A recent topic of this blog has been the made-up insurance fraud statistics by the insurance industry, which has been discussed in Is the Insurance Industry’s Fraud Statistic Fraudulent? and Insurance Professor Jay Feinman Comments About Insurance Fraud Statistics. I have always wondered why we encounter such few allegations of policyholder fraud from insurers such as Amica, Chubb, and Lexington Preferred who charge higher premiums and compete on service rather than price. These companies do not nitpick their customers to death, and the focus is on fully paying the loss right away.
Continue Reading Does Nitpicking On Claims Have An Adverse Effect on Policyholder Morals?

This weekend’s post, Is the Insurance Industry’s Fraud Statistic Fraudulent? resulted in several great comments. One was from Rutger’s insurance law professor, Jay Feinman, who wrote the book, Delay Deny Defend–Why Insurance Companies Don’t Pay Claims and What You Can Do About It. His book should be in everybody’s personal library.
Continue Reading Insurance Professor Jay Feinman Comments About Insurance Fraud Statistics

Insurance fraud is always wrong. It is especially wrong when the insurance company is defrauding its own customer. The American Policyholder Association (APA) has taken a bold step by hiring experienced insurance fraud investigators to review and investigate actions by insurance companies that are wrongful and fraudulent.
Continue Reading Is The Insurance Company Committing Fraud? Report It To The American Policyholder Association Professional Fraud Investigators

I wrote a post eight years ago: Public Adjuster Arrested For Intentionally Inflated Fire Claim Denies Allegations. The post had a long public denial by the public adjuster. The charges were dismissed. The public adjuster brought a malicious prosecution and other claims against those involved with his arrest. A recent summary judgment Order1 ruled against the public adjuster.
Continue Reading The Rest of the Story of a Public Adjuster Accused of Fraud, and Requirements to Provide Information About Suspected Fraud To Authorities

In a follow-up to a post last spring, Appraisals Can Lead to Nasty Legal Battles—Should Appraisers and Umpires Get Insurance Protecting Them, a federal judge has allowed the insurance company to file a counterclaim against the policyholder church, its appraiser, and a unilaterally appointed umpire.1 The counterclaim is one that readers of this blog should study because it raises issues about the propriety of appointing an umpire in a separate petition from a pending lawsuit concerning the controversy, how a new appointment of a new umpire after the first one resigns is to be handled, and whether the umpire was indeed appointed unilaterally.
Continue Reading $56 Million Dollar Appraisal Award Leads to Fraud Counterclaim and Lawyer Hostility

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?