Watch the full video at https://rumble.com/v2m6km8-millions-for-defense-not-a-dime-for-tribute.html and at https://youtu.be/czeSca9t3M8
In a no-fault auto insurance case brought in New York, State Farm Fire and Casualty Company, the plaintiff insurer determined prima facie right to summary judgment of:
- file the examination under oath of defendant insured Lesie Merle, in which she testified that she primarily garaged the car involved in the accident in Far Rockaway, New York, rather than in Connecticut;
- an affidavit from its insurer Christina Ardito, establishing that such misrepresentation to the plaintiff as to the car’s location was material.
IN State Farm Fire And Casualty Company v. Lesie Merle, Katie Dieubon, Brittani Watson, Yolaunda Vaughn, Affinity Rx Inc, All County, LLC, Amsc, LLC, Benessere Services Inc, Honest Acupuncture PC, Integrated Interventional Pain Management PC, Khawaja Asim Siddique, MD, Lite Care Rehab Pt PC , Macintosh Medical, PC, Medical Mri PC, Noam Kurtis Md PC, Patient Chiropractic, PC, And Wind Physical Therapy PC, Index No. 153004/2021, MOTION SEQ. no. 002, 2023 NY Slip Op 31281(U), Supreme Court, New York County (April 19, 2023) the court ruled in favor of State Farm.
FACTS
Plaintiff determined that Defendant Brittani Watson did not appear for an examination under oath (“EUO”) in accordance with the terms of the policy. Failure of an injured person to appear for one [“EUO”] is a defense to any claim for benefits by that person or their assigns.
State Farm established through claims specialist Richa Sinha who certified EUO testimony led to the conclusion that the accident was staged. This prima facie established the plaintiff’s right to reject claims arising from the accident.
DECISION
Accordingly, it was ordered that:
- plaintiff’s motion for summary judgment granted;
- defendant Lesie Merle’s motion to vacate the default judgment against her was denied;
- Plaintiff shall not be obligated to provide any coverage, compensation or pay any money, sums or funds to any of the Defendants Defendants herein for any and all fault-related services for which claims and/or bills have been or may in the future be, submitted by Defendants the defendants to the plaintiff;
- Defendants defendants lack standing to seek or recover no-fault, uninsured/underinsured, and property damage benefits and/or claims filed by or on behalf of BRITTANI WATSON because she violated a condition precedent to coverage by failing to appear for an examination under oath in connection with the claim that gave rise to the above-described lawsuit;
- that Defendants Defendants lack authority to seek or receive No-Fault reimbursements for any bills submitted by or on behalf of LESIE MERLE, because she engaged in a scheme to defraud and/or fraudulently obtain insurance from Plaintiff by knowingly submitting submitted an application for insurance that contained material misrepresentations of fact and false and/or fraudulent statements;
- that the alleged November 26, 2019 motor vehicle accident that gave rise to the aforementioned lawsuit was not the product of a covered event as defined in the applicable insurance policy issued by the plaintiff since the November 26, 2019 event, was the product of a staged and/or intentional event;
- Plaintiff, due to no coverage and because the alleged accident on November 26, 2019 was the result of a staged and/or intentional event, is not obligated to pay any sums, money, damages, awards and/or benefits to any of the Defendants in question, their agents, employees, assigns and/or heirs arising out of ongoing or future proceedings, any uninsured/underinsured motorist lawsuits and arbitrations, no-fault arbitrations and suits seeking to recover no-fault benefits, third-party suits and arbitrations; and all property damage claims resulting from the alleged accident on November 26, 2019.
Refusing to be cowed by a lawsuit seeking benefits for a fraudulent, staged car accident and a fraudulently obtained insurance policy, State Farm defeated the multiple claims created as part of the fraud scheme. Every insurer should emulate State Farm and thoroughly investigate every claim and, when fraud is suspected, gather the necessary evidence and refuse to pay and be willing to litigate the matter.
(c) 2023 Barry Zalma & ClaimSchool, Inc.
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Barry Zalma, Esq., CFE, can be found at http://www.zalma.com and zalma@zalma.com
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