News & Analysis as of

Insurance Industry Insurance Claims

Troutman Pepper Locke

New York Legislators Investigate Residential Property Insurance

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In a press release published August 25, New York Senators James Skoufis, Jamaal Bailey, and Brian Kavanagh announced a joint investigation into residential property insurance. The purpose of the investigation is “to identify...more

Mandelbaum Barrett PC

What Makes Catastrophic Brain Injury Cases Different From Other Personal Injury Claims?

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The moment a traumatic brain injury occurs, everything changes for you and your family. Unlike a broken bone that heals or a cut that leaves a scar, brain injuries create invisible wounds that can permanently alter...more

J.S. Held

When the Smoke Clears: Business Interruption Claims from Wildfire Evacuations Without Physical Damage

J.S. Held on

Over the past three to four summers, the insurance industry has seen a significant increase in wildfire evacuation claims (also known as civil authority). The Insurance Bureau of Canada ranked the summer of 2024 as the...more

Zelle  LLP

No Exceptions (Unless Prescribed by Law): Court Grants Motion to Preclude Attorneys’ Fees Even Though Carrier Will “Not Entertain”...

Zelle LLP on

In this case, Safeco Insurance Company of Indiana (“Safeco”) issued a residential policy to Venugopal Muriki (the “Insured”) covering the Insured’s dwelling. On December 10, 2024, the Insured submitted a claim with Safeco...more

Zelle  LLP

Rescission: Timing Matters Under Texas Law

Zelle LLP on

As discussed in an article Zelle drafted in November 2023, "Viewpoint: Non-renewal, Cancellation, Reformation and Rescission of Insurance Policies in Texas", an insurer that wishes to rescind an insurance policy on the basis...more

King & Spalding

Aetna Policy Attempts to Circumvent Two Midnight Rule for MA Plans

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In a recent Aetna newsletter update (also referred to as OfficeLink), Aetna advised that it would change its reimbursement approach for emergent or urgent inpatient stays that span at least one midnight at facilities that...more

Cozen O'Connor

When Algorithms Deny: AI and the New Frontier of Bad Faith

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As industries across the board adopt artificial intelligence (AI), insurers have likewise recognized its potential to enhance efficiency in claims administration. Yet with this opportunity comes tension: consumers expect both...more

Cozen O'Connor

South Florida Wildfires Status & Subrogation Risk Analysis

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Two wildfires in the Everglades near the Broward County border remain fully uncontained, causing widespread smoke, degraded air quality, and reduced visibility across South Florida. Current Situation Overview - Two...more

J.S. Held

Gross Profit Calculation Challenges in Business Interruption Insurance After UAE Floods and COVID-19

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Often, forensic accountants face practical challenges when calculating business interruption (BI) losses. These issues have been highlighted by recent claims following COVID-19 and the 2024 storm in the UAE which caused...more

Maynard Nexsen

Keeping an Eye Out for Litigation Involving Increasingly Popular Gap Coverage

Maynard Nexsen on

So-called “gap” insurance policies – policies that provide critical-illness, hospital-indemnity and specified-disease coverage – have been on the rise due to a number of factors, including the frequency of high-deductible...more

Bradley Arant Boult Cummings LLP

Texas Court Exposes Key Gap in Professional Liability Coverage for Home Health Franchisors

In the home health care business? Whether a franchisor, franchisee, or independent agency, beware of bodily injury exclusions in professional liability policies that could eliminate coverage for otherwise covered claims....more

Wiley Rein LLP

Professional Services Exclusion Bars Coverage for Suit Stemming from Faulty DNA Analysis

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In a win for Wiley’s client, a Florida federal court held that a professional services exclusion barred coverage for underlying litigation arising out of the insured’s faulty DNA analysis services. A DNA laboratory provided...more

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

Jackson Walker

Senate Bill (SB) 2544: Mediation Filing Deadlines for Out-Of-Network Facilities

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The recently enacted Texas Senate Bill (SB) 2544 imposes mandatory mediation filing deadlines for out-of-network (OON) facility providers. Under Insurance Code Chapter 1467, OON facility providers (including ambulatory...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

Goldberg Segalla

Navigating the Time-Limited Policy Limits Demand: Best Practices for Insurers and Defense Counsel

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In the evolving landscape of insurance litigation, the time-limited, policy limits demand has emerged as a high-stakes challenge for insurers, defense counsel, and claims professionals alike. These demands – often issued...more

Pillsbury - Policyholder Pulse blog

Strength in Numbers—The Class Actions Strategy for Insurance Claims

When wildfires, floods or other disasters strike, multiple policyholders can be affected in similar ways. But historically, each policyholder would take on their insurance company alone—a tough task, especially for individual...more

WaterStreet Company

2025 Trends in P&C Insurance: Technology, Competition and Innovation

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The U.S. P&C insurance industry is in the midst of profound transformation in 2025, driven largely by rapid technological advancement and evolving risk dynamics. According to Kelly King, a seasoned expert with over 30 years...more

J.S. Held

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

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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

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

Bracewell LLP

Q&A: Essential Questions to Ask When Preparing Your Commercial Property’s Hurricane Insurance Policy

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Commercial property hurricane insurance presents complex challenges that require careful consideration and strategic planning. Business owners must understand critical coverage elements, policy limitations and claim...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

Kennedys

Appellate Court of Illinois decision reminds insurers to communicate with insureds or face potential consequences: Estoppel of...

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The Appellate Court of Illinois recently reminded insurers that they may be estopped from raising coverage defenses through their misleading acts or statements, including silence. In Monroy-Perez v. Sentry Select Ins. Co.,...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

Cozen O'Connor

Texas Supreme Court Reaffirms Procedure for Litigating Bad Faith Claims in UM/UIM Cases

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In In Re State Farm Automobile Insurance Co. and Lindsey Nicole Dessart, 712 S.W.3d 53 (Tex. 2025), the Texas Supreme Court clarified the proper procedure for litigating bad faith claims related to uninsured/underinsured...more

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