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TODAY'S TOP DEVELOPMENTS Tuesday, July 9, 2013   Industry news, expert analysis, and daily updates on the most significant insurance coverage legal developments—from the insurance and legal experts of The National Underwriter Company.  CASE LAW Homeowner’s Insurance Florida Supreme Court Holds that Replacement Cost Policy Included General Contractor’s Overhead and Profit A divided Florida Supreme Court has held that an insurer’s required payment under a replacement cost policy included overhead and profit, where the insured was reasonably likely to need a general contractor for the repairs, because the insured would be required to pay costs for a general contractor’s overhead and profit for the completion of repairs in the same way the insured would have to pay other replacement costs he or she was reasonably likely to incur in repairing the property. Read More Automobile Insurance Florida Supreme Court Holds that Insurer May Not Limit PIP Reimbursements Based on Medicare Fee Schedule without Providing Notice A divided Florida Supreme Court has ruled that, with respect to “Personal Injury Protection” policies issued after January 1, 2008, an insurer may not limit reimbursements based on the Medicare fee schedules in Section 627.736(5)(a), Florida Statutes (2008), without providing notice to its insured of an election to use the Medicare fee schedules as the basis for calculating reimbursements. Read More Employee Benefits Florida Supreme Court Finds Ambiguity in Home Health Care Insurance Policy’s Automatic Benefit Increase Percentage Provision A divided Florida Supreme Court, in responding to questions certified by the U.S. Court of Appeals for the Eleventh Circuit, has determined that the “automatic benefit increase percentage” in a “Limited Benefit Home Health Care Coverage Certificate of Insurance,” which had been issued to policyholders as evidence of insurance under a group policy, applied to the dollar values of the policy’s “lifetime maximum benefit amount” and its “per occurrence maximum benefit.” The court concluded that the policy was ambiguous, with one reasonable interpretation – the one it adopted – being that the “automatic benefit increase percentage” by which “benefits increase by 8% each year” applied to all the benefit categories set forth on the certificate schedule. Read More Automobile Insurance Florida Appeals Court: Modified Golf Cart Was a “Low Speed Vehicle” and Policy Thus Provided Coverage for Collision A Florida appellate court has ruled that a modified golf cart fell within the statutory definition of a “low speed vehicle” and, as such, was a “motor vehicle.” Therefore, the appellate court ruled, the insurer was obligated to indemnify the insured for damages stemming from an accident that occurred while he was driving the golf cart in a retirement community in Florida in which many residents utilize golf carts as a means of transportation. Read More View All Case Law Developments    LEGISLATIVE/REGULATORY Homeowner’s Insurance NY Senator Gillibrand Urges FEMA to Review Flood Insurance Policy and Reverse Denials of Sandy Flood Insurance Claims Based on ‘Earth Movement’ Exclusion U.S. Senator Kirsten Gillibrand (D-NY) has urged the Federal Emergency Management Agency to review its regulatory mandates and reverse “earth movement” denials for homeowners hit by Superstorm Sandy who purchased federal flood insurance. Senator Gillibrand wrote in a letter to FEMA Administrator Craig Fugate that it was “unacceptable” for the federal government “to use such loopholes to deny responsible homeowners the benefits that they have paid for through their insurance premiums. To deny these claims pulls the rug out from underneath homeowners who are relying on their flood insurance policies to repair and rebuild their homes, now nearly eight months after Sandy hit our shores…. I request that you immediately review the regulatory requirements for FEMA’s standard flood insurance policy and reconsider the denials that have been issued to homeowners based on the ‘earth movement’ exclusion.” Read More Alternative Risk and Captives ACA is Leading Health Care Providers into the Captive Market The number of captive insurance operations set up by U.S. health care is expected to increase between 2013 and 2015. Many will be driven by the Patient Protection and Affordable Care Act. Read More View All Legislative/Regulatory Developments      INDUSTRY NEWS Richard Ward to Resign as Lloyd’s Chief Executive Read More AIG Name Returns to Canada as “AIG Canada” Read More “Hank” Greenberg’s New Empire Read More Berkshire Hathaway Specialty Insurance Names Lori Spoon Rafkin as Senior Vice President Read More Todd Jones Named Chief Executive Officer of Willis North America Read More View All Industry News Q&A Med Pay Coverage Under the PAP Browse our entire library of over 2,500 insurance resources and forms.    INSURANCE COVERAGE  LAW REPORT View Entire July Insurance Coverage Law Report   View Insurance Coverage Law Report Archives Steven A. Meyerowitz, ESQ. Director, FC&S Legal Victoria Prussen Spears, ESQ. Associate Director, FC&S Legal FC&S Legal Editorial Advisory Board Mitchell J. Auslander, Willkie Farr & Gallagher LLP Carrie Cope, Schuyler, Roche & Crisham, P.C. Anjali C. Das, Wilson Elser John F. Finnegan, Chadbourne & Parke LLP Michele L. Jacobson, Stroock & Stroock & Lavan LLP Timothy P. Law, Reed Smith LLP Donald S. Malecki, Malecki, Deimling, Nielander & Associates, LLC Cort T. Malone, Anderson Kill & Olick, P.C. D. Milone, Kelley Drye & Warren LLP Joseph P. Monteleone, Tressler LLP Anne M. Murray, Rivkin Radler LLP Jerold Oshinsky, Kasowitz, Benson, Torres & Friedman LLP Seth B. Schafler, Proskauer Rose LLP David D. Thamann, The National Underwriter Company FC&S Daily Legal Report ($795 annual subscription) is included as part of your subscription to FC&S Legal: The Insurance Information Center. FC&S Daily Legal Report and The Insurance Coverage Law Report are publications of The National Underwriter Company. For more information on how to subscribe to FCS& Legal, please contact customer service at 1-800-543-0874 or customerservice@sbmedia.com. 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