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.
Continue Reading Insurance Fraud – It’s a Widespread Industry Problem

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.
Continue Reading Cell Phone Records Support Insurer’s Denial Based on Fraud

In unpublished decision, the Ninth Circuit Court of Appeals recently denied an accounting firm’s appeal relating to a claim for coverage triggered by an email scam that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 Is an Email Scam Causing a Business to Lose Clients’ Money Covered Under a First-Party Commercial Policy?

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.


Continue Reading Using a Motion in Limine to Exclude Evidence of Prior Fires or Prior Insurance Claims

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. . . .


Continue Reading Former Director of Hi-Rise Engineering is Indicted in New York

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.


Continue Reading FEMA Whistleblowers Speak-Out at Washington, DC Hearing

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 New Jersey Independent Adjuster Sentenced to 32-Months in Prison for Defrauding the New Jersey Turnpike Authority