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New headlines added throughout the day, so stop back for updates on key rulings and more. NEW! 5/11/2008 12:32:03 PM EST Posted by Robert G. Rassp, Esq.
DWC Unveils Proposed Rules
On May 9, 2008, the Division of Workers’ Compensation announced the long awaited revision of the permanent disability rating schedule (PDRS) which changes the arrangement of FEC adjustments for each injured part of body and also increases each FEC multiplier as well.
Effective Dates for 2009 PDRS
The proposed 2009 PDRS, mandated by Cal. Lab. Code &
5/10/2008 12:10:11 AM EST
5/9/2008 1:29:29 PM EST As the DWC starts its transition to a "less paper" world, the workers' comp community will need to have ready access to everything related to EAMS (Electronic Adjudication Management System.) How will conferences and trials be conducted? What type of equipment do I need to use EAMS? How will privacy concerns be addressed?
I. Answers to Frequently Asked Questions
All of these questions and more can be found on the DWC website by clicking on: http://www.dir.ca.gov/dwc
5/2/2008 11:24:04 AM EST The attempts to prevent insurance fraud are not entirely useless. As I report in this month's issue of Zalma's Insurance Fraud Letter, the following were convicted of variations of the crime of insurance fraud:
Convictions
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5/1/2008 11:51:57 AM EST Posted by Vivi GormanLexisNexis Insurance Law Center Staff The Second District California Court of Appeal this week prevented a general contractor’s insurer from recouping defense costs relating to an underlying construction defects lawsuit from an insurer of a drywall subcontractor under a theory of equitable contribution where the underlying complaint makes no allegations concerning drywall installation or defects.
In Monticello Insurance Co. v. Essex Insurance Co. (April 28, 2008), the additional insured endorsement at issue i
4/30/2008 11:39:59 AM EST It should be axiomatic that almost every lawsuit is defended by one or more insurance companies and most civil judgments are paid by insurance. Vexatious litigation skews actuarial tables and increases the cost of insurance to everyone.
A case in point is Molski v. Evergreen Dynasty Corp., No. 05-56452 (9th Cir Create an account or login to post comments. | Comments (0)
4/28/2008 10:17:41 AM EST I. Overview of the System
DWC is entering the digital age. The Electronic Adjudication Management System (EAMS) will allow us to switch from paper to paperless in a gradual three-step process.
4/22/2008 12:53:38 PM EST Available now for a limited time! The recording and power point presentation for the LexisNexis webinar The Silent PPO Dilemna: California’s Medical Providers Harmed by Stealth Contracts are now posted on this site.
To listen to the audio recording and to access the power point presentation of the Silent PPO webinar, go to Continue reading >>
4/18/2008 11:37:35 AM EST Insurance fraud is seen as such a minor crime that a lawyer claimed, as a defense to a murder charge, that "it was only insurance fraud." The fight against insurance fraud will continue unabated and without success, as long as the public and lawyers consider it to be so proper that it would be a defense to a more serious crime.
Defense Attorney Diamond''s argument in People v. Golay & Rutterschmidt (the "Black Widows" case) is one of the reasons why insurance
4/17/2008 12:02:48 PM EST The State of Louisiana has made and is making so-called “Road Home” grants to Louisiana homeowners rebuilding homes damaged or destroyed by Hurricanes Katrina and Rita. The homeowners assign the right to all insurance benefits that may be due them, up to the amount of the grant. Louisiana contends that insurers have been denying benefits actually due, thereby reducing Louisiana’s recoveries. It filed a massive class action against more that 200 insurance car Create an account or login to post comments. | Comments (0)
4/16/2008 11:57:02 AM EST In a move that will stick in the craw of the plaintiffs'' bar and stop most claims of bad-faith, improve the availability and price of insurance in Minnesota, and take the profit motive out of insurance claims, Minnesota lawmakers approved a bill limiting bad faith claims against insurers. The new statute passed on April 14, 2008: (1) Limits bad faith causes of action to first party claimants only, (2) requires a reasonable basis for denying a claim and (3) allows insurers to conduct fraud or fi Create an account or login to post comments. | Read Comments (6)
4/15/2008 4:26:51 PM EST The 1994 Northridge, California earthquake that caused billions of dollars in damages across Southern California also drew unscrupulous lawyers and public adjusters seeking fast money. Investigation was limited and because of the catastrophe many unnecessary and spurious suits were filed. Insurance fraud was rampant and insurers paid rather than fight. In addition insurers denied claims they should not have denied.
