News & Analysis as of

Fraud Insurance Claims

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
Marshall Dennehey

Appellate Court Affirms Ruling a Sworn Proof of Loss and Estimate Related to Later Claim Was Inadmissible as Hearsay and...

Marshall Dennehey on

Universal Property & Casualty Insurance Company v. Luis Nacimiento, Fla. 3rd DCA, 3D23-0301, Apr. 3, 2024 - The insured reported a claim to Universal Casualty & Property Insurance Company in February 2016 for water damage...more

Goldberg Segalla

Fraud Doesn't Pay in New York – August 2024 Update

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As a part of our Quarterly Practice Group Update, we are pleased to produce our latest installment of our continued success in fraud litigation. This report was originally conceptualized three years ago as a one-time...more

Robins Kaplan LLP

AI’s Impact on Property Insurance Coverage

Robins Kaplan LLP on

Artificial Intelligence (AI) is the simulation of human intelligence processes by machines, such as computer systems for assistance in quickly answering complicated questions, researching a specific topic, or creating an...more

Segal McCambridge

Michigan Supreme Court Cracks Down on Fraud in Claims filed with the MAIPF: Honesty Matters Throughout the Process

Segal McCambridge on

Car insurance plays a crucial role in protecting drivers and their finances after an accident. It provides financial support for medical bills, lost wages, and car repairs. However, a recent Michigan Supreme Court decision in...more

Faegre Drinker Biddle & Reath LLP

Court Sides with Long-Term Care Insurer Over Claim Denial and Potential Fraud

A judge from the District of Colorado recently issued an opinion that might leave the door open for long-term care insurers to void policies after the contestability period expires if an insured commits fraud. See Meyer v....more

J.S. Held

Fidelity Investigations: A Comprehensive Guide to Successful Claims Outcomes

J.S. Held on

Introduction: Understanding Fidelity Investigations - Fidelity / Crime / Financial Institution Bonds, in a general sense, cover an insured from the willful theft of property, money, and securities by one of their employees...more

J.S. Held

Auto Insurance Fraud Investigation: Perspectives from Experts in Accident Reconstruction

J.S. Held on

As interest rates and financial pressures on families continue to mount, more and more drivers may be unable to pay their repair bill for damage they caused or for mechanical issues on their vehicles. A common response is...more

Bradley Arant Boult Cummings LLP

The Haunting in the Cornfield: Relators’ Qui Tam Claim Confirmed Dead by the Eighth Circuit

The Eighth Circuit Court of Appeals recently affirmed judgment against relators in a case alleging that a group of dairy farmers growing corn violated the False Claims Act by filing false insurance claims paid by the Federal...more

Kohrman Jackson & Krantz LLP

Coverage Challenges in Ransomware Claims: Cyber Insurance Policies and Trends in Denials

A consistent pattern emerges in data breach and cyber-attack cases when companies turn to their insurers for coverage after such incidents. Whether they possess specialized cyber insurance or not, insurers often decline...more

Kerr Russell

Did I Commit Fraud?

Kerr Russell on

Question: I am under audit by a dental plan I participate with. The audit has identified a few issues in connection with how my billing employees have been submitting claims for payment. For example, the name of the treating...more

Latham & Watkins LLP

Avoiding Buyer’s Remorse in M&A Deals

Latham & Watkins LLP on

Changing market dynamics have led buyers to assess available options to address post-closing target company issues. Amid the buoyant market of 2021 and early 2022, compressed deal timelines and frenzied competition...more

Marshall Dennehey

Why Insurance Carriers’ DPRPs Should Be Specific as to What Claims/actions Are and Are Not Arbitrable to Protect Themselves...

