In Humana Inc. v. Teva Pharmaceuticals USA, Inc., the District Court for the Middle District of Florida (the “Court”) dismissed claims brought by Humana under the Racketeer Influenced and Corrupt Organizations Act (“RICO”) against Teva Pharmaceuticals USA and a few specialty pharmacies (collectively, “Teva”). The Court ruled that Humana lacked standing to sue due to the indirect purchaser rule. Despite the case’s dismissal, it’s important for hospitals and health care providers to focus on compliance with payors as
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AI Issues in the Commercial Auto Policy: The Insurer’s Perspective
Amundsen Davis Transportation Alert
August 14, 2025
The introduction of artificial intelligence into commercial vehicles has revolutionized the insurance marketplace. Conventional thinking runs that this technology will be beneficial for insurers. For example, AI-enhanced dash cameras have the ability to spot distant vehicles and road obstructions far better than the naked eye. This allows for fleet operators to quickly deploy mitigation techniques, such as braking and gear-shifting, thus avoiding serious accidents. Additionally, predictive maintenance sensors exist to alert drivers
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More Than a Diagnosis: The Objective Evidence Gap That Sinks LTD Claims
When it comes to long-term disability (LTD) claims, having a diagnosed medical condition is only part of the story. Many claimants are surprised to learn that simply proving you have a medical condition, and even having the support of a treating provider as well, does not guarantee an approval of a claim. What can make or break a case to insurers and courts is whether you can objectively prove how your condition limits your ability to work. This distinction
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The Hidden Dangers of Working Part-Time While on Long-Term Disability
If you’re getting Long-Term Disability (LTD) benefits, you might wonder: can I work part-time when I’m on Long-Term Disability?
The answer is usually yes! Long-Term Disability policies are all different and so it’s important to consult the terms of your specific policy (also called the “plan documents.”) If you don’t have a copy of the policy terms, you should be able to obtain them from either the Long-Term Disability insurance company or your employer. The plan documents are usually
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Some Thoughts on Minor Settlements and GALs in Personal Injury Cases
I devote a not-so-small portion of my practice to serving as a guardian ad litem in cases involving minor settlements. I scratched my head a number of times last year at anecdotes I heard and things I witnessed myself when it came to dealing with minor settlements.
And that got me thinking; maybe we should all think a bit more about how to most effectively and efficiently approach settlements offered to minors.
I am hopeful that anyone reading this
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Wisconsin Appellate Court Interprets Construction Defect Exclusion and Fungi Exclusion
Cincinnati Insurance Company v. James Ropicky, et al., No. 2023AP588, 2024 WL 5220615 (Wis. Ct. App. Dec. 26, 2024)
On December 26, 2024, the Court of Appeals of Wisconsin issued is decision in Cincinnati Insurance Company v. James Ropicky, et al., No. 2023AP588, 2024 WL 5220615 (Wis. Ct. App. Dec. 26, 2024), addressing whether an ensuing cause of loss exception to a Construction Defect Exclusion, Fungi Exclusion, and Fungi Additional Coverage endorsement contained in a homeowner’s insurance policy issued
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Climate Change: Are Insurers Really ‘Covering Less’?
Policyholders nationwide are frustrated with the insurance industry in general. The recent murder of one of the nation’s largest healthcare insurers by a disgruntled policyholder is just one glaring example.[1] Or consider the 26.4% premium increase homeowners across the country experienced over the past three years on average.[2] Here in Wisconsin, homeowners saw their premiums jump 21.4% on average since 2018. While policyholder dissatisfaction is certainly expected in the wake of national headlines and skyrocketing premiums, it
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Standards for Insurance Bad Faith Under Wisconsin Law
Oftentimes, when an insured sues their insurance company for not providing benefits the insured believes they are entitled to under their policy, the insured alleges that the insurance company breached the applicable contract and did so in bad faith. Wisconsin law makes clear that breach of contract and bad faith are distinctly separate claims, with different elements that the insured must establish.
