Watch the full video at https://rumble.com/v1m1ut6-zalmas-insurance-fraud-letter-october-1-2022.html and at https://youtu.be/dIKdl29A1lU
Read the full issue at ZIFL-10-01-2022
Insurers proactive against fraud
CIGNA Obtains $14,371,384.95 Verdict Against Fraudulent Health Care Provider
Because police, prosecutors and government insurance fraud investigators are rarely willing to arrest or prosecute insurance fraud perpetrators, it is necessary for insurers to be proactive and sue those who attempt or succeed in defrauding insurers.
IN Connecticut General Life Insurance Company and CIGNA Health And Life Insurance Company v. Mike Ogbebor and Stafford Renal LLC, no. 3:21-cv-00954 (JAM), United States District Court, D. Connecticut (September 6, 2022) CIGNA successfully sued a fraudulent supplier and obtained a default judgment of nearly $15 million against the corporate defendants and its alter ego individual.
Read the full story at ZIFL-10-01-2022
Another Florida insurer is insolvent
FedNat Insurance Co. is now insolvent and facing liquidation — the sixth Florida property insurer this year to throw in the towel.
The Florida Department of Financial Services filed a consent agreement with the Leon County Circuit Court, detailing the extent of FedNat’s financial problems and asking the court to approve DFS as receiver for the insurance company.
The move was not unexpected, after FedNat agreed in May to cancel policies, transfer others to a sister company and wind down operations in what regulators hoped would be an orderly runoff. Financial rating firm Demotech also withdrew its stability rating for FedNat on August 1, 2022.
Read the full story at ZIFL-10-01-2022
Free insurance videos
Barry Zalma, Esq., CFE has posted five days a week videos on insurance claims, insurance claims laws, insurance fraud and insurance coverage at https://www.rumble.com/zalma.https://rumble.com/c/c-262921.
He now limits his practice to that of an insurance consultant specializing in insurance coverage, insurance claims management, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance-related disputes. 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.
Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
For the past 54 years, Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their claims professionals to become insurance claims professionals.
See the more than 400 videos at https://www.rumble.com/zalma
Good news from the Coalition Against Insurance Fraud
In shock and blood pressure rising, Sharon Beighton was shocked to learn that Bruce Saunders fell into a wood chipper and was ground up while clearing trees on her property near Brisbane, Australia. A tragic accident, it seemed. Prosecutors allege he was murdered: In a complex love affair, Sharon Graham had two lovers hit Saunders over the head with a crowbar and place his lifeless body in the wood chipper so she could claim on his $750,000 (AU) life policy. Graham is a former boyfriend of Saunders and was a policyholder. Roses cleared trees with Saunders and swung the death-dealing crowbar. Peter John Koenig helped Roser feed Sanders into the wood chipper. Roser then lied about a tree branch hitting Saunders, leaving him wobbly and bleeding. Seemingly confused, Saunders stood precariously on top of the wood chipper and fell into the sizzling leaves – head first. Police photos show Saunders’ leg sticking out of the chippings horizontally. Graham planned his murder for six months. Still, Saunders’ murder was senseless to Beighton. Far from mad, he appeared perfectly alert and was not bloodied, she told investigators. Beighton’s granddaughter said Graham made a “big deal” about how much money Saunders had and that “he would die first, and she would get it all.” Graham called the life insurance company just days after the murder to collect the money. Graham and Roser are brought to justice. Koenig pleaded guilty.
Read the full list of convictions at ZIFL-10-01-2022
A resource for insurance professionals
After practicing insurance law for over five decades, Barry Zalma, an internationally recognized and award-winning insurance expert and author, releases several educational books on Amazon.com. The publications are designed to inform claimants, special investigation unit investigators, coverage attorneys, bad faith plaintiffs’ attorneys, insurance administration, and the general public of policy buyers about insurance claims procedures and insurance fraud. Each resource benefits from key insights and lessons learned from Zalma’s 55+ years of practical experience as a tort claim and insurance attorney.
To be an insurance professional requires continuous learning. That is the motivation behind my writing; I have felt the need to share my experiences to help people in the industry learn how to handle claims properly and avoid allegations of bad faith.” See his latest interview for new adjusters at https://player.fm/series/daily-claims/episode-11-advice-for-new-and-aspiring-adjusters.
