Westlaw Topical Highlights: Insurance, October 11, 2013

October 11, 2013

insuranceWestlaw Topical Highlights for Insurance provides summaries of significant federal and state judicial decisions and legislative and administrative activities affecting Insurance law.  A Westlaw subscription is required to access the documents linked from this page.

Jury: The Insurance Fraud Prevention Act did not imply a right to a jury trial.  Allstate New Jersey Ins. Co. v. Lajara 2013 WL 5538723 (N.J.Super.A.D.)  The Insurance Fraud Prevention Act did not imply a right to jury trial. Insurers filed suit against chiropractic care practitioners, physicians, and others arising out of the insurers’ payments on allegedly fraudulent claims for personal injury protection benefits. The Act was silent on the right. The Superior Court, Appellate Division, noted that the Legislature was empowered to provide for such a right and knew how to do so, and therefore, the Court was reluctant to consider such a right implied when it was not expressed. Furthermore, the Act authorized the Commissioner of Banking and Insurance to issue restitutionary orders in order to restore any losses to the insurers, which could only be challenged in a summary proceeding before the Office of Administrative Law (OAL), in which proceedings there was no jury. Moreover, the Act was expressly intended to confront aggressively the problem of insurance fraud by facilitating the detection of insurance fraud, eliminating the occurrence of such fraud through the development of fraud prevention programs, requiring the restitution of fraudulently obtained insurance benefits, and reducing the amount of premium dollars used to pay fraudulent claims. The Legislature’s apparent goal to create a swift and cost-effective remedy was evident in the provisions which authorized non-jury administrative actions, whereas speed and efficiency were usually not included among the many strengths of a jury trial. 2013 WL 5538723.  (The full-text of the rest of the Topical Highlights is available within Westlaw Next, subscription required).

 Industry Regulation: Vision care insurer’s independent participating provider (IPP) agreement violated Patient Access to Eye Care Act.  Spectera, Inc. v. Wilson 2013 WL 5508602 (Ga.)

Automobile: Letter from UIM insurer accepting coverage was sufficient to trigger statutory safe harbor provision.  Zimmerman v. Allstate Property and Cas. Ins. Co. 2013 WL 5497223 (Or.)

Motion Practice: Insureds failed to present new and additional facts required to grant renewal of insurance broker’s motion to dismiss.   Dauria v. Castlepoint Ins. Co. 2013 WL 5496097 (N.Y.Sup.)

Liability: Factual issue existed as to whether insured made misrepresentations in sworn statements in proof of loss.  OSA Healthcare, Inc. v. Mount Vernon Fire Ins. Co. 2013 WL 5348600 (N.D.Ga.)

Duty to Defend: Insured potentially could be liable for other conduct that would be within policy period due to nature of class action.  Nationwide Mut. Ins. Co. v. Harris Medical Associates, LLC 2013 WL 5341498 (E.D.Mo.)