Thomas F. Segalla, Author at The Insurance & Reinsurance Report

After being denied coverage under her employer’s long term disability plan, an employee filed an ERISA action for benefits. The employee argued that the court should review the matter under a de novo standard. The Seventh Circuit held that the benefits determination was subject to an arbitrary and capricious standard of review rather than de novo because the plan grants the insurer discretion in its benefits determinations. …

September 29, 2009 Industry News

National Association of Insurance Commissioners Government Relations Leadership Council approved proposed legislation intended to modernize regulation of reinsurance by the states for submission to Congress

Last week, the National Association of Insurance Commissioners Government Relations Leadership Council approved proposed legislation intended to modernize regulation of reinsurance by the states for submission to Congress. The proposed legislation establishes a "Reinsurance Supervision Review Board," which has power to:

"(1) evaluate the reinsurance supervisory systems of the States to determine whether such jurisdictions qualify as Home State Supervisors or Port of Entry Supervisors under standards recommended by the NAIC and adopted by the Board;

(2) evaluate the reinsurance supervisory systems of non-U.S. Jurisdictions …

September 28, 2009 Bad Faith and Extra-Contractual Liability

Court Affirms Imposition of Punitive Damages Award For Insurer’s Bad Faith In Rescinding Health Insurance Policy

Mitchell v. Fortis Ins. Co.

(Supreme Court of South Carolina, September 14, 2009)

Policyholder brought causes of action for breach of contract and bad faith rescission against his insurance company, and sought actual and punitive damages as a result of the company’s termination of his health care insurance from original issuance on the grounds of a purported material misrepresentation due to a subsequent positive HIV test and mis-dated referral note. The jury awarded the policyholder $36,000 in actual damages on the breach of …

September 28, 2009 Uncategorized

South Carolina Supreme Court Holds Coverage For Advertising Injuries Includes Trademark Infringement Claims

Super Duper, Inc. v. PennsylvaniaNat. Mut. Ins. Co., et. al..

(Supreme Court of South Carolina, September 14, 2009)

As an issue of first impression in South Carolina was whether a policy’s inclusion of an advertising injury also encompassed trademark infringement claims pertaining to educational materials for children. Mattel Inc. challenged the insured’s registration of four trademarks and the insured subsequently brought a declaratory judgment action in federal district court to determine if its trademark infringed on Mattel’s trademarks. Super Duper was insured by …

September 27, 2009 Industry News

International Alternative Dispute Resolution Academy to be Held November 18 – 20 in Chicago

The International Alternative Dispute Resolution Academy is an educational program designed to provide advanced practice and training on arbitration and mediation. Over three days, our expert faculty, consisting of practitioners, mediators, and arbitrators, will lead participants through a combination of interactive discussions and workshops. The program will follow a proven format of demonstration and hands-on practice.

Highlights will include small group sessions on drafting ADR provisions and building a winning case based upon a hypothetical fact pattern. Mock role-playing vignettes will demonstrate how to prepare your client …

September 25, 2009 Uncategorized

District Court Divests Itself of Jurisdiction in CIGNA Class Action Settlement

Miller v. Connecticut Gen. Life Ins. Co.

(S.D. W. Va. Sept. 11, 2009)

The plaintiff filed suit against CIGNA to enforce an arbitration award for life insurance benefits. The plaintiff, a West Virginia resident, was a member of a settlement class in a class action brought against CIGNA in U.S. District Court for the Central District of California. The litigation involved alleged misrepresentations made by CIGNA and its agents to purchasers of life insurance proceeds. A Final Order from that action provided that the court …

September 24, 2009 Reinsurance

District Court Denies Motion to Vacate Arbitration Decision Involving Crop Insurance Policies

Svancara v. Rain and Hail LLC

(D. Neb., September 11, 2009)

Plaintiffs-policyholders purchased separate crop insurance policies from defendant-insurer through an agent. The policies included identical clauses concerning arbitration. The policyholders made separate claims under their individual policies for crop damage which the insurer denied. The policyholders then proceeded to arbitration and the arbitrator returned separate awards in favor of the insurer on each of the policyholders’ claims. The policyholders then filed suit in the district court claiming that the insurer …