Marshall Dennehey on

GEICO filed a complaint against a series of medical providers asserting claims under the New Jersey Insurance Fraud Prevention Act (IFPA), violations of RICO, common law fraud and unjust enrichment. Some of the medical...more

Ervin Cohen & Jessup LLP

Companies That Pay Hackers May Be Able to Recoup Their Losses

Where companies are victimized by ransomware or email scams, their losses arise from payments made by an officer or employee of the company. In the case of ransomware, a company’s files are held hostage pending payment...more

Bennett Jones LLP

Court of Appeal Endorses Draconian Deterrent to Insurance Fraud

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In Abbas v Esurance Insurance Company of Canada, 2023 ABCA 36 [Abbas], the Alberta Court of Appeal endorsed what it described as draconian consequences for insurance fraud as consistent with the Insurance Act, RSA 2000 c I-3...more

J.S. Held

Detecting Inflation-Driven Fraud in Marine Stock Throughput Insurance Claims

J.S. Held on

Following the easing of Covid pandemic restrictions, we are now facing a fresh “cost of living crisis” created by rising inflation and soaring energy bills. The Guardian newspaper reported that forecourts at petrol...more

J.S. Held

The Role of Forensic Accountants in Measuring and Detecting Fraud in Employee Loss Claims

J.S. Held on

Insurance claims for employee losses are generally examined by insurance carriers. The carrier will often retain a forensic accountant who has the ability to measure employee losses. Employee losses are typically categorized...more

Carlton Fields

Federal Court Rejects Computer Fraud Coverage for Social Engineering Loss

Carlton Fields on

In SJ Computers LLC v. Travelers Casualty and Surety Company of America, the U.S. District Court for the District of Minnesota recently addressed the scope of insurance available for a phishing scheme under the terms of a...more

J.S. Held

Insurance Claims & Fraud Investigations: Where Forensic Accountants Bring Value

J.S. Held on

Forensic accountants are independent, highly specialized accountants with strict confidentiality policies who are involved in investigating financial information to assist attorneys, insurance companies, businesses,...more

J.S. Held

The Role of Forensic Accountants in Measuring and Detecting Fraud in Inventory Loss Claims

J.S. Held on

Insurance claims for loss of inventory are generally examined by insurance carriers. The carrier will retain a forensic accountant who has the ability to quantify out of sight inventory losses. Out of sight inventory losses...more

ArentFox Schiff

Investigations Newsletter: Archegos Executives Charged With Conspiring To Defraud Banks Out of Billions

ArentFox Schiff on

Archegos Executives Charged With Conspiring To Defraud Banks Out of Billions - On Wednesday, April 27, 2022, the US Attorney’s Office for the Southern District of New York unsealed an indictment charging Sung Kook “Bill”...more

Rivkin Radler LLP

Insurance Update - February 2022

Rivkin Radler LLP on

Causation, an issue courts often wrestle with when deciding insurance coverage issues, lands the starring role in our February Insurance Update. •A county experienced higher costs due to the opioid crisis. Does its...more

Lowenstein Sandler LLP

In the Know: The Lowenstein Insurance Recovery Group’s Tip of the Month - October 2021

Lowenstein Sandler LLP on

A recent coverage case from Illinois is a helpful reminder to policyholders that they should not take no for an answer when insurers deny a claim based on uninsurability, restitution, disgorgement, or fraud. In fact, those...more

Faegre Drinker Biddle & Reath LLP

To Rescind or Not to Rescind, That’s Only Half the Question

An insured applies for a life insurance policy, answering “no” to all medical and health-related questions. She dies within two years of her application, and the insurer discovers she was in fact diagnosed with cancer two...more

Wiley Rein LLP

Texas Court Holds Late Notice Bars Coverage

Wiley Rein LLP on

The United States District Court for the Northern District of Texas, applying Texas law, has held that an insured’s late notice of a claim bars coverage, rejecting arguments that (i) the initial complaint did not constitute a...more

Seyfarth Shaw LLP

Insurers, ERISA Plans and Other Payors: Beware of COVID-19 Fraud Schemes!

Seyfarth Shaw LLP on

On March 23, 2020, the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) issued an alert to the public about fraud schemes related to the novel coronavirus (COVID-19)....more

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