3 months ago

Man Bites Dog Story
Insurer Defeats No Fault Fraudsters
Post 5117

In State Farm Fire And Casualty Company v. 123 Medical Group, P.C. D/B/A OPEN MRI, et al, Index No. 151183/2025, 2025 NY Slip Op 32297, Supreme Court, New York County (June 30, 2025) plaintiff sought a declaratory judgment that plaintiff is not obligated to pay no-fault benefits for the medical treatment of Darrel Branch Andy Celeste, Marie Clermont, and Marie Merzier for injuries they allegedly sustained in a motor vehicle collision on February 12, 2024, based upon plaintiffs' founded belief that the collision at issue was not an insured event but staged as part of an insurance fraud scheme

Plaintiff moved for a default judgment against certain defendants, 123 Medical Group, P.C. d/b/a Open MRI, 999 Coney Island Enterprises Inc., and multiple alleged health care providers.

DISCUSSION

In order to establish its entitlement to a default judgment plaintiff must submit proof of:

(1) service of the summons and complaint;

(2) the facts constituting the claim; and

(3) defendants' default in answering or appearing.

Where, as here, service was effected on certain defendants via the New York State Secretary of State is required, per statute to establish its additional service of the summons and complaint by first class mail at these defendants' last known address.

Plaintiff satisfied these requirements. It has also established the additional mailing of the summons and complaint upon the corporate defendants as required, notice of default with affirmation of mailing and defendants' default. While multiple filed Answers between March 11, 2025 and May 12, 2025, these filings were timely rejected by plaintiff as untimely.

Finally, plaintiff has provided proof of the facts constituting its claim through the affidavit of Micki Fraley, an employee of the Special Investigative Unit of State Farm Fire and Casualty detailing the basis for plaintiffs conclusion that the subject collision was staged.

Accordingly, it was ORDERED, ADJUDGED, and DECLARED that State Farm Fire and Casualty Company has no duty to provide, pay, or honor any current or future claims by 123 Medical Group, P.C. d/b/a Open MRI, and multiple other alleged health care providers, including but not limited to claims for Mandatory Personal Injury Protection (No-Fault), Additional Personal Injury Protection, Uninsured/Underinsured Motorist Coverage, and Supplemental Uninsured/Underinsured Motorist Coverage, in connection with the alleged collision of February 12, 2024 and it is further ORDERED that plaintiff shall, within twenty days from the date of this decision and order, serve a copy of same with notice of entry upon defendants and upon the Clerk of the Court, who is directed to enter judgment accordingly; and it is further ORDERED that such service upon the Clerk of the Court shall be made in accordance with the procedures set forth in the Protocol on Courthouse and County Clerk Procedures for Electronically Filed Cases (accessible at the "E-Filing" page on the court's website).

ZALMA OPINION

Insurance Fraud takes no less than $308 Billion a year. Insurers are required by law to maintains a Special Investigative Unit (SIU) to investigate and work to defeat fraud. State Farm's SIU found detailed evidence that a series of health care providers provided services to people involved in s fake auto accident intended to defraud State Farm and cause money to be provided to health care providers who take a lien and claim - falsely - that they provided health care to the occupants of the car in the staged accident. Since the police fail or refuse to prosecute the health care providers State Farm acted proactively to obtain a judgment they do not owe the health care providers who are violating the no-fault law.

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