News & Analysis as of

Insurance Claims Regulatory Requirements

Kennedys

Proposed Washington code amendments modify insurer claims handling requirements

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Proposed Washington Administrative Code amendments would tighten the deadlines and increase insurers’ requirements while simultaneously finding a single misstep a basis for a violation....more

Phelps Dunbar

Louisiana Changes its "Proof of Loss" Law

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The Louisiana Legislature recently passed HB 437 which enacts La. § R.S. 22:1892.3 (effective August 1), in an attempt to clarify parties’ respective obligations as it relates to Proof of Loss statements and corresponding...more

Epiq

When Treatment Costs Exceed Settlements

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Navigating the complex landscape of lien resolutions in mass torts is a challenge for both plaintiffs’ and defense attorneys. One of the biggest hurdles is complying with federal and state regulations to resolve health care...more

Orrick, Herrington & Sutcliffe LLP

Who Is Accountable for AI?

Orrick’s John Bautista sat down with Rune Kvist, founder and CEO of Artificial Intelligence Underwriting Company, to explore accountability in AI and how creating auditable standards and insurance products could unlock...more

Mintz - Health Care Viewpoints

WISeR Model Will Test the Use of Artificial Intelligence for Prior Authorization in Medicare: Key Considerations for Health Care...

The Center for Medicare and Medicaid Innovation (CMMI) recently announced a six-year payment model for 2026-2031 called the Wasteful and Inappropriate Service Reduction (WISeR) Model. WISeR will test the use of artificial...more

Schwabe, Williamson & Wyatt PC

OP-ED: How to Repair Landslides‎—One Insurance Policy at a Time

If a landowner receives a government order to clean up a landslide on their property, who should pay for it — the property owner or their liability insurer? About 20 times per year, the city of Portland issues an order to...more

JUSTICENTER

How Long Is an Insurance Check Good For?

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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

Wiley Rein LLP

SEC Tolling Request Not a Securities Claim Against Insured Company Under D&O Policy

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A Delaware Superior Court, applying Delaware law, has held that the United States Securities and Exchange Commission’s (“SEC”) request to toll the statute of limitations did not constitute a “Securities Claim” under a D&O...more

WaterStreet Company

Certified Mail vs. Proof of Mail for Insurance

WaterStreet Company on

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

McGlinchey Stafford

Strategic Risk Mitigation for Insurance Providers Amidst PFAS-Related Environmental Liability

McGlinchey Stafford on

The increasing volume of litigation involving Poly- and Perfluoroalkyl Substances (PFAS) presents substantial financial and operational uncertainties for the insurance sector. Due to their environmental persistence and...more

Haight Brown & Bonesteel LLP

2024 Insurance Law Compendium for California

The Fair Claims Settlement Practice Regulations set forth the relevant time limits for claims handling responses and determinations. The most important time limits are: 15 days to acknowledge receipt of claim (10 Cal. Code...more

Polsinelli

Delaware Department of Insurance Launches Exams of Third Party Administrators

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Key Takeaways - The Delaware Department of Insurance (Department) is conducting targeted market conduct exams of Third Party Administrators (TPAs) for compliance with state insurance laws and regulations....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

Morgan Lewis

(AI)n’t Done Yet: States Continue to Craft Rules to Manage AI Tools in Healthcare

Morgan Lewis on

As the regulation of artificial intelligence (AI) tools in healthcare settings rapidly evolves, state medical boards and related agencies are at the forefront of development and enforcement. While some states have taken...more

Pillsbury - Policyholder Pulse blog

The Latest on PFAS: What Policyholders Need to Know Now

We have previously written on the evolving risks associated with PFAS—also known as “forever chemicals”—and their implications for policyholders navigating environmental liabilities involving both PFAS and PFAS-related...more

Goldberg Segalla

One-Time Change: Employers and Carriers Must Go Beyond Simply Authorizing the Benefit

Goldberg Segalla on

Florida law entitles injured workers to a one-time change in physicians. This one-time change is a procedural right, per Florida Statute 440.13(2)(f). When the change is granted, the employer or carrier must deauthorize the...more

Marshall Dennehey

Reimbursement of Pennsylvania Department of Human Services Lien Is Found Not Automatic by Pennsylvania Commonwealth Court

Marshall Dennehey on

Key Points: No formal liability for payment of work-related medical expenses is triggered on the part of the employer/insurer until such expenses are properly submitted in accordance with the terms and provisions of the...more

Rodemer Kane Attorneys at Law

Can You Get Car Insurance the Same Day of an Accident in Colorado?

Car insurance is a legal requirement for all drivers in Colorado. This ensures financial protection for drivers in case of an accident. But what happens if you get into an accident and don't have car insurance? Can you get...more

Laughlin, Falbo, Levy & Moresi LLP

A NEW MEDIC-ERA; Changes to CMS Review Guidelines in 2025

Vast changes are swiftly approaching regarding the efforts Workers’ Compensation practitioners must make in protecting Medicare’s interests in future medical settlements. The Centers for Medicare/Medicaid Services (CMS) has...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

Zelle  LLP

Presuit Notice to Third-Party Adjuster Does Not Comply with Section 542A.003(a) of the Texas Insurance Code

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As a question of first impression, The United States District Court for the Northern District of Texas analyzed whether issuing pre-suit notice to a third-party adjuster satisfies Section 542A.003(a) of the Texas Insurance...more

Hendershot Cowart P.C.

Your Employee Lawyered Up. Now What? Best Practices for Contractors Following a Worksite Injury

Hendershot Cowart P.C. on

When a workplace injury occurs at your construction site, the actions you take in the immediate aftermath can significantly impact potential legal consequences, insurance claims, and your business's financial health....more

Hogan Lovells

UK pension trustee liability insurance: Key insights for trustees

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Pension trustee liability (PTL) insurance can be a crucial safeguard for trustees of UK pension schemes. This article explains: the cover typically provided; the importance of timely notifications; exclusions (what isn’t...more

Chartwell Law

Two Major Updates to Pennsylvania Medicare Set-Aside Rules

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The Centers for Medicare & Medicaid Services (CMS) recently announced two significant updates to Workers’ Compensation Medicare Set-Aside (WCMSA) rules, effective in 2025. These changes affect $0 MSA proposals and immediate...more

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