Whether it is referred to as a “fraudulent insurance act” or just plain “insurance fraud,” each state prohibits certain acts or omissions that it considers fraudulent. In Georgia, the legislature has enacted Ga. Code § 33-1-16, which defines what it considers to be a “fraudulent insurance act.” In addition, Ga. Code § 33-1-16 imposes varying degrees of reporting requirements on those who have knowledge of a fraudulent insurance act being committed
Continue Reading Reporting Fraudulent Insurance Acts in Georgia: Is There a Requirement to Report?

A recent Florida case1 has a lengthy discussion about cases where changing valuations by the insured are then used by clever insurance company attorneys to argue that a post-loss fraud has occurred. This is now a common practice in litigation throughout the country as policyholders, public adjusters, and contractors make differing estimates of loss and have different opinions about what the measure of the loss should be.
Continue Reading Insurance Company Attorneys Often Wrongfully Argue That a Fraud Occurs When Parties Only Have a Difference of Opinion

One thing I learned during my two years as a young associate at Paul B. Butler & Associates (lka Butler & Pappas) was that saying you were a champion of saving the insurance company money by putting people in jail for insurance fraud or not paying based on the account of fraud made for happy insurer clients eager to send us more business. Insurance companies send business to claims vendors who go out of their way to say that the insurance company’s customers are frauds and deceitful people for any number of reasons. Actual insurance fraud is never right. Yet from the amount of it, which insurance claims vendors say is occurring, insurance companies must sell the most defective product in America if it magically transforms so many law abiding people into crooks.
Continue Reading Who Is Defrauding Whom When It Comes To Big Differences In Appraisal Awards?

Douglas Quinn is the President of the American Policyholder Association (APA.). He was in Orlando last Saturday afternoon. The meeting was somewhat impromptu and had a number of leaders from the National Association of Public Insurance Adjusters.
Continue Reading American Policyholder Association Makes Resonating Comments About Insurance Fraud Against Policyholders

“We hope this sentence sends a message that this conduct will not be tolerated in our county.”
—Matt Smid, Tarrant County Assistant Criminal District Attorney

According to the Tarrant County district attorney’s office, a Tarrant County judge sentenced Richard Livesay to five years in prison after he pled guilty to various charges including fraud and barratry for filing fraudulent hail claim lawsuits. Livesay reportedly would have received more than $300,000 had his fraudulent scheme not been uncovered.
Continue Reading Attorney Richard Kent Livesay Pleads Guilty to Charges of Insurance Fraud Involving Roof Claims

Chubb Corporation has a good reputation in the insurance industry for fairly handling claims and paying insureds what they are owed. Chubb fell victim to an overzealous adjuster, Dennis Sorge, who was colluding with a contractor he hired to estimate repair costs. The contractor, Paul H. Mertz Jr., would inflate the estimates and then Sorge steered the repair work back to the Mertz. After a 40-day trial, Judge Nelson S. Roman entered a judgment of nearly $12.3 million against Mertz and Sorge. The judgment was suspended only as to Sorge due to bankruptcy issues. Mertz was also ordered to pay Chubb’s costs and attorney fees.

Continue Reading Chubb Awarded $12.3 Million in Insurance Fraud Scheme

William David Rodeffer III of Folkston, Georgia, was arrested for collecting $40,000 in insurance premium payments from two clients for nearly three years for insurance policies that were never purchased. Claims Journal reported today about the arrest and listed their source as the Florida Department of Financial Services.

Continue Reading Unlicensed Insurance Agent Arrested for Stealing Premiums

Nestled right on the Delaware River in New Hope, Pennsylvania, is the historic Bucks County Playhouse. The original structure dates back to 1790 and is was formally a grist mill.1 While the theater and its stage have seen some of entertainment’s biggest stars, including Robert Redford, Angela Lansbury, and Dick Van Dyke, its name is in the paper these days for another reason: insurance fraud.

Continue Reading Pennsylvania Playhouse Owner Headed to Jail for Insurance Fraud