Mealey's Insurance Fraud
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August 18, 2022
Insurers Seek To Recover More Than $2.3M In PIP Benefits Paid To Clinics
NEWARK, N.J. — State Farm Guaranty Insurance Co. and State Farm Indemnity Co. filed suit in a New Jersey federal court on Aug. 1, alleging common-law causes of action for fraud and unjust enrichment to recover actual damages of more than $2.6 million in personal injury protection (PIP) benefits it paid to chiropractic clinics, as well as violation of the New Jersey Fraud Prevention Act.
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August 17, 2022
Clinic’s Reconsideration Bid Denied In Fraudulent No-Fault Insurance Case
TAMPA, Fla. — Noting that a health care clinic “simply renews the arguments it has been making since the inception” of insurers’ action seeking to recover $2.1 million in allegedly fraudulent no-fault insurance charges, a federal judge in Florida on Aug. 15 denied the clinic’s motion for reconsideration of the court’s July order granting partial summary judgment to the insurers.
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August 17, 2022
Settlement Reached In Vandalism Coverage Suit; Parties Stipulate To Dismissal
LOS ANGELES — An insured and a businessowners insurer on Aug. 15 filed a stipulation of dismissal with prejudice in California federal court after reaching a settlement on the insured’s claims for breach of contract and bad faith in a dispute over whether the insured misrepresented material facts regarding the extra expenses it incurred following the vandalism of its property.
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August 16, 2022
Judge Says Bad Faith Claim Fails; $44M Verdict Entered For Insured’s Equipment Loss
LOS ANGELES — Following a California federal judge’s July 1 summary judgment ruling in favor of a commercial property insurer on an insured’s bad faith claim in an equipment breakdown coverage dispute, a jury on July 29 entered a more than $44 million verdict in favor of the insured after finding that the insurer breached its duty to pay the insured’s claim.
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August 15, 2022
Anti-Fraud Provision Does Not Bar PIP Claim, Michigan Panel Rules In Reversal
GRAND RAPIDS, Mich.— A Michigan appeals panel held Aug. 11 that an insurance policy’s anti-fraud provision does not bar a claim for mandatory no-fault personal injury protection (PIP) insurance benefits, reversing a lower court’s grant of summary disposition in favor of insurers and remanding for further proceedings.
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August 09, 2022
Man Takes Dismissal Of Insurer’s RICO Claims Against Him To 2nd Circuit
BROOKLYN, N.Y. — A man accused of taking part in a complex scheme to defraud Allstate Insurance Co. and several of its related affiliates on Aug. 8 appealed to the Second Circuit U.S. Court of Appeals a New York federal judge’s July 13 ruling adopting a magistrate judge’s recommendation and voluntarily dismissing the claims against him.
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August 09, 2022
Judge Enters $202,371 Default Judgment In Insurer’s Fraud Suit Over U-Haul Incident
PHOENIX — A federal judge in Arizona on July 26 granted an insurer’s motion for a default judgment against defendants in its lawsuit alleging they “orchestrated” a U-Haul accident and filed a fraudulent insurance claim, entering a $202,371.10 default judgment jointly and severally against the defendants plus pre- and post-judgment interest.
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August 08, 2022
Amicus: Precedent Misapplied In Granting Lender Summary Judgment In FCA Suit
CHICAGO — A federal judge in Indiana erred in granting summary judgment against a relator in a False Claims Act (FCA) lawsuit in which the relator alleged that a mortgage lender fraudulently approved insurance for Federal Housing Authority Administration (FHA) loans that did not meet U.S. Department of Housing and Urban development requirements because the judge improperly ruled that the relator failed to plead the elements of materiality and causation in stating her claims, the U.S. government argues in an Aug. 1 brief as amicus curiae filed in the Seventh Circuit U.S. Court of Appeals.
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August 03, 2022
Judge Won’t Reconsider Denial Of Stay Of Pending State Court Actions Against Insurers
BROOKLYN, N.Y. — A federal judge in New York on Aug. 1 denied no-fault insurers’ motion to reconsider her denial of their motion to stay all pending state court actions filed against them by medical provider insureds, rejecting their argument that the “expressly authorized” exception to the Anti-Injunction Act applies.
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August 03, 2022
Judge Adopts Recommendation, Awards Insurer $50,000 For Fraudulent Prescriptions
BROOKLYN, N.Y. — A federal judge in New York on Aug. 1 awarded Government Employees Insurance Co. (GEICO) and three related entities damages of nearly $50,000 against a doctor for aiding and abetting fraud by submitting fraudulent claims for unneeded prescription pain medications but dismissed a racketeering charge against him, adopting the recommendation of a magistrate judge to partially grant and partially deny the insurers’ motion for default judgment.
