Archives

The Filed Rate Doctrine and the Insurance Arena

Vonda Mallicoat Laughlin

Volume 18

Issue 2

PUBLISHED

Spring 2012

Abstract

This article discusses the modern application and jurisprudential background of the “filed rate doctrine,” which courts use to uphold the validity of rates approved by regulatory agencies and to bar claims implicating those rates. The doctrine has enduring relevance in insurance litigation and overrides certain common legal principles. The article examines the doctrine’s broad applicability and provides a comprehensive overview of the many issues affecting its use. It reviews early cases that established the doctrine—predating the U.S. Supreme Court’s oft-cited decision in Keogh v. Chicago & Northwestern Railway Co.—and shows how the doctrine emerged from judicial deference to federal railroad rate regulations enacted by the Interstate Commerce Commission, grounded in legislative intent and concerns about fairness among ratepayers. The doctrine later expanded to other federally regulated industries, including energy and telecommunications. Its applicability to insurance litigation emerged in the mid-1980s. The article highlights recent cases demonstrating how courts have applied the doctrine to the insurance industry and how litigants have attempted to avoid its application. It delves into insurance-specific issues and conflicting authority on applying the doctrine in this context, and it addresses the doctrine’s use in claims for equitable relief as well as its inapplicability to certain claims, such as allegations of regulatory violations. The article further examines its relevance to fraud claims, charges outside basic rates, antitrust claims, discrimination claims, RICO claims, breach of contract claims, and kickback allegations, along with issues of administrative review. It concludes by considering the future of the filed rate doctrine and predicting its continued significance in insurance litigation.

Medically Unnecessary: How the Laws in Medicare Part D’s Coverage of Off-Label Medicines With Demonstrable Medical Necessity Prevents Better Healthcare Outcomes, Including for Beneficiaries With Psychiatric Disorders

Alexander W. Wang

Volume 19

Issue 1

PUBLISHED

Fall 2012

Abstract

This article examines the hardships faced by Medicare Part D patients—particularly mental health patients—in obtaining coverage for necessary but off-label drug prescriptions. It argues that the current Medicare Part D system is failing not only in its mission to provide quality care but also in its goal of cost-effectiveness. The paper advocates a comprehensive reform approach that would address both deficiencies by allowing case-by-case exceptions to the FDA-approved use requirement when such exceptions are supported by scientific evidence. This type of exception process would enable deserving beneficiaries to obtain the prescriptions they need while also avoiding the heightened costs associated with an abundance of undertreated or mistreated patients.

The Evolution of the Advertising Injury Exclusion in the Insurance Service Office, Inc.’s Comprehensive General Liability Insurance Policy Forms

Kyle Lambrecht

Volume 19

Issue 1

PUBLISHED

Fall 2012

Abstract

This article examines whether Comprehensive General Liability (CGL) insurance policy forms provide coverage for third-party patent infringement claims under the forms’ “advertising injury” provision. It traces the evolution of these forms—from the 1973 CGL standard forms through the 1986 revisions and up to the 1998 and 2001 broad-form versions. The article then discusses three leading cases, all of which hold that insurers have a duty to defend policyholders against third-party patent infringement claims when the alleged infringement involves an advertising technique that is itself patented. In the aftermath of these decisions, however, changes were made to the CGL policy forms that are likely to benefit insurers seeking to avoid coverage and that further the trend toward increasingly limited policyholder protection for third-party patent infringement claims.

Supervisory Colleges: Improving International Supervisory Coordination

Kelly Kirby

Volume 19

Issue 1

PUBLISHED

Fall 2012

Abstract

This article examines the insurance industry’s role as a key player in the international financial system, focusing on how insurers and regulators are working toward greater cooperation and coordination—both domestically and globally—to help ensure that events like the 2008 Financial Crisis are not repeated. It highlights the rise of supervisory colleges and explains the need for states to participate meaningfully in these international forums, which have the potential to identify and mitigate systemic risk. The article details the benefits and challenges of such a broad scheme of international supervision and concludes by arguing that supervisory colleges represent an important step in the right direction for achieving effective international regulatory oversight.

Stranger-Initiated Annuity Transactions and the Case for Insurable Interest

Kendall J. Burr, Thomas F.A. Hetherington, & David T. McDowell

Volume 19

Issue 1

PUBLISHED

Fall 2012

Abstract

This article addresses whether insurable interest requirements—such as those enacted in many states to prohibit Stranger-Originated Life Insurance policies (STOLIs)—should also apply to Stranger-Originated Annuity Transactions (STATs). The article argues that they should, highlighting the inherent similarities between STATs and STOLIs and analyzing the flawed reasoning in the lone case holding that insurable interest requirements do not apply to STATs. The authors then examine various state insurance statutes and contend that many of them may already prohibit STAT contracts. In other words, the statutory framework for criminalizing STAT schemes may already exist, making the key task one for the courts, which must properly interpret and enforce these statutes.

