News & Analysis as of

Reimbursements Insurance Litigation

Arnall Golden Gregory LLP

Healthcare Providers Keep Singing the Blues About Unfair Reimbursement Rates But Blue Cross Blue Shield Won’t Change Its Tune

After more than a decade of litigation and more than $5 billion in settlements, the Blue Cross Blue Shield Association (“BCBSA”) and its affiliate insurance companies (the “BCBS Entities”) appear to be up to their old tricks....more

Marshall Dennehey

Commonwealth Court Rejects Insurer’s Reimbursement Claim Against Pharmacy in Billing Dispute

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Pioneer Construction Company, Inc., Eastern Alliance Insurance Company, and employers Alliance, Inc. v. Insight Pharmaceuticals, LLC d/b/a Insight Pharmacy; No. 867 C.D. 2022; filed May 12, 2025; Judge Covey - A workers’...more

Arnall Golden Gregory LLP

Landmark $9.25M AGG Class Action Settlement Against UnitedHealthcare Receives Preliminary Approval, Class Claim Submission Process...

AGG Healthcare Litigation attorneys Rich Collins and Landen Benson represent two of the three named plaintiffs in an ERISA class action against UnitedHealthcare (“United”), involving the insurer’s denial of access to proton...more

Goldberg Segalla

Court Highlights Distinction Between Pre- and Post-Retirement Benefits and Workers’ Compensation Carrier’s Reimbursement Rights...

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The recent New York Court of Appeals decision in Matter of Schulze v. City of Newburgh Fire Department (April 10) has significant implications for municipal employers and workers’ compensation insurance carriers in New York,...more

Stoel Rives - Notice of Appeal

Oregon Supreme Court Clarifies Contribution Rights under the Oregon Environmental Cleanup Assistant Act

Last week, the Oregon Supreme Court issued an important decision interpreting the Oregon Environmental Cleanup Assistance Act (OECAA), clarifying the boundaries of insurer contribution rights and the scope of the statute’s...more

Chartwell Law

Evolving Cannabis Law and Workers’ Compensation

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As our understanding of medicine evolves - alongside society’s increasingly relaxed attitude toward cannabis - it’s no surprise that corresponding adjustments are emerging in the field of workers’ compensation law....more

Marshall Dennehey

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

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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

Laughlin, Falbo, Levy & Moresi LLP

Who Pays What: The Pitfalls of Contribution and Reimbursement Among Co-Defendants in Workers’ Compensation

The recent Barahona v. ABM Janitorial Services (2024) 53 CWCR 4, decision sheds light on a common but often misunderstood issue in California workers’ compensation: how liability is shared among multiple employers and...more

Kerr Russell

The Difference Between ‘Non-Covered’ vs. ‘Disallowed’ Services

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Question: I have had several colleagues describe their experience with dental plan audits. All of them have had to pay something back. Sometimes they say this is due to a service being deemed a “noncovered service.” Other...more

Buchalter

I Just Lost My Home or Business to a Fire, What Do I Do Next?

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Take a deep breath. Losing one’s home or business to a fire is devastating and the road to recovery will be long and winding. First and foremost, you need to take care of yourself and your family. Make sure everyone is safe,...more

Rumberger | Kirk

Florida Supreme Court Says Permissive Language of Florida PIP Statute and Policy Provisions Dictate Payment of Medical Expenses by...

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In Florida, personal injury protection (PIP) coverage limits reimbursement of medical charges to 80% of “all reasonable expenses.” What is “reasonable” is generally determined by a statutory schedule of maximum charges...more

Farella Braun + Martel LLP

When Can an Insurer Pursue a Malpractice Claim Against Defense Counsel Retained for an Insured? Part II: When Can an Insurer...

