

Adams & Reese

Florida Launches “Check My Contract” Program in Wake of Hurricane-Related Insurance Claims

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In a proactive move aimed at protecting property owners, the Florida Department of Financial Services (DFS) has launched what it refers to as its “Check My Contract” program. This initiative is geared towards residential and...more

J.S. Held

Energy Consumption Analysis: The Impact on Insurance Claims During Extreme Weather Events

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The Role of Energy Consumption Analysis in Extreme Weather Insurance Claims - Water damage to structures is among the most common type of first party property insurance claims. During periods of extreme weather, water...more

Ogletree, Deakins, Nash, Smoak & Stewart,...

Colorado Gears Up for Sweeping New Paid Family and Medical Leave Insurance Program

​​​​​​​Colorado employers may want to begin preparing for the implementation of Colorado’s new state-run Paid Family and Medical Leave Insurance (FAMLI) program. While Colorado voters approved Proposition 118 nearly two years...more

Faegre Drinker Biddle & Reath LLP

State Insurance Spotlight: Washington State OIC Guidance Concerning COVID-19

State insurance departments across the country are continuing to provide guidance in response to the COVID-19 outbreak. In this update, Faegre Drinker spotlights the current Washington State Office of the Insurance...more

Saul Ewing LLP

On Demand Insurance is Here But Will it Stay?

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On demand insurance allows insurance policies to be purchased via the internet or smartphone applications. Millennials are more than twice as likely as prior generations to purchase an insurance policy in this manner. Valerie...more

The Volkov Law Group

Managing Third-Party Vendor Cybersecurity Risks (Part II of III)

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We all know that businesses rely on a large number of third-party vendors to support their business operations.  Many of these third parties require access to a company’s data and its internal information and technology...more

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