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August 02, 2022
N.J. Panel Affirms Dismissal Of Insurer’s Fraud Suit Against Attorney, Firm
TRENTON, N.J. — A New Jersey appeals panel on July 26 affirmed a lower court’s dismissal of an insurer’s lawsuit alleging that an attorney and his law firm violated the New Jersey Insurance Fraud Prevention Act (IFPA), finding that there was no harm to the insurer because it was undisputed that the attorney was always paid a reasonable amount in litigating personal injury protection claims on the insurer’s behalf.
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August 02, 2022
Panel Dismisses Hotel Operator’s Appeal In Irma Dispute For Lack Of Jurisdiction
ATLANTA — The 11th Circuit U.S. Court of Appeals on June 28 dismissed a hotel operator insured’s appeal challenging a lower federal court’s denial of its post-trial motions and motion for a mistrial in an insurance dispute stemming from the insured’s alleged filing of a fraudulent Hurricane Irma commercial property damage claim, finding that it lacks jurisdiction.
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August 02, 2022
Beneficiary’s Claims For Contract Breach, Bad Faith To Proceed, Judge Says
OKLAHOMA CITY — A life insurance beneficiary’s claims for breach of contract and bad faith based on the life insurer’s rescission of a life insurance policy can proceed because issues of fact exist as to whether the insured misrepresented whether he used tobacco products within the year prior to the policy’s issuance, an Oklahoma federal judge said July 26.
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August 02, 2022
Homeowners Insurer Was Within Rights To Cancel Policy Based On Insured’s Statement
NASHVILLE, Tenn. — A homeowners insurer did not breach its contract and act in bad faith in canceling an insured’s policy because the insurer was within its rights to cancel the policy based on the insured’s representation, whether true or not, that the rental property at issue was vacant, a Tennessee federal judge said July 19 in determining that the insurer owes no coverage for damages sustained to the rental property by a tornado.
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July 29, 2022
Relators Reinforce Appeal In Suit Alleging Employer Fraudulently Billed Medicare
PHILADELPHIA — In a July 21 reply brief filed in the Third Circuit U.S. Court of Appeals, relators reiterated their argument seeking reversal of a Pennsylvania federal court’s summary judgment ruling in favor of their former employer in their lawsuit alleging that it fraudulently billed Medicare and Medicaid by admitting and recertifying patients for hospice who were not actually eligible for hospice, contending that the Centers for Medicare & Medicaid Services (CMS) “has made clear that the requirement of medical record documentation supporting hospice certification is a substantial requirement.”
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July 29, 2022
Florida High Court Won’t Review Property Insurance ‘Concealment Or Fraud’ Provision
TALLAHASSEE, Fla. — The Florida Supreme Court on July 20 declined to accept jurisdiction of a property insurer’s petition asking it to review whether a state appellate court correctly held that the standard “Concealment or Fraud” provision in property insurance policies in the state “contains a facial ambiguity to be construed against Florida’s property insurers, contrary to” opinions reached by other state appellate courts.
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July 29, 2022
New Jersey Federal Judge Denies Doctor New Trial In Health Care Fraud Suit
NEWARK, N.J. — Testimony about false claims submitted to insurance companies that was admitted at a doctor’s trial but not included in the superseding indictment against her was “direct, intrinsic evidence of the conspiracy alleged” in the indictment and, thus, was not subject to Federal Rule of Evidence 404(b) and its notice provisions, a federal judge in New Jersey ruled June 28, denying the doctor’s motion for a new trial.
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July 27, 2022
Disability Insurer Properly Rescinded Policy, Federal Judge Says In Adopting Report
CENTRAL ISLIP, N.Y. — In a July 22 docket order, a New York federal judge adopted a magistrate judge’s recommendation to grant a disability insurer’s motion for summary judgment, agreeing with the magistrate judge’s conclusion that the insurer properly rescinded the disability policy based on fraudulent and material misrepresentations made by the insured regarding a preexisting neck condition and that the insurer did not act in bad faith in handling the insured’s claim.
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July 26, 2022
Couple May Plead Bad Faith Against Auto Insurer For Fraud Accusation, Judge Rules
PITTSBURGH — A Pennsylvania federal judge on July 18 denied an insurer’s motion to dismiss a married couple’s claims for bad faith and breach of contract after it denied their claim for vehicular damages suffered at a repair shop and accused them of insurance fraud but agreed to dismiss the couple’s claims for defamation and intentional infliction of emotional distress.
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July 24, 2022
Breach Of Contract, Bad Faith Claims Fail In Vandalism, Misrepresentation Dispute
LOS ANGELES — A California federal judge on July 15 granted an insurer’s motion for summary judgment on an insured’s claims for breach of contract and bad faith after determining that the breach of contract claim cannot proceed because the insured misrepresented material facts regarding the extra expenses it incurred following the vandalism of its property and that the bad faith claim cannot proceed because no reasonable jury could find that the insurer acted in bad faith in handling the claim.