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Sleep with dogs You will wake up with fleas



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An insurer proved that it faced claims for damages from stage accidents. The medical providers for the fraudsters who claimed to be injured in the staged accidents claimed a right to be paid for their services. The insurer disagreed.

IN National General Insurance Online, Inc., et al. v. Franklin Blasco, et al., AB Medical Supply, Inc., et al.2022 NY Slip Op 06252, No. 2019-13906, Index No. 605852/18, Supreme Court of New York, Second Department (November 9, 2022), the New York Court of Appeals considered an action for a judgment declaring plaintiffs not liable to pay certain no-fault claims to defendants AB Medical Supply, Inc., AB Quality Health Supply Corp., ACH Chiropractic, PC, Energy Chiropractic, PC, FJL Medical Services, PC, JFL Medical Care, PC, JPF Medical Services, PC, Jules Francois Parisien, Kings Rehab Acupuncture, PC, and Maria Shiela Masigla.

The judgment granting the portion of plaintiffs’ motion seeking summary judgment of the complaint insofar as it was asserted against those defendants held that plaintiffs have no obligation to provide no-fault coverage for the subject claims.

FACTS

In April 2017 and June 2017, within days of defendants Jerry Noland and Franklin Blasco obtaining auto insurance, the vehicles for which the insurance was issued were involved in two separate car collisions when they came into contact with two separate taxicabs. The insurer was suspicious, investigated and found that the accidents were staged.

In or around April 2018, the plaintiffs, National General Insurance Online, Inc., and National General Insurance Company, sued Noland, Blasco and other individuals involved in the collisions, as well as, among others, the defendant medical providers who claimed the collisions were intentional and the insurers were owed nothing.

After the Supreme Court (the trial court) granted the plaintiffs’ motion for leave to appeal against the persons involved in the two collisions, the plaintiffs moved for summary judgment on the complaint to the extent it was asserted against the medical defendants, arguing that they are not liable to pay malpractice claims submitted to them by the physician defendants in connection with the collisions.

The Supreme Court granted that part of the motion. A judgment was handed down on November 13, 2019. The medical defendants appealed.

ANALYSIS

The medical care defendants failed to meet their burden of showing that the portion of plaintiffs’ motion seeking summary judgment of the complaint to the extent it was asserted against them was premature.

Further, in what should be obvious, an intentional and incremental collision caused in furtherance of insurance fraud is not a covered accident under an insurance under New York law. Here, the plaintiffs established their prima facie right to judgment as a matter of law by showing, by admissible evidence, that the subject collisions were intentionally caused or staged.

The doctor defendants failed to raise a triable issue of fact. Accordingly, the Supreme Court properly granted the portion of plaintiffs’ motion for summary judgment of the complaint to the extent asserted against the physician defendants.

Take the profits from the crime of insurance fraud

National General adopted a very effective method of deterring or defeating insurance fraud: they took the profits from the crime. By suing both the fraudsters and the so-called medical providers who allegedly provided medical services to the fraudsters, they avoided paying everyone who participated in the fraud and made it known to the fraudsters that National General is not an insurer worth attempting to defraud.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, now limits his practice to serving as an insurance consultant specializing in insurance coverage, insurance claims management, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims attorney and more than 54 years in the insurance industry.

He can be reached at http://www.zalma.com and zalma@zalma.com.

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