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The judgment for insurance fraud confirmed | Zalma on insurance



I State of Utah v. Julio Ayala No. 20170928-CA, 2022 UT App 1, Court of Appeals of 26, Utah, January 26 proved that Julio Ayala was involved in several car accidents while driving his truck and trailer. Ayala filed claims with several insurance companies and these insurance companies paid for many chiropractic treatments and claims for property, among other things. Ayala later admitted to a private detective that he had not been injured in the accidents but still believed he was entitled to insurance benefits.

After Ayala was charged with a crime, the case was tried without a jury and the court convicted Ayala of a pattern of illegal activity and a case of gross insurance fraud. Ayala appealed, arguing (1) that the trial court committed a manifest error in convicting him based on insufficient evidence that his crime met the threshold for a third-degree crime and (2) that his representative was ineffective in not calling an expert witness to rule on misinterpretation. in Ayala's interview with the private detective.

BACKGROUND

Between January 2010 and July 2012, Ayala was involved in five car accidents. In each accident, he was driven from behind by another vehicle. For three of these accidents – the first in January 2010, the second in December 2010 and the third in April 2012 – Ayala filed a claim with his insurance company, which in turn paid for chiropractic care for him and damage to his vehicles and trailers.

In March 2013, Ayala had another similar accident. When he again sought insurance benefits for alleged damage to his trailer, the insurance company sent a private detective to interview him. Since Ayala mainly speaks Spanish, the private detective provided an interpreter (interpreter) to convey questions to Ayala and his lawyer. Ayala's lawyer, who was present during the interview, spoke English and Spanish and intervened several times to help clarify the interpretation of the investigator's questions to Ayala.

During the interview, Ayala admitted that he had not been injured in any of the accidents. . Ayala stated that his insurance coverage entitled him to chiropractic treatment after the accidents, even though he had not been injured. Ayala agreed with the private detective that he had "received treatment for no reason" and added, "[S] because I am covered because of my insurance and that is my right." At the end of the interview, Ayala confirmed that he had understood all the investigator's questions.

A complaint was lodged with the Insurance Fraud Division of the Utah Insurance Department, and the state accused Ayala of a pattern of illegal activity and two cases of insurance fraud.

in December 2010 and the accident in April 2012, even though he had not been injured in these accidents. The district court also convicted Ayala of breach of insurance fraud.

ANALYSIS

As regards the lawyer's awareness of the interpretation issues, the court found the following about arrest:

  • to address all of its problems through cross-examination rather than calling on an expert to testify.
  • The lawyer believed that the testimonies of several chiropractors would objectively establish that Ayala was injured, and he considered the problems of interpretation to be one ".
  • In retrospect, the lawyer wished he had called an expert to testify about problems with interpretation.

Regarding the testimony of the two experts, the court made the following findings:

  1. the transcripts and they did not listen to an audio recording of the interview iew.
  2. The first expert interpreter "acknowledged that a large part of the language is non-verbal. Voice tone, eye contact, body language and gestures do not occur in written translation, and an interpreter sitting next to the individual for whom they are interpreting may more easily determine if the individual understands the interpretation. "[19659013] The other expert interpreter admitted that" he [was] lacked something contexts and nuances that [could] can not be determined solely by examining the printout. "
  3. The expert interpreters pointed out some words in the interpretation that could have been replaced by more precise terms. The first expert noted that for the English word "injury", the interpreter used the Spanish language, which usually refers to "hurt feelings or actual physical harm, depending on the context."
  4. The expert explained that it would have been more correct to use another Spanish language that is "commonly used to describe a more serious injury."
  5. The other expert interpreter noted that when Ayala spoke of his "right" to receive insurance benefits, a more accurate interpretation would have conveyed that Ayala believed he was "deserving" of
  6. Although the two expert interpreters "were credible" and their "expertise undisputed [, ]… many of the objections to the quality of the interpretation [the] were more technical than practical."

The experts' interrogation testimonies and report did not convince the district court that the interpretation was misunderstood by Ayala to any significant degree, or that Ayala's response during the insurance investigation was so misunderstood and incorrect

Ayala asked the Court of Appeal to conclude that the district court wrongly convicted him of gross insurance fraud because the evidence did not show that he had received at least $ 1,500 in fraudulent insurance benefits – the minimum limit of 1965. Contrary to the request, the Court of Appeal concluded that the judge did not err, as there was sufficient evidence to show that Ayala received almost $ 2,000 in insurance benefits in connection with his fraudulent insurance claim. Specifically, Defense Appendix 5 (produced by Ayala at the trial) included six application forms for chiropractic treatments received from April 20 to May 18, 2012, in connection with the accident and claim in April 2012. Consequently, there was sufficient evidence to support Ayala's third-degree conviction.

Ayala's defense was not affected by the lawyer's alleged failure to perform and the court found that the lawyer was familiar with the facts of the case and was confident in his ability. to cross-examine an interpreter on his own, and thus he would not have to hire an expert. The lawyer's cross – examination of the Interpreter provided the same information about the problematic aspects of the interpretation that the two experts would have offered. It is therefore clear that the testimony of the experts on the quality of the interpretation – if they had been included in the proceedings – would not have had any effect on the outcome of the proceedings for the simple reason that their testimony would not have added anything to the testimony of the lawyer's on their own.

Although it may be true that the interpretation was inelegant because it suffered from certain shortcomings and lack of nuances, any problems with it were not so profound that they undermined the confidence of the Court of Appeal at the end of the proceedings.

Therefore, the Court of Appeal concluded that erred in convicting Ayala of gross insurance fraud, as sufficient evidence was presented at the trial that Ayala received more than $ 1,500 in insurance benefits in connection with fraudulent allegations related to that bill.

Major insurance frauds are ignored by prosecutors. A fraud of $ 1500 to $ 2000 was tried for a judge, the defendant was convicted correctly and will be punished appropriately because he was ignorant enough, with his lawyer present, to tell an investigator that he was not injured in any of the accidents and got chiropractic treatment which – what he considered to be a right – despite the fact that there was no physical reason for the treatment. Taking this case to appeal is an example of why states hate to bring insurance fraud cases to justice because of the cost of a lawsuit and an appeal far exceeds the amount taken in the fraud. But if other states imitate Utah, all prosecutions and convictions will deter others from attempting fraud.


© 2022 – Barry Zalma

Barry Zalma, Esq. coverage, handling of insurance claims, bad faith and insurance fraud almost equally for insurers and policyholders.

He also acts as an arbitrator or media for insurance-related disputes. He practiced law in California for more than 44 years as a lawyer for insurance coverage and claims management and more than 54 years in the insurance industry.

Subscribe to "Zalma on Insurance" at https://zalmaoninsurance.locals.com/subscribe and "Excellence in Claims Handling "at https://barryzalma.substack.com/welcome.

You can contact Mr. Zalma at https://www.zalma.com, https://www.claimschool.com, zalma@claimschool.com and zalma@zalma.com. Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.

You can find the interesting podcast "Zalma On Insurance" at https://anchor.fm/barry-zalma; you can follow Zalma on Twitter at; you should watch Barry Zalma's videos on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; or videos at https://rumble.com/zalma. Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claimslibrary/ The last two issues of ZIFL can be found at https://zalma.com/zalmas-insurance- fraud- letter-2 /


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