Following a devastating loss to one’s home, as is the case throughout California due to recent fires and mudslides, the process of contacting your insurer to begin the rebuilding or repair can be complicated and daunting. Many are quick to begin the rebuilding and repairs immediately or as soon as possible. However, there are requirements in working with your insurer to properly rebuild or repair. If an insured fails to follow appropriate protocols, the insurer can not only deny coverage, but do so on the basis of fraud.
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All insurance companies have a Special Investigative Unit [SIU] that handles elevated claims. Policyholders may be informed by the claims adjuster that their claim has been transferred to the SIU, leaving the insured confused and perhaps apprehensive. So, what does it mean when a claim has been transferred to the SIU?
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Fraud is generally defined as an act done with the intent to deceive or misrepresent others in order to attain or secure some unlawful gain or deprive a victim of a legal right. Different courts, states, and bodies of law throughout our country have their own unique causes of action based in fraud, or where fraud is the primary allegation.
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When insurers investigate insurance claims and suspect that something about the claim is not quite right, they often assign special investigation units evaluate whether the claim lacks merit or is otherwise fraudulent. In Young v. Progressive Casualty Insurance Company,1 a federal district court in California recently upheld an insurer’s denial of its insured’s claim for the theft of his motor home based on the policy’s fraud and misrepresentation provisions. The court’s decision was based primarily on the cell phone records of the insured’s son.
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Motions in limine are commonly used to seek a pre-trial ruling regarding excluding inadmissible or prejudicial evidence. At the federal level, Federal Rules of Evidence (“FRE”) 103(d) and 104(c),1 402,2 403,3 and 611(a)4 and Federal Rule of Civil Procedure (“FRCP”) 16(c)5 provide the underlying bases for in limine motions, though the power to rule on such motions inheres in the district court’s authority to manage the course of trials.6 Whether to grant or to deny a motion in limine falls within the broad discretion of the district court.7

The admissibility of evidence of an insured’s prior fires and prior insurance claims was the subject of a motion in limine in Chicago Import, Inc. v. American States Insurance Company,8 a case arising out of a 2007 warehouse fire alleged to have been an act of arson.


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Former director of Hi-Rise Engineering, Matthew Pappalardo was indicted on a 50-count indictment stemming from Hi-Rise’s role in altering their engineering reports to defraud policyholders from monies owed due to Superstorm Sandy damage. Contained within the indictment were 25 counts of Forgery in the second degree, in violation of Penal Law Sect. 170.10(1) and 25 counts of the Unauthorized Practice of a Profession in violation of Education Law Sect. 6512(1).

A person is guilty of forgery in the second degree when, with intent to defraud, deceive or injury another, he falsely makes, completes or alters a written instrument which is or purports to be, or which is calculated to become or to represent if completed. . . .[an] instrument which does or may evidence, create, transfer, terminate or otherwise affect a legal right, interest, obligation or status. . . .

A person violates Education Law Sect. 6512(1), while not being authorized to practice under said law, practiced or offered to practice or held himself out as being able to practice the profession of engineering, a profession in which a license was a prerequisite to the practice of the acts, or aided or abetted an unlicensed person to practice the profession of engineering. . . .


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I wish I didn’t have to write this blog. I say that because although we are the Policyholder’s Advocate, and I’d rather blog about policy issues, case law, and statutes—not about impartiality or fraud regarding a government agency’s handling of the Sandy Review Process. However, these topics are pertinent to the field of law and Merlin Law Group likes to keep you informed on all variables and challenges your claim may face.


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