News & Analysis as of

Insurance Fraud

Reimbursement Manager Pleads Guilty for Prior Authorization Process Issues

by Bass, Berry & Sims PLC on

On Monday, June 19, 2017, Elizabeth Gurrieri became the second former employee of Insys Therapeutics (Insys) to plead guilty to federal anti-kickback charges related to the drug Subsys, an expensive fentanyl-based painkiller....more

$4 Million Liability for Bad Legal Advice to a Chiropractor

by Faegre Baker Daniels on

Allstate Insurance has won a judgment of nearly $4 million against a NY lawyer and Calif. consultant who guided a NJ chiropractor in structuring a medical practice designed to appear to meet the requirements of the state...more

Fighting Insurance Fraud in Latin America

by Zelle LLP on

Though they are a minority, fraudulent claims can amount to very significant sums of money, causing insurers to re-think their business practices and take action to mitigate the negative impact resulting from fraud. ...more

Florida's SIU Tool Belt Is a Bit Lighter Today

Florida has been plagued with insurance fraud for decades.  All insurance coverages are susceptible to fraud, but scams are especially prevalent in the context of automobile accidents.  Staged crashes, patient brokering,...more

What Is Prompt Notice? Second Circuit Analyzes Late Notice In New York

Property insurance policies typically require that, once an insured suffers a loss, the insured report the loss to the insurance carrier promptly. The purpose of such a provision is to allow an insurer to investigate a claim...more

Virginia Court Dismisses RICO Claim Against WYO Flood Insurer and Its Adjusters

by Cozen O'Connor on

The preemptive effect of the National Flood Insurance Program (NFIP) on overlapping claims asserted by policyholders based on federal and state common law theories of liability is well established. “Numerous courts have held...more

A Liar and A Cheat? 3 Ways to Pay...

by Seyfarth Shaw LLP on

Seyfarth Synopsis: Insurer gets to pick its remedy when hospital engages in dishonest billing and illegal kickbacks…to the tune of $41 million. Judge Lynn Hughes of the U.S. District Court for the Southern District of...more

Insurance Coverage – Insurance Fraud Prevention Act

by Low, Ball & Lynch on

The People ex rel. Allstate Insurance Company, et al. v. Daniel H. Dahan, et al. - Court of Appeal, Second District (September 15, 2016) - Under Section 1871.7 of the California Insurance Frauds Prevention Act...more

"Collateral lies" do not necessarily undermine an insurance claim

by Allen & Overy LLP on

An insured was not precluded from recovering under an insurance policy even though it had made a false statement during the claims process with a view to strengthening its claim. The Supreme Court in Versloot Dredging BV &...more

Adjuster Tools for Water Losses

Lois Chamberlain sat down at her desk, adjusted her reading glasses, and stared at the screen filled with columns of check requests — each supported by a claim summary. Lois was two weeks from her retirement party. She...more

Blog: Supreme Court Determines That An Insurer Can Set Aside A Settlement Of A Personal Injury Claim Even If, At The Time Of...

by Cooley LLP on

In Hayward v Zurich Insurance Company plc [2016] UKSC 48, the Supreme Court held that the insurer, Zurich, which had settled a personal injury claim by the claimant, Mr Hayward, despite suspecting fraud on the part of the...more

Collateral lies: The lie is dishonest but the claim is not

by Reed Smith on

The Supreme Court rules that a collateral lie embellishing a valid claim does not amount to a fraudulent claim. Versloot Dredging BV and another (Appellants) v HDI Gerling Industrie Versicherung AG and others [2016] UKSC...more

Distinguishing ‘collateral lies’ from the fraudulent claims rules in insurance contracts: the lie is dishonest but the claim is...

by Reed Smith on

In Versloot Dredging BV and another v HDI Gerling Industrie Versicherung AG and others [2016] UKSC 45, handed down, last month, the Supreme Court ruled that a “collateral lie” made during the course of an insurance claim...more

Real Property & Title Insurance Update: Weeks Ending June 24 & July 1, 2016

by Carlton Fields on

REAL PROPERTY UPDATE - Foreclosure/Leave to Amend: borrower should have been granted leave to amend to assert affirmative defenses pursuant to motion filed 13 days before trial because there was no prejudice, the...more

An Injured Third Party’s Knowingly False Deposition Testimony Establishes the Materialty Component for Insurance Fraud

by Cozen O'Connor on

On May 13, 2006, Edward Feierstein was driving home from his Philadelphia fitness club when his car was rear-ended. Two days later, Feierstein filed a claim with the tortfeasor’s liability insurer seeking reimbursement for...more

New Jersey Supreme Court Holds that a Person Violates the Insurance Fraud Statute Even if Insurer is Not Duped Into Paying a...

by Cozen O'Connor on

In the recent case of State of New Jersey v. Robert Goodwin, 224 N.J. 102, 129 A.3d 316 (N.J. 2016), the Supreme Court of New Jersey held that a person violates the insurance fraud statute, N.J.S.A. 2C:21-4.6(a), even if he...more

Two Federal Courts Uphold Criminal Convictions for Insurance Brokers

by Carlton Fields on

Two federal appellate decisions highlight the potential criminal liability for rogue agents. First, in United States v. Binday, the Second Circuit Court of Appeals upheld mail and wire fraud convictions of three individuals...more

Important Court Decision For No-Fault Insurers -- Federal Court Rejects Argument To Limit Insurers’ Right To Seek Judicial Relief...

We are pleased to inform you of a very favorable recent caselaw development in the no-fault insurance area, in which our firm played a significant role. Specifically, on March 24, 2016, in the case of Liberty Mutual Fire...more

New Law in New Jersey Increases Scope of Insurance Fraud to Insurance Certificates

by Saul Ewing LLP on

Contractors should be aware of a New Jersey law that could cause them to be found liable for insurance fraud if they provide insurance certificates to owners containing false or misleading information. The new law, which goes...more

Penalty Declined – Party Escapes Summary Judgment Despite Evasive Discovery Responses

On February 17, 2016, the Court of Appeal for the Fourth Appellate District in People ex rel. Government Employees Insurance Company (“GEICO”) v. Cruz (Court of Appeal D067061, Superior Court Case 37-2013-00029878),...more

UK Financial Regulatory Developments - January 2016 #9

by Dentons on

FCA updates IPRU-INV, FC and EG - FCA is updating its Handbook on its website to convert the Interim Prudential sourcebook for Investment Businesses (IPRU-INV), the Financial Crime Guide (FC) and the Enforcement Guide...more

Blog: UK Insurance Fraud Taskforce Produces Its Final Report

by Cooley LLP on

In January 2016 the Insurance Fraud Taskforce produced its final report into the serious issue of fraud in insurance, a problem which is reported to cost more than £3bn each year. The proposals made in the report are...more

Fraudulent Auto Accident Claims Cost Consumers

by Howard Ankin on

Dishonest motorists, passengers and pedestrians are involved in numerous auto accidents each year, and while actual damages from these accidents may be insignificant, these scammers make fraudulent claims for nonexistent...more

Tribunal fines insurance broker for mishandling client moneys

by Dentons on

The Tribunal has fined former insurance broker Terence Joint £10,000 for failings in relation to the handling of client money. Due to personal circumstances Mr Joint became disconnected from the day-to-day running of the...more

A New Arrow in the Quiver for Physicians Facing Dual Civil and Criminal Fraud Investigations

by Cole Schotz on

At a time when doctors face increased pressure from competition, reduced fee schedules, and greater scrutiny from insurance company Special Investigative Units (“SIUs”) and State Office of Insurance Fraud Prosecutors...more

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