News & Analysis as of

Insurance Claims Insurance Industry Fraud

J.S. Held

Fidelity Investigations: A Comprehensive Guide to Successful Claims Outcomes – Second Edition

J.S. Held on

Introduction: Understanding Fidelity Investigations - Fidelity / Crime / Financial Institution Bonds, in a general sense, cover an insured from the willful theft of property, money, and securities by one of their employees...more

Davis Wright Tremaine LLP

Anthem's New Chargemaster-Based Claim Edits: Which Charges and Providers Will Anthem's New Process Target and How Will It Impact...

Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more

Stevens & Lee

New Changes to Medicare and Private Prior Authorization Processes

Stevens & Lee on

Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more

Zelle  LLP

Court Grants Insurer’s Motion for Summary Judgment on Nearly All of Insureds’ Causes of Action

Zelle LLP on

Schnatzmeyer v. State Farm Ins. Co., No. 3:23-CV-02820-K, 2025 WL 1697505, at *1 (N.D. Tex. June 17, 2025). In a case involving two overlapping freeze claims—and a substantial array of legal issues affecting insurers in...more

JUSTICENTER

How Long Is an Insurance Check Good For?

JUSTICENTER on

If you’ve received a settlement check from an insurance company after a car accident, property damage claim, or injury settlement, you might be wondering: how long is an insurance check good for? While holding onto it for a...more

Zelle  LLP

Invoking ‘Our Option’ and Preferred Contractor Network Endorsements

Zelle LLP on

Increasing abuses in the claims process have caused insurance companies to rethink the traditional model of sending out cash to pay claims. Far too often, that cash is used for purposes other than fixing damage, with a...more

Orrick, Herrington & Sutcliffe LLP

Pennsylvania governor launches new consumer protection tools

Recently, Pennsylvania Governor Josh Shapiro announced that he launched a new centralized consumer protection hotline, website and email address to assist Pennsylvanians in reporting scams and resolving financial and...more

Goldberg Segalla

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

Goldberg Segalla on

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

Miller Nash LLP

The Northwest Policyholder | When the Application is the Risk: Application-Based Insurance Policy Rescission

Miller Nash LLP on

Surprised insurers are unhappy insurers. And unhappy insurers are more likely to resist paying claims. As are insurers who fail to heed their good faith and other obligations to their policyholders. So if you seek coverage...more

Wiley Rein LLP

New Jersey Appellate Court Affirms Rescission of Policies Based on Law Firm’s Misrepresentation in Applications

Wiley Rein LLP on

In a win for Wiley’s client, a New Jersey appellate court, applying New Jersey law, affirmed a trial court’s decision rescinding four lawyer’s professional liability policies because of material misrepresentations made in the...more

Wiley Rein LLP

Lending Exclusion in Bankers Professional Liability Policy Bars Coverage For Claim Alleging Financing a Ponzi Scheme

Wiley Rein LLP on

The United States District Court for the Central District of California, applying California law, has held that a lending exclusion in a bankers professional liability policy barred coverage for underlying lawsuits alleging...more

Marshall Dennehey

Appellate Court Affirms Ruling a Sworn Proof of Loss and Estimate Related to Later Claim Was Inadmissible as Hearsay and...

Marshall Dennehey on

Universal Property & Casualty Insurance Company v. Luis Nacimiento, Fla. 3rd DCA, 3D23-0301, Apr. 3, 2024 - The insured reported a claim to Universal Casualty & Property Insurance Company in February 2016 for water damage...more

Robins Kaplan LLP

AI’s Impact on Property Insurance Coverage

Robins Kaplan LLP on

Artificial Intelligence (AI) is the simulation of human intelligence processes by machines, such as computer systems for assistance in quickly answering complicated questions, researching a specific topic, or creating an...more

Segal McCambridge

Michigan Supreme Court Cracks Down on Fraud in Claims filed with the MAIPF: Honesty Matters Throughout the Process