In Part I (”When Can an Insurer Pursue a Malpractice Claim Against Defense Counsel Retained for an Insured”) of our two-part article published by the ABA’s Insurance Coverage Litigation Committee (ICLC), we addressed the...more

Rivkin Radler LLP

Insurance Update - December 2023

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Our December Insurance Update features a few firsts from state high courts. For the first time: •The Supreme Court of Hawaii addresses reimbursement of defense costs. •The Supreme Court of Illinois addresses coverage for...more

Marshall Dennehey

County Court Rules in Favor of Insurer Regarding Application of the 2007 Medicare Part B Non-Facility Limiting Charge

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Next Medical Florida, LLC a/a/o Marvin Jackson v. United Services Automobile Assoc., Volusia County Case No: 2022-11377-CODL (71) - This suit involved the legal issue of whether or not the insurer was required to reimburse...more

White and Williams LLP

Top Developments October 2023

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DEFENSE COST REIMBURSEMENT - Cont’l Cas. Co. v. Winder Labs., LLC, 73 F.4th 934 (11th Cir. 2023) Eleventh Circuit predicts that, under Georgia law, insurers found to have no duty to defend underlying suits could not...more

Carlton Fields

Munich Re Prevails in Alabama Reinsurance Dispute

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A federal court recently agreed with Munich Re that it was not obligated to reimburse an insurer for losses and fees the insurer incurred in litigation with its professional liability carrier regarding a bad faith claim...more

Marshall Dennehey

Fourth District Court of Appeals Reverses Itself Regarding Application of the 2007 Medicare Part B Non-Facility Limiting PIP...

Marshall Dennehey on

Progressive Select Ins. Co. v. In House Diagnostic Services, Inc. a/a/o Darryl Frazier, No. 4D21-2581 - This suit involved the legal issue of whether Progressive Select Insurance Company incorrectly determined the...more

Pillsbury - Policyholder Pulse blog

Subrogation 101 (and Why Should I Care?)

What is subrogation? Why am I being asked to waive it? Should I care? To answer that last question, let’s take a quick run at the first two. What Is Subrogation? “Subrogation” refers to the act of one person or party standing...more

Lowenstein Sandler LLP

Finding the Right Fit: The Duty to Defend vs. the Duty to Reimburse (Part II)

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Hosts Lynda A. Bennett and Eric Jesse of Lowenstein’s Insurance Recovery Group continue their discussion about the difference between the duty to defend, the duty to reimburse, and the duty to advance. They run through the...more

Lowenstein Sandler LLP

The Difference between the Duty to Defend and the Duty to Reimburse: What Policyholders Need to Know

In this episode of “Don’t Take No for an Answer,” hosts Lynda A. Bennett and Eric Jesse of Lowenstein’s Insurance Recovery Group discuss the difference between a duty to defend versus a duty to reimburse. They explain why...more

Ervin Cohen & Jessup LLP

Companies That Pay Hackers May Be Able to Recoup Their Losses

Where companies are victimized by ransomware or email scams, their losses arise from payments made by an officer or employee of the company. In the case of ransomware, a company’s files are held hostage pending payment...more

Wiley Rein LLP

Eighth Circuit Affirms Medicare Reimbursement Claim Is Not “Based on Professional Services”

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The United States Court of Appeals for the Eighth Circuit, applying Iowa law, has held that a professional liability insurer had no duty to defend and indemnify a medical clinic and its director for claims by the clinic...more

McDermott Will & Emery

This Week in 340B: February 2023 #2

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This weekly series provides brief summaries to help you stay in the know on how 340B cases are developing across the country. Each week we comb through the dockets on more than 40 340B cases to provide you with a quick...more

Wiley Rein LLP

Nevada Supreme Court Holds Insurer May Recoup Defense Costs

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Answering a certified question regarding a matter of first impression, the Nevada Supreme Court has held that an insurer is entitled to reimbursement of defense costs expended in defense of an insured where a determination is...more

Payne & Fears

Nevada Supreme Court Recognizes an Insurer's Reimbursement Claim

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The Nevada Supreme Court held that insurers may seek reimbursement of defense costs if a court determines that it owed no duty to defend and the insurer reserved reimbursement rights. In Nautilus Insurance Company v....more

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