Zalma's Insurance Fraud Letter - October 1, 2022

Zalma's Insurance Fraud Letter - October 1, 2022

Insurer Proactive Against Fraud

CIGNA Obtains $14,371,384.95 Judgment Against Fraudulent Health Care Provider

Since police, prosecutors and state insurance fraud investigators are seldom 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 fake provider and obtained a default judgment for almost $15 million against the corporate defendant 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 must be liquidated – 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 troubles and asking the court to approve DFS as the receiver for the insurer.

The move was not unexpected, after FedNat agreed in May to cancel policies, transfer others to a sister company and wind down operations with what regulators hoped would be an orderly runoff. The Demotech financial rating firm 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 published five days a week videos on insurance claims, insurance claims law, insurance fraud and insurance coverage matters at https://www.rumble.com/zalma.https://rumble.com/c/c-262921.

He now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, 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 handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 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 make it possible for insurers and their claims staff 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 her blood pressure rising, Sharon Beighton was stunned to learn Bruce Saunders fell into a woodchipper 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 “quadrangle,” Sharon Graham had two lovers hit Saunders on the head with a crowbar and place his lifeless body into the chipper so she could claim his $750K (AU) life policy. Graham is a former boyfriend of Saunders and was policy beneficiary. Roser was clearing trees with Saunders and swung the death-dealing crowbar. Peter John Koenig helped Roser feed Sanders into the chipper. Roser then lied that a tree branch hit Saunders, making him woozy and bleeding. Seemingly confused, Saunders supposedly stood unsafely on top of the chipper and tumbled into the churning blades — head-first. Police photos show Saunders’ legs sticking out of the woodchipper horizontally. Graham plotted his murder for six months. Yet Saunders’ murder made no sense to Beighton. Far from woozy, he appeared perfectly alert and wasn’t bloody, 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 everything.” Graham called the life insurer just a few days after the murder to collect the money. Graham and Roser face trial. Koenig pled guilty.

Read the full list of convictions at ZIFL-10-01-2022

A Resource for the Insurance Professional

After practicing insurance law for over five decades, Barry Zalma, an internationally recognized and award-winning insurance expert and author, is releasing multiple education books on Amazon.com. The publications are designed to inform claims people, special investigation unit investigators, coverage lawyers, plaintiffs’ bad faith lawyers, insurance management and the insurance buying public on insurance claims procedures and insurance fraud. Each resource leverages key insights and learnings from Zalma’s 55+ years of practical experience as a claims person and insurance coverage attorney.

To be an insurance professional requires continuous learning. That’s the motivation behind my writing; I have felt a need to share my experiences to help people in the industry learn how to properly handle claims and avoid accusations of the tort 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 that can be purchased through Amazon as Paperback and Kindle e-books.

Health Insurance Fraud Convictions
U.S. Attorney & Feds Increase Efforts to Prosecute Fraud Perpetrators
Durable Medical Equipment Company Health Care Fraud Sentenced to Seven Years in Federal Prison

Daniel Pintado Cazola, on September 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 trying to conceal his connection to the crime by listing a straw owner in corporate and bank records.

Earlier this year, Pintado Cazola pled guilty to one count of conspiracy to commit health care fraud, wire fraud, and mail fraud, and one count of aggravated identity theft.

Read the full list of convictions at ZIFL-10-01-2022

Prosecutors Allow Arson-for-Profit to Succeed
Stupid Plea Bargain Destroys Insurer’s Right to Restitution

Intentionally burning a dwelling and the concomitant presentation of an insurance claims is an arson for profit and two serious felonies. However, in The People V. Damon Lawrence George, C095325, California Court of Appeals, Third District, Placer (September 12, 2022) Damon Lawrence George was allowed by the prosecution to plead guilty only to the unlawful burning of his house. The People, failing to understand the implications upon an insurer, allowed the insurance fraud to succeed by dismissing several related charges against defendant, including insurance fraud, without obtaining a People v. Harvey (1979) 25 Cal.3d 754 (Harvey). waiver, and allowing the defendant to keep the money paid.

Read the full story at ZIFL-10-01-2022

Other Insurance Fraud Convictions
Salt of the Earth Michigan Farmer Will Pay $1.2 Million Settlement Over Crop Insurance Fraud

Gaylord D. Lincoln and G. Lincoln Farms, LLC, located in Springport, Michigan, agreed to pay $1,200,000 to resolve allegations that they violated the False Claims Act by causing the submission of fraudulent claims for federal crop insurance and federal farm benefit payments. 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 U.S. Department of Agriculture’s (“USDA”) Farm Service Agency (“FSA”) by operating a scheme to avoid benefit program payment limitations. Specifically, the United States alleged that the defendants placed their farmland and crops in the names of their employees, who served as a facade for defendants but had no financial risk or interest in the crops and had them enroll in FSA benefit programs. These individuals then provided the FSA benefit payments to the defendants. The United States further alleged that defendants caused these individuals to take out fraudulent federal crop insurance policies for these crops, even though they had no insurable interest in these crops, and that the proceeds of the policies went to the defendants.

The complaint and other filings in this case can be found on the Court’s online docket under United States v. Lincoln, No. 1:21-cv-1089 (W.D. Mich.).

Read the full list of convictions at ZIFL-10-01-2022

New Books:
“How to Acquire, Understand, and Make a Successful Claim on a Commercial Property Insurance Policy: Information Needed for Individuals and Insurance Pros to Deal With Commercial Property Insurance”

The New Book is now available as a Kindle book here, paperback here and as a hardcover here.

The Tort of Bad Faith
What Every Insurance Professional, Every Insurance Coverage Lawyer, Every Plaintiffs Bad Faith Lawyer, and Every Insurance Claims Person Must know About the Tort of Bad Faith

Available as a Hardcover  Available as a paperback  Available as a Kindle Book

Insurance Fraudsters Deserve No Quarter
What every insurer should know about how it can be proactive in the efforts against insurance fraud by refusing to pay every fraudulent claim.
How Giving No Quarter Worked

Many years ago a client I represented was offended that an insured tried to defraud him and the people who were names in the syndicate he represented at Lloyd’s, London. I walked the Underwriter through the debris of the house that was burned, showed him some of the remains of the allegedly highly valuable fine arts, and then explained how he was deceived into issuing the policy. I was the attorney for Lloyd’s underwriters for the fine arts and Imperial Casualty for the homeowners policy.

Barry Zalma, Esq., CFE

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, 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 handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

Over the last 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 make it possible for insurers and their claims staff 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 podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921