RICO Archives - The Insurance & Reinsurance Report

September 22, 2015 Fraud

Feels like a Fraud: Fifth Circuit Rules in Favor of Insurer; Awards $6M in Fraudulent Claims Case

In Allstate Insurance Company et al. v. Michael Kent Plambeck, DC, et al. United States Court of Appeals for the Fifth Circuit, September 17, 2015, an insurer was awarded a $6 million verdict against a group of chiropractors, lawyers and telemarketers that coerced individuals into making fraudulent claims against the insurer. The District Court awarded the verdict based on the Racketeer Influenced and Corrupt Organizations Act (RICO). On September 17, 2015, the Fifth Circuit Court upheld the verdict.

The insurer accused the telemarketers of …

May 20, 2015 Uncategorized

Indiana Supreme Court Finds Insured Afforded Coverage For “Professional Services”

In Wellpoint, Inc. v. National Union Fire Insurance Company of Pittsburgh, PA, No. 49S05-1404-PL-244 (Ind. Apr. 22, 2015) the Indiana Supreme Court reversed the trial court and granted summary judgment for Anthem, Inc.against numerous reinsurers (Excess Reinsurers), finding that Anthem was afforded coverage in the underlying litigation under the reinsurance policies.

Anthem, a large managed health care organization, was self-insured for E&O liability. It purchased policies from other insurers to reinsure its E&O liabilities. The underlying litigation consisted of several lawsuits filed against …