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Delaware court: settlement for statutory damages, calculated without reference to actual damages incurred, is for penalty, not covered loss

Wiley Rein LLP
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USA
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May 14 2013

A Delaware trial court has held that a settlement for statutory damages paid by a health care organization represents uncovered penalties rather than

Under California law, medical malpractice policies do not cover medical board professional disciplinary actions

Wiley Rein LLP
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USA
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June 15 2012

A New Jersey appellate court, applying California law, has held that a medical malpractice liability insurer had no duty to reimburse an insured physician for defense costs incurred in connection with a professional disciplinary action brought against him by the California Medical Board

Claim first made when insured received writ of summons

Wiley Rein LLP
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USA
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February 17 2012

A Pennsylvania state court has held that a claim against an insured psychiatrist was first made under his professional liability policy when he was served with a writ of summons commencing a malpractice suit, not when he received a medical records request for a deceased patient or when he sought help from the insurer in responding to the request

Employees' claims for unpaid medical benefits not "loss" under company's fiduciary liability policy

Wiley Rein LLP
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USA
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January 19 2012

The United States District Court for the Southern District of West Virginia has held that employees’ claims for unpaid medical benefits arising from the mismanagement of a company’s benefits plan constituted “benefits due” and therefore were carved out from the definition of “loss” in the entity’s fiduciary liability policy

Insurer must defend claim for non-covered damages

Wiley Rein LLP
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USA
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December 20 2011

Applying Louisiana law, the United States Court of Appeals for the Fifth Circuit has held that an insurer had a duty to defend even though the damages sought in the lawsuit were not covered

Professional services exclusion in policy issued to medical provider applies to all actions directed at patient treatment

Wiley Rein LLP
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USA
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December 5 2011

The United States District Court for the Western District of Washington has held that a professional services exclusion in a policy issued to a medical provider excludes coverage for any claims arising from the medical treatment of individuals

Insured's misrepresentation in reinstatement application not material where policy required insurer to offer extension

Wiley Rein LLP
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USA
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September 21 2011

Applying California law, the United States District Court for the Southern District of California has held that a dentist’s misrepresentation in seeking extension of a policy was not material where the policy required the insurer to offer and allow the extension

Exclusion for sexual misconduct precludes duty to defend employer

Wiley Rein LLP
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USA
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September 14 2011

Applying Texas law, the United States Court of Appeals for the Fifth Circuit has held that an exclusion for claims "arising out of" sexual misconduct applied to bar coverage for a medical group for a lawsuit alleging that its employee sexually assaulted a patient. Nat'l Fire Ins

Exclusion for sexual misconduct precludes duty to defend against employer

Wiley Rein LLP
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USA
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September 7 2011

Applying Texas law, the United States Court of Appeals has held that an exclusion for claims “arising out of” sexual misconduct applied to bar coverage for a medical group for a lawsuit alleging that its employee sexually assaulted a patient

Settlement with insurer as to claim did not bar coverage for later-arising interrelated claim

Wiley Rein LLP
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USA
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August 26 2011

Applying Michigan law, the United States District Court for the Eastern District of Michigan has held that a release executed between an insurer and policyholder that settled the parties’ coverage dispute under the applicable policy with respect to a claim did not preclude coverage for an interrelated claim made after the release

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