The Economics of Insurance Law—A Primer

Ronen Avraham

Volume 19

Issue 1

PUBLISHED

Fall 2012

Abstract

This article presents a law and economics perspective on insurance law as a whole, offering both an overview of major topics in the field and a discussion of the central themes in the economic analysis of insurance law and its leading cases. It also introduces a theoretical framework—the two islands functional approach—that can help resolve persistent puzzles in insurance law. Ultimately, this paper aims to assist insurance law judges, lawyers, students, and legislatures in correctly conceptualizing and addressing the legal problems that arise in courts and in insurance practice.

Bad Faith at Middle Age: Comments on “The Principle Without a Name (Yet),” Insurance Law, Contract Law, Specialness, Distinctiveness, and Difference

Robert H. Jerry, II

Volume 19

Issue 1

PUBLISHED

Fall 2012

Abstract

In this article, Robert Jerry expounds on Professor Abraham’s article on insurer liability for bad faith by pointing out that the concept of institutional bad faith is not a new phenomenon, but rather, one that is as old as the insurance industry itself. Jerry focuses on Abraham’s depiction of the “specialness” and “distinctiveness” of insurance, while exploring additional instances of “rotten to the core” systemic bad faith dating as far back as the nineteenth-century. Much like Abraham did in his article on bad faith, Jerry uses these examples of systemic bad faith to further his assertion that the insurance industry, due to its “specialness,” is held to higher standards of care than other realms of “ordinary business.”

Liability for Bad Faith and the Principle Without a Name (Yet)

Kenneth S. Abraham

Volume 19

Issue 1

PUBLISHED

Fall 2012

Abstract

In this article, Kenneth Abraham examines the concept of liability for bad faith practices by insurers. He argues that although liability for bad faith has existed for roughly half a century, it has yet to be fully recognized as part of the formal body of insurance law. Abraham describes what has been, to some extent, a transmogrification in insurers’ bad faith claims-handling practices: what once could be dismissed as an occasional isolated incident or “screw up” can now be characterized as systemic bad faith. He provides four examples, each highlighting a form of systemic bad faith practice undertaken by an insurer. Abraham concludes by discussing the uniqueness of the insurer–consumer relationship and explaining how that relationship creates obligations of fair dealing for insurers that simply do not exist for other private enterprises.

Double Trouble – An Ex-Spouse’s Life Insurance Beneficiary Status & State Automatic Revocation Upon Divorce Statutes: Who Gets What?

Kristen P. Raymond

Volume 19

Issue 2

PUBLISHED

Spring 2013

Abstract

This note analyzes the status of an ex-spouse’s designation as a life insurance beneficiary when the insured fails to designate a new beneficiary following divorce. It first discusses life insurance contracts generally, emphasizing that, like other insurance contracts, they are governed by principles of contract law. This contractual foundation has led most states to uphold the insurance contract and award policy proceeds to the ex-spouse in the event of a beneficiary dispute. The note then examines the minority rule—under which divorce automatically terminates an ex-spouse’s beneficiary status—and analyzes the constitutionality of automatic revocation statutes under the Contract Clause. Next, it discusses the property settlement exception and its application under both the majority and minority rules. The note concludes by suggesting that courts adopt a two-pronged approach in adjudicating these disputes, focusing on executing the insured’s intent and ensuring the uniform application of the jurisdiction’s existing rule.

A Billion Dollar Problem: The Insurance Industry’s Widespread Failure to Escheat Unclaimed Death Benefits to the States

Devin Hartley

Volume 19

Issue 2

PUBLISHED

Spring 2013

Abstract

This note examines whether insurers are violating state unclaimed property statutes and unfair claims settlement practices statutes by failing to take affirmative steps to locate and pay beneficiaries of life insurance policies or, alternatively, by failing to escheat the proceeds to the state. It shows that the current claims settlement practices of the nation’s largest insurers do indeed violate these statutes. Specifically, the insurance industry has used the Social Security Administration’s Death Master File (DMF) to identify deceased annuitants and terminate annuity payments but has failed to use the same technology to identify deceased insureds and pay beneficiaries. Additionally, this note describes the industry’s reaction to regulatory scrutiny of its claims settlement practices and predicts a paradigm shift from an industry that pays beneficiaries only upon the filing of a claim to one that proactively seeks to identify deceased insureds and pay out the associated benefits.