Insurance Fraud

News & Analysis as of

Insurance Coverage – Insurance Fraud Prevention Act

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

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...

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

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...

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

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

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...

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

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

Jury Awards Aetna $37.4M in Medical Billing Fraud Case

A California jury in Aetna Life Insurance Company v. Bay Area Surgical Management LLC, et al., 1-12-CV-217943 (Superior Court of Santa Clara County), unanimously awarded Aetna Inc. over $37.4 million in damages, finding that...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

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

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

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

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

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

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

Health Care Physicians in the Crosshairs: Criminal Prosecution

Recent changes to our health care system have been at the forefront of the American news cycle for several years. But certain aspects have not received adequate attention. One example is the scrutiny federal and state...more

Twitter Ordered by Irish Court to Disclose Information about Author of Tweet

Twitter International Company (TIC) in Dublin, Ireland was reportedly ordered by a High Court to disclose data about the source of tweets about a whistleblower. The tweets, which included allegations of insurance fraud, are...more

Texas Property Insurers Consider Changes to Hail Policies

Texas is in the midst of a hail lawsuit crisis. Tens of thousands of lawsuits have been filed across the state, with dozens more being filed every day. Many of the lawsuits involve meritless claims solicited by case-runners...more

Insurance Fraud Act Suits by Insurers Held to Trigger Right to Jury Trials in New Jersey

Last week, the New Jersey Supreme Court unanimously held that a civil defendant sued by an insurance company for violations of the state’s Insurance Fraud Prevention Act (IFPA) has the right to trial by jury. In Allstate New...more

Courts Say There’s No Claim for “Reverse Bad Faith.” Could They Be Wrong?

Last month, in State Auto Property & Casualty Ins. Co. v. Hargis, No. 13-5020 (6th Cir. May 6, 2015), the U.S. Court of Appeals for the Sixth Circuit predicted that the Kentucky Supreme Court would not allow insurers to sue...more

Sixth Circuit Refuses to Create a Cause of Action for Reverse Bad Faith

In an opinion handed down last week, the Sixth Circuit Court of Appeals refused to adopt a new cause of action under Kentucky law for a reverse bad faith claim by an insurer against its insured where the Kentucky Supreme...more

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