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 … Continue Reading
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?… Continue Reading
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 … Continue Reading
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 … Continue Reading
In unpublished decision, the Ninth Circuit Court of Appeals recently denied an accounting firm’s appeal relating to a claim for coverage triggered by an email scam that caused the firm to mistakenly send wire transfers of client funds to fraudsters.… Continue Reading
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 … Continue Reading
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 … Continue Reading
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 … Continue Reading
Since the Florida Legislature is currently in session, we are being inundated with insurance industry talking points in the media. The most consistent talking point, and the one that frustrates me the most, is that we need to eradicate “fraud” because it is costing consumers money.… Continue Reading
Ed Rust must have muttered, "you’ve got to be kidding," after learning that a McKinsey & Company consultant and State Farm employee were accused of siphoning about $900,000 in consulting fees and expenses.… Continue Reading
We’ve all heard that ‘crime doesn’t pay’ but plaintiffs in Akers v. Auto-Owners1 clearly forgot this adage, as they attempted to defraud the insurance company out of millions of dollars. As we at Merlin Law Group always tell our clients, be honest.… Continue Reading
On January 8, 2015, Robert Napolitano, of Clifton, New Jersey was sentenced to thirty-two (32) months in prison and three years supervised release1 after pleading guilty to “charges that he defrauded the [New Jersey Turnpike Authority (“NJTA”)] out of insurance money meant to cover the cost of repairs to turnpike property,” totaling approximately $900,000.00.2… Continue Reading
United States Senator Robert Menendez – the senior senator from New Jersey, today issued a letter seeking a full investigation into the fraudulent altering of reports by carrier friendly experts. Followers of our blog know that this has risen to the forefront of Superstorm Sandy flood litigation. Essentially, carriers and their experts are accused of … Continue Reading
An engineering firm has produced an alleged fraudulent report of an engineer’s opinion in a Superstorm Sandy flood lawsuit. Outcome oriented vendor firms providing outcome oriented reports is a big problem for consumers of insurance after a loss occurs. Reports can be altered and language changed which can be disastrous for insurance customers and save … Continue Reading
Regardless of whether you’re the plaintiff or defendant in an insurance dispute, fabricating or otherwise altering evidence can have some very serious consequences. Earlier this summer, the Sixth District Texas Court of Appeals issued a memorandum opinion involving two of the most severe sanctions parties can face under Texas law for such misconduct – monetary … Continue Reading
One of the trickiest parts of property insurance claims is the contents portion of the claims. Even if the insured saved receipts to prove the age and cost of personal property,those receipts are often stored in the same general place as the personal property and suffer the same fate as the personal property. Accordingly, policy … Continue Reading
On this blog, we often try to educate homeowners so they can be protected. In the past, we have urged homeowners to read their homeowner insurance policies and to ask questions if there are terms or provisions they do not understand. Well, here is another important tip: Obtain a copy of your policy from your … Continue Reading
Steve Badger gets the 2014 Insurance Defense Attorney Macho Man Award. His works, What The Hail Is Going On In Texas?,1 and The Emerging Hail Risk: What The Hail Is Going On?,2 have envious insurance defense attorneys complaining that they have been slow to address the needed “tough guy” for the insurance industry, and others … Continue Reading
Five years ago, I noted in a post, Are Insurance Fraud Statistics Fraudulent?, that some insurance companies seemed to have declared war on their own customers by calling them cheats and frauds:… Continue Reading
All adjusters are called upon to make good faith evaluations of loss. The obligation of all adjusters is to make certain that the policyholder receives the full amount of benefits owed under the policy. When disagreements occur over the value of loss, appraisals and umpires often become involved. The recent arrest of a public adjuster … Continue Reading
Everybody deserves to be considered innocent of criminal conduct until proven guilty. That certainly was not how government officials responded to the arrest of a Florida public adjuster accused of inflating the benefits owed as a result of a fire claim.… Continue Reading
When a policyholder disputes a property damage claim, insurance company representatives often dig in their heels and try to stand firm on the denial or the low valuation. Insurance companies frequently allege various unsupported reasons and defenses to avoid paying what is due. Some insurance companies accuse consumers of insurance fraud even when the facts … Continue Reading
When a federal judge analyzes an insurance dispute and states that "pigs can fly and hell has frozen over," I pay attention. In Brooks v. Foglio,1 the Honorable Joseph Eron Irenas noted the following and explained the facts:… Continue Reading
