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Zalma Insurance Fraud Letter – November 15, 2022



See the full video at https://rumble.com/v1ugehy-zalmas-insurance-fraud-letter-november-15-2022.html and at https://youtu.be/2LLr4abAY2g and the full pdf of the question at http : //zalma.com/blog/wp-content/uploads/2022/11/ZIFL-11-15-2022.pdf

In the twenty-sixth year of publication of Zalma’s Insurance Fraud Letter, Issue 22 will provide articles on the following topics:

An invalid policy may not respond to a claim

Douglas McKenzie and Jeffery Bigsby (collectively, “Plaintiffs”) filed this insurance litigation action against GEICO Marine Insurance Company (“GMIC”) in the Superior Court of Washington for Snohomish County on April 7, 2022. GMIC dismissed the complaint. IN Douglas McKenzie and Jeffery Bigsby v. GEICO Marine Insurance CompanyCivil Action No. 2:22-cv-00647-BJR, United States District Court, WD Washington, Seattle (November 2, 2022), the USDC settled the dispute.

A person being convicted of insurance fraud when filing a claim must a priori lead to the cancellation of an insurance policy. Schladetzky’s fraud invalidated the policy. The plaintiffs, unable to collect from the criminal, attempted to collect from the insurance policy issued to Schladetzky. Although the court considered the plaintiffs’ arguments, it had no choice but to grant GMIC’s motion because there was no policy to respond to their claims. They have a judgment against the person responsible for their losses and they should be putting their efforts into collecting money from him, not trying to persuade a defrauded insurer to increase the costs of the fraud the criminal imposed on GMIC.

You can read this article in its entirety at ZIFL-11-15-2022

The State Bar of California and Tom Girardi

On November 3, 2022, the State Bar of California published an open letter. For those of you who haven’t read previous reports on Attorney Girardi, he was found penniless and accused of using money belonging to his clients in trust accounts for personal use. As a result of the state bar investigation, he was eventually deposed. The Attorney General was embarrassed by his lack of action and has issued an open letter to explain his position. Everyone involved in the insurance business should be familiar with the contents of the announcement and letter.

GIRARDI SUSPENDED AND STATE’S ADHUS ACCELERATED CUSTOMER SECURITY FUND PAYOUTS

The chief trial attorney requested that Girardi be ousted in 2021; After a default, Girardi was disbarred by the Supreme Court in June 2022. Also in 2021, even before Girardi was disbarred, the State Bar’s Client Security Fund began making payments to its victims on an accelerated basis.

On behalf of the entire board, I want to express our appreciation to everyone who has reached out with their thoughts, concerns and complaints. We hear you, loud and clear. Your experiences serve as a sobering reminder of the importance of our efforts to do better. We are committed to doing so, to fulfill our mission to protect the public.

You can read this article in its entirety at ZIFL-11-15-2022

Double Jeopardy eliminates three out of four convictions

IN The People of the State of Colorado v. Natasha Earnce Robinson, No. 19CA1768, 2022 COA 124, Court of Appeals of Colorado, Third Division (Oct. 27, 2022) found prosecutors overcharged a defendant but upheld her insurance fraud conviction.

Natasha Earnce Robinson appealed the conviction in jury verdicts that found her guilty of four counts of insurance fraud and one count of false reporting to authorities. She argued, among other things, that because her four insurance fraud convictions are based on a single insurance claim, those convictions are multiple in violation of double jeopardy principles.

You can read this article in its entirety at ZIFL-11-15-2022

Good news from the Coalition Against Insurance Fraud

Read about the following and 18 convictions at ZIFL-11-15-2022

A pain doctor made more than $400,000 in false claims to Medicare and Medicaid about steroid injections that were neither reasonable nor medically necessary in the Pittsburgh area. Patients and employees said Dr. John Keun Sang Lee required the patients to receive steroid injections – even when the patients said the injections did not help but rather caused more pain and other injuries. Lee also told employees to withhold their patients’ medications if they objected to the injections. To justify billing insurance companies, Lee told staff to use templates where his patients had 80% relief from previous pain injections. Lee pleaded federally guilty. Up to 10 years in prison awaits when Lee is sentenced on March 7.

You can read this article in its entirety at ZIFL-11-15-2022

How to increase the professionalism of insurance professionals

The insurance industry has been less than effective in training its staff. Their employees, whether claims, insurance or sales, are hungry for education and training to improve their work in the industry.

You can read this article in its entirety at ZIFL-11-15-2022

Florida’s Efforts to Deter Insurance Fraud

On October 19, 2022, Florida Chief Financial Officer (CFO) Jimmy Patronis held a press conference in Cape Coral to highlight fraud prevention efforts in the wake of Hurricane Ian. During the press conference, the Chief Financial Officer announced that he will propose legislation, including cracking down on bad Public Adjusters by limiting their ability to take advantage of Floridians under financial duress, combating Assignment of Benefits (AOB) abuse by completely eliminating the use of AOB, create a state attorney general’s office focused solely on property insurance fraud to hold fraudsters accountable to the full extent of the law, and finally called for a $3 million anti-fraud campaign.

You can read this article in its entirety at ZIFL-11-15-2022

Health insurance fraud convictions

Home care manager sent to prison for $21 million Medicare fraud

Felix Amos, 72, Houston, pleaded guilty on Dec. 18, 2018, to conspiracy to commit health care fraud. On October 31, 2022, United States District Judge Andrew S. Hanen ordered him to serve 30 months in federal prison and three years of supervised release. He was further ordered to pay $21,197,440 in restitution.

On March 22, a jury returned guilty verdicts against Fausat Adekunle, 39, Richmond, on 10 counts after a four-day jury trial. Judge Hanen later ordered her to serve 144 months in federal prison to be immediately followed by three years of supervised release. She must also pay restitution of $21,197,440.14.

You can read this article including 14 convictions in full at ZIFL-11-15-2022

Other insurance fraud

Former Seal Beach insurance agent convicted of theft from elderly consumer

Vincent Allen LaGrange, 66, of Seal Beach, a former licensed insurance agent was convicted in San Bernardino County Superior Court of a misdemeanor count of larceny from an elderly person after a Department of Insurance investigation found he acted as a licensed insurance agent to collect insurance premium payments from consumers but lowers premiums and leaves consumers uninsured. LaGrange was sentenced to one year of probation and has made full restitution to his victims.

The Department of Insurance revoked LaGrange’s license and his entity license, which operated as LaGrange and Associates Inc, and Empire-Valley Insurance Services, in May 2016 after proving he had overcharged an elderly consumer by collecting earthquake coverage twice and misleading her about the billing. LaGrange even financed her premium with a separate finance company without her knowledge and tried to reapply for a new license six months later but was denied.

You can read this article including 9 convictions in full at ZIFL-11-15-2022

(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. Subscribe and receive videos limited to Excellence in Claims Handling subscribers at locals.com https://zalmaoninsurance.locals.com/subscribe.Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.

Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published on https://zalma.substack.com. Go to the Zalma On Insurance podcast at https://anchor.fm/barry-zalma; Follow Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to Insurance Claims Library – https://zalma.com/blog/insurance-claims-library




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