See the full video at https://rumble.com/v12cg12-true-crime-of-insurance-fraud-video-no.-61.html and at https://youtu.be/MSCx8DTGR0M
Jimmy wanted a new pickup in the worst way. He decided to deliberately destroy his old car, make a claim on his insurance and use the proceeds to buy a new F150.
Jimmy revealed his plan to his best friend, Winifred. She agreed to help – as a lookout for oncoming traffic – the night they chose to destroy the car.
Jimmy, with his friend Winifred as a passenger, intentionally drove his pickup off the road and over a small cliff at 55 km / h. He did not let her out of the truck to be his “look out” as planned. He thought it would be more realistic to make a statement – one that would not be questioned by his insurance company, if Winifred was in the car with him.
As planned, the car did not survive the crash. Unfortunately, Winifred did not do that either.
The heirs claimed that they were entitled to benefits for underinsured motorists (UIM) under the Farmers and County Mutual policy because Jimmy was underinsured. In addition, they claimed that Winifred’s death was “unintentional”.
Farmers and County Mutual’s response was, translated by the lawyer:
“Give us a break.”
The heirs claimed that Jimmy and Winifred intended to destroy the truck, not Winifred. The death was unintentional.
In it Winifred’s Heirs v. Farmers & County Mutual arbitration, Farmers and County argued that the interpretation of “accident” in liability policies is hyper-technical and legalistic and should not apply the same term in UIM policies. The arbitrator ruled in favor of the insurer.
The heirs sued, lost in the district court, which adopted the arbitrator’s decision. The heirs appealed and a court of appeal agreed that, for UIM purposes, an “accident” is an “event” which from the perspective of the insured and the underinsured motorist is “unforeseen, unintentional unexpected or the like.”
An injury is not unintentional, the appellate court declared, if the injurious event was intended or expected. It is not necessary that the insured intends or expects the damage.
People who make mistakes should not profit from it. Paying Winifred’s heirs for her death while acknowledging that she was knowingly part of a criminal act is tantamount to paying the heirs to an armed robber who is shot to death by the police during his armed robbery.
If our courts continue to honor criminals, and their heirs, for causing their own harm, the system will destroy itself. If the insurance companies continue to pay to settle this type of fraudulent claim because it is cheaper than fighting to a conclusion, all of us who buy insurance will be affected.
Every person who buys insurance should call their insurers – GIVE US A BREAK!
(c) 2022 Barry Zalma & ClaimSchool, Inc.
Barry Zalma, Esq., CFE, now limits his internship to the position of insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. 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. He is available at http://www.zalma.com and email@example.com.
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