Wisconsin first recognized the tort of bad faith in the state Supreme Court’s seminal decision in the
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Contractually Defining UIM Coverage
Miller v. West Bend Mutual Insurance Company
No. 2023AP1697 (Wis. Ct. App. Oct. 22, 2024) (recommended for publication)
In Miller v. West Bend Mutual Insurance Company, the Wisconsin Court of Appeals considered whether Wisconsin law permits insurers to define “underinsured motor vehicle” to exclude government-owned vehicles in a UIM policy. No. 2023AP1697 (Wis. Ct. App. Oct. 22, 2024). The court answered in the affirmative and recommended the opinion for publication, thereby confirming that the 2011 amendments to Wisconsin’s auto
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Connelly: How to Pull the Wrench from the Works
In last week’s post, we talked about the Connelly case before the U.S. Supreme Court, which involved a fight between an estate and the IRS about whether money from a Key Person Insurance policy (that a company takes out on the lives of its shareholders) should count toward the company’s fair-market valuation for the purposes of estate taxes for the shareholder’s estate. The link for last week’s post can be found here.
With the context and case last
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Can I Sue My Insurance Company for Denying Coverage?
Posted on August 21,2024 in Insurance Coverage Litigation
Few of us enjoy paying our insurance premiums every month, yet we do so because we understand that catastrophes can happen and we may need a safety net to cover our health, home, and finances in an emergency.
When an insurance company tries to deny or reduce coverage for illegitimate reasons, this is called “bad faith insurance.” The law prohibits insurance companies from acting this way, and people who
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The Wisconsin Court of Appeals’ Provides Further Guidance on the Intersection Between Volitional Acts and Occurrences
McLaughlin v. Gaslight Pointe Condominium Association, LTD
No. 2023AP1011 (Wis. Ct. App. Apr. 17, 2024)
In McLaughlin v. Gaslight Pointe Condominium Association, LTD, the Wisconsin Court of Appeals contributed to Wisconsin’s ever-growing body of caselaw examining when an insured’s intentional conduct may constitute an “occurrence” within the meaning of a CGL policy. No. 2023AP1011 (Wis. Ct. App. Apr. 17, 2024) (recommended for publication). The court also examined several exclusions commonly found in CGL policies. In brief, the facts of
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Mitigating Litigation Risk for Small Businesses
In the business world, there is always the risk of litigation–even for small businesses. Unfortunately, as a business continues its operations, the possibility of litigation turns from an “if” to a “when.” Litigation can be expensive, time-consuming, and stressful. Here are some basic considerations that can help mitigate the risk of litigation for a small business.
1. Put it in writing in definite terms.
As stated in Field of Dreams, “If you build it, they will come. . .”
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Policy Exceptions – A Tale of Two Interpretations
Robert Bolger v. Massachusetts Bay Insurance Company, 2022AP742
In Bolger, Massachusetts Bay Insurance Company (MBIC) issued a homeowner’s insurance policy to Bret and Amy Achtenhagen that covered their primary home and further provided personal liability and medical payments to others coverage. The policy contained an exclusion for bodily injury “arising out of the ownership, maintenance, use, loading or unloading of …motorized land conveyances …owned or operated by …an ‘insured,’” subject to an exception for “[a] vehicle or conveyance not
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Irrevocable Life Insurance Trusts Make Your Estate Tax Efficient
Irrevocable Life Insurance Trusts may alleviate heavy tax burdens on your estate. Are you aware your life insurance policy may bring a heavy tax burden along with it? Many individuals and families are unaware of how their life insurance policies may affect their estate plans, especially those with significant wealth. But fear not, there’s a solution that might just alleviate this stress: Irrevocable Life Insurance Trusts (ILITs) and Crummey Letters.
Let’s break it down into simpler terms.
What’s an
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Is the first settlement offer the right move for your claim?
Suffering a personal injury is a challenging experience, and the first settlement offer may seem like a lifeline.
However, before accepting it, it is important to carefully reconsider for several reasons.
Assessing the full extent of injuries
One key reason to reconsider the initial settlement offer is the need to fully understand the extent of your injuries. Often, immediate medical expenses are evident, but some injuries may not manifest immediately. It is important to give yourself time to assess
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