Author: Goldberg Segalla

Life, Health, Disability & ERISA

Extra-Record Evidence Denied Challenging Substantive Determination.

Richard v. Fleet Financial Group Incorp. LTD Employee Benefit Plan

(2nd Cir., February 24, 2010) 

 

In an ERISA action, plaintiff challenged the denial of her long term disability benefits due to chronic fatigue syndrome.  The Court held that, under a discretionary review, the insurer’s decision to deny benefits was reasonable and supported by substantial evidence.  The objective evidence in the administrative record considered by the Second Circuit included surveillance videos, occupational therapy assessment, independent evaluation, independent review of the claims file and statements …

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Arbitration

District Court Finds that Arbitration Clause is Enforceable and Valid

Franz v. Allegheny Investments, Ltd. (N.D. Ohio February 11, 2010)

A former employee sought brought suit against his former employer for the employer's alleged failure to promptly notify the relevant insurance carrier and provide defense coverage to the employee for claims made against him and the employer in a Financial Industry Regulatory Authority arbitration.  As a result of employer's failures, the employee ultimately had to retain counsel to defend him in the arbitration.  At the underlying arbitration, the employer successfully defended the claim, but the former employee was found liable.

The

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Arbitration

Arbitration Clause In Insurance Contract Enforceable under the Federal Arbitration Act

Duke University v. National Union Fire Ins. Co.

M.D. N.C., February 4, 2010

 

This action involves a dispute by plaintiff policyholder against defendant insurer alleging breach of an insurance policy by the insurer’s failure to advance and/or pay all of the policyholder’s defense costs.  Defendant insurer then instituted a third-party action against United Educators, claiming that it was entitled to contribution, subrogation and declaratory relief.

 

The policy between the policyholder and third party defendant included an arbitration agreement and third party …

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CaseWatch

Cases for CaseWatch: Insurance January 27, 2010 Edition

Cases provided courtesy of Lexis.

Copple Construction, LLC v. Columbia Nat. Ins. Co. 

Farmers Ins. Exchange v. Johnson 

GEICO v. City of Newark 

Hopkins v. The MEGA Life and Health Ins. Co. 

Johnson v. Progressive Insurance Co. 

Kasid v. Country Mut. Ins. Co. 

Lloyds Underwriters at London v. Keystone Equipment Finance Corp. 

Lopez v. United Automobile Ins. Co. 

McQuinnie v. American Home Assurance Co. 

Metropolitan Trans. Auth. v. Zurich Am. Ins. Co. 

Montemurro v. Granite …

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Arbitration

Arbitration Compelled Regarding GAP Coverage

Sawyers v. Herrin-Gear Chevrolet Co., Inc.

(Miss., January 7, 2010)

 

The Mississippi Supreme Court held that it has jurisdiction to consider the merits of an interlocutory appeal regarding whether a claim arising from GAP coverage should be arbitrated.  Plaintiff filed a complaint alleging fraud, breach of contract and bad faith, against an auto dealer and an insurance company who provided “GAP Asset Protection Deficiency Waiver Addendum.”   The defendants made a motion to compel arbitration, which was granted by the trial court.  Plaintiff then filed …

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Reinsurance

Connecticut District Court Dismisses Complaint Against Reinsurer

Arrowood Surplus Lines Ins. Co. v. Westport Ins. Corp.

(D. Conn. January 5, 2010)

 

Plaintiff’s predecessor, Royal Surplus Lines Insurance Company (“Royal Surplus”) entered into an agreement pursuant to which it assumed the liabilities and acquired the related assets of Connecticut Specialty Insurance’s Company (“Connecticut Specialty”) covered business as of December 31, 2001.  From February 1, 1999 until May 16, 2000, Employers Reinsurance Company (“Employers Reinsurance”) reinsured a class of policies Connecticut Specialty issued, including one to Equity Residential (“Equity”) that went into …

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Life, Health, Disability & ERISA

Eleventh Circuit Court Reversed Lower Court Holding In Favor Of Insurer On Denial Of ERISA Claims

Capone v. Aetna Life Ins. Co.

(United States Court Of Appeals, Eleventh Circuit, January 5, 2010)

 

This action arises out of a diving accident wherein policyholder struck his head on the bottom of the ocean while diving in the Bahamas, paralyzing himself from the neck down.  Policyholder sought benefits under the Accidental Death and Personal Loss provision of his employee health insurance policy administered by Aetna.  Aetna denied the policyholder’s claim for benefits and the district court granted Aetna’s motion for summary …

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