Visit Zalma’s Insurance Claims Library to view all publications available for purchase through Amazon as Paperback and Kindle eBooks.
Health insurance fraud convictions
The US Attorney and the Feds are stepping up efforts to prosecute fraudsters
Durable Medical Equipment Company Health Care Fraud Sentenced to Seven Years in Federal Prison
Daniel Pintado Cazolaon Sept. 9, was sentenced to 87 months in prison for his role in using a durable medical equipment company to commit Medicare and Medicaid fraud and for trying to hide his connection to the crime by listing a straw owner in corporate and bank records.
Earlier this year, Pintado Cazola pleaded guilty to one count of conspiracy to commit health care fraud, wire and mail fraud, and one count of aggravated identity theft.
Read the full list of convictions at ZIFL-10-01-2022
Prosecutors allow arson to succeed
Stupid Plea Bargain destroys the insurer‘s Right to restitution
Deliberately burning down a home and making an insurance claim at the same time is arson and two serious crimes. However in The People V. Damon Lawrence George, C095325, California Court of Appeals, Third District, Placer (September 12, 2022) Damon Lawrence George was pleaded guilty by the prosecution only to the illegal burning of his house. The People, not understanding the consequences for an insurer, allowed the insurance fraud to succeed by dismissing several related charges against the defendant, including insurance fraud, without obtaining a People vs. Harvey (1979) 25 Cal.3d 754 (Harvey). waiver, and allow the defendant to keep the money paid.
Read the full story at ZIFL-10-01-2022
Other insurance fraud
Salt of the Earth Michigan farmer to pay $1.2 million settlement for crop insurance fraud
Gaylord D. Lincoln and G. Lincoln Farms, LLC, located in Springport, Michigan, agreed to pay $1,200,000 to settle allegations that it violated the False Claims Act by submitting fraudulent claims for federal crop insurance and federal farm benefits. The settlement amount was negotiated based on the defendants’ ability to pay.
This settlement resolves civil claims the United States brought against the defendants in a December 2021 lawsuit. In its complaint, the United States alleged that the defendants defrauded the United States Department of Agriculture’s (“USDA”) Farm Service Agency (“FSA”) by operating a scheme to avoid benefit program limitations. Specifically, the United States alleged that the defendants placed their farmland and crops in the names of their employees, who acted as a front for the defendants but had no financial risk or interest in the crops and caused them to enroll in the FSA benefit program. These individuals then provided FSA benefits to the defendants. The United States further alleged that the defendants caused these individuals to take out fraudulent federal crop insurance policies for these crops, even though they had no insurable interest in those crops, and that the proceeds of the insurance went to the defendants.
The complaint and other filings in this case are available on the court’s online docket below United States v. Lincoln1:21-cv-1089 (WD Mich.).
Read the full list of convictions at ZIFL-10-01-2022
New books:
“How to Obtain, Understand and Successfully Claim Commercial Property Insurance: Information Needed by Individuals and Insurance Professionals to Manage Commercial Property Insurance”
The new book is now available as a Kindle book here, paperback here and as a hardcover here.
Bad faith damages
What Every Insurance Professional, Every Insurance Attorney, Every Bad Faith Claimant’s Attorney, and Every Person With an Insurance Claim Needs to Know About Bad Faith Torts
Available as hardcover Available as paperback Available as Kindle book
Insurance fraudsters don’t deserve a quarter
What Every Insurer Should Know About How To Be Proactive In Anti-Insurance Fraud Efforts By Refusing To Pay Every Fraudulent Claim.
How Giving No Quarter Worked
Many years ago a client whom I represented was aggrieved that an insured attempted to defraud him and the persons who were names in the syndicate he represented at Lloyd’s, London. I walked the underwriter through the debris from the house that burned, showed him some of the remains of the allegedly very valuable art, and then explained how he was duped into issuing the policy. I was a solicitor for Lloyd’s underwriters for the fine arts and Imperial Casualty for the home owners policy.
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 also serves as an arbitrator or mediator for insurance-related disputes. 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.
For the past 54 years, Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their claims professionals to become insurance claims professionals.
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455;
Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.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; I publish daily articles at 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