Segal McCambridge on

Car insurance plays a crucial role in protecting drivers and their finances after an accident. It provides financial support for medical bills, lost wages, and car repairs. However, a recent Michigan Supreme Court decision in...more

Faegre Drinker Biddle & Reath LLP

Court Sides with Long-Term Care Insurer Over Claim Denial and Potential Fraud

A judge from the District of Colorado recently issued an opinion that might leave the door open for long-term care insurers to void policies after the contestability period expires if an insured commits fraud. See Meyer v....more

Bradley Arant Boult Cummings LLP

The Haunting in the Cornfield: Relators’ Qui Tam Claim Confirmed Dead by the Eighth Circuit

The Eighth Circuit Court of Appeals recently affirmed judgment against relators in a case alleging that a group of dairy farmers growing corn violated the False Claims Act by filing false insurance claims paid by the Federal...more

Marshall Dennehey

Why Insurance Carriers’ DPRPs Should Be Specific as to What Claims/actions Are and Are Not Arbitrable to Protect Themselves...

Marshall Dennehey on

GEICO filed a complaint against a series of medical providers asserting claims under the New Jersey Insurance Fraud Prevention Act (IFPA), violations of RICO, common law fraud and unjust enrichment. Some of the medical...more

Bennett Jones LLP

Court of Appeal Endorses Draconian Deterrent to Insurance Fraud

Bennett Jones LLP on

In Abbas v Esurance Insurance Company of Canada, 2023 ABCA 36 [Abbas], the Alberta Court of Appeal endorsed what it described as draconian consequences for insurance fraud as consistent with the Insurance Act, RSA 2000 c I-3...more

J.S. Held

Detecting Inflation-Driven Fraud in Marine Stock Throughput Insurance Claims

J.S. Held on

Following the easing of Covid pandemic restrictions, we are now facing a fresh “cost of living crisis” created by rising inflation and soaring energy bills. The Guardian newspaper reported that forecourts at petrol...more

J.S. Held

The Role of Forensic Accountants in Measuring and Detecting Fraud in Employee Loss Claims

J.S. Held on

Insurance claims for employee losses are generally examined by insurance carriers. The carrier will often retain a forensic accountant who has the ability to measure employee losses. Employee losses are typically categorized...more

Carlton Fields

Federal Court Rejects Computer Fraud Coverage for Social Engineering Loss

Carlton Fields on

In SJ Computers LLC v. Travelers Casualty and Surety Company of America, the U.S. District Court for the District of Minnesota recently addressed the scope of insurance available for a phishing scheme under the terms of a...more

J.S. Held

The Role of Forensic Accountants in Measuring and Detecting Fraud in Inventory Loss Claims

J.S. Held on

Insurance claims for loss of inventory are generally examined by insurance carriers. The carrier will retain a forensic accountant who has the ability to quantify out of sight inventory losses. Out of sight inventory losses...more

Rivkin Radler LLP

Insurance Update - February 2022

Rivkin Radler LLP on

Causation, an issue courts often wrestle with when deciding insurance coverage issues, lands the starring role in our February Insurance Update. •A county experienced higher costs due to the opioid crisis. Does its...more

Lowenstein Sandler LLP

In the Know: The Lowenstein Insurance Recovery Group’s Tip of the Month - October 2021

Lowenstein Sandler LLP on

A recent coverage case from Illinois is a helpful reminder to policyholders that they should not take no for an answer when insurers deny a claim based on uninsurability, restitution, disgorgement, or fraud. In fact, those...more

Faegre Drinker Biddle & Reath LLP

To Rescind or Not to Rescind, That’s Only Half the Question

An insured applies for a life insurance policy, answering “no” to all medical and health-related questions. She dies within two years of her application, and the insurer discovers she was in fact diagnosed with cancer two...more

28 Results
 / 
View per page
Page: of 2

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
- hide
- hide