Their errors caused the state of California Create an account or login to post comments. | Comments (0)
4/15/2008 12:10:08 PM EST Although insurance fraud is the least prosecuted of major felonies, I try to give credit to those few agencies who actually arrest, try and convict insurance fraud criminals. Here are some I collected last month. As you read note the wide disparity in penalties imposed by the various jurisdictions.
Medicaid Fraud Defeated CVS Caremark Corp. agreed in March 2008 to pay almost $37 million to nearly two dozen states and the federal government to settle Comments (0)
4/14/2008 1:40:34 PM EST Insurance fraud is not a local problem. It is a depletion of the wealth of the entire country. Insurance fraud is recognized to be a $100 Billion yearly crime in which the victims of the crime are insurers who are less than loved by the public. If properly prepared, however, the insurer victim can avoid liability to those who attempt to profit from an insurance policy by fraudulent conduct.
The majority of fraudulent insurance claims are made by people with legitimate claims covered Comments (0)
4/9/2008 10:09:56 AM EST
Judge Brian E. Sandoval of the U.S. District Court in Nevada awarded a partial summary judgment to a leading national gaming operator. Pinnacle Entertainment, Inc., in an insurance coverage case arising out of Hurricane Katrina.
The c Create an account or login to post comments. | Read Comments (1)
4/9/2008 8:59:49 AM EST The Louisiana Supreme Court has unanimously enforced the flood exclusion for Hurricane Katrina losses in New Orleans. Sher had a five-unit apartment building that suffered some wind damage to the upper stories and had flood waters reach a level of four feet deep in the first level. The trial court held the flood exclusion ambiguous and ineffective. A jury made separate awards for damage to the upper stories and damage to the first level and a lost rents award for both parts o Create an account or login to post comments. | Comments (0)
4/8/2008 9:05:10 AM EST On April 7, 2008, the Fifth Circuit reversed a judgment for actual and punitive damages against State Farm in a Mississippi bad faith case arising out of Hurricane Katrina. Storm surge had left the Broussards’ home totally destroyed, leaving only the foundation slab. Their policy had “named peril” coverage for wind damage to their personal property and “open peril” coverage for da Create an account or login to post comments. | Comments (0)
4/7/2008 9:17:37 AM EST Policyholder notified his insurer regarding a trademark infringement lawsuit over his band name, "The Doors", and requested coverage under his commercial general policies. Insurer denied coverage on the basis that such a claim was excluded from coverage under the "field of entertainment" exclusion. The Ninth Circuit concluded that there is an argument that the complaint asserts a separate breach of contract action that, at minimum, raises at least the potential for coverage u Create an account or login to post comments. | Comments (0)
3/27/2008 4:12:03 PM EST Posted by Vivi GormanLexisNexis Insurance Law Center Staff If you fancy yourself an insurance geek extraordinaire (or even apprentice), it’s the kind of thing that’ll make you say “saweet” out loud. Now you can get asbestos insurance case news of 2007 all together in your favorite place: this link right here. Mea Comments (0)
3/24/2008 2:37:28 PM EST Posted by Jeffrey W. StempelWilliam S. Boyd Professor of Law at the William S. Boyd School of Law, University of Nevada, Las Vegas Hurricane Katrina engendered an avalanche of coverage litigation (calling it a "flood" would be too badly sick a pun). Countless hours of judicial and attorney time (and corresponding financial and social cost) has been expended, primarily over the degree to which property destruction resulted from windstorm versus water damage, with substantial disputing over the question of whether the broadly worded flood exclusions foun Create an account or login to post comments. | Read Comments (3)
3/24/2008 11:58:33 AM EST A plenary session at the ICLC Annual Meeting on February 28 was entitled “Confronting Catastrophe: Pandemics, Hurricanes, Terrorists – Oh My!” The program noted that “The extreme ruin caused by Hurricane Katrina would pale in comparison to a nationwide calamity, such as a flu pandemic. This audience interactive session will leverage the advice of experts, including professionals who endured Hurri |