Am I In Trouble?
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Bankruptcy Fraud Defeats Legitimate Insurance Claim
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Insurance fraud, like any other profession, improves with practice. The beginner, unaware of the tools available to an insurer, makes a stupid error that will destroy him or her.
Abraham MacPherson was an insurance fraud novice. He had succeeded, with ease, in defrauding his bank by submitting a false financial statement as part of the application for a loan. He even convinced an FBI Agent, checking his fraudulent loan application, that he was the victim of a dishonest loan broker. Success made Abraham bold. He decided it was time to branch out into insurance fraud.
The Petition for bankruptcy, like most filed in the Bankruptcy court showed MacPherson to have no equity in any of his property and no money. He reported his assets as only $500 in jewelry and the tools of his plumbing trade since they were exempt from the grasp of his creditors. What he did not tell the Bankruptcy Court was that MacPherson also owned a $150,000 twin engine Cessna Aircraft that he used to go on hunting and ski trips. He did not tell his lawyer about the airplane because he did not want it sold for the benefit of the judgment creditor whom he felt cheated him.
The day his debts were discharged Abraham called his insurance broker. He advised the broker that his home had been burglarized. He claimed the burglars took all of the jewelry on the schedule. He demanded the immediate issuance of a check for $41,960.
MacPherson stuck to his story. He demanded immediate payment or he would complain to the California Department of Insurance and file suit.
Moseby reported to his principal, the insurer, who decided to deny the claim for fraud. Further, following the law, since MacPherson had admitted to Bankruptcy fraud, the insurer instructed Moseby to pass the information he had obtained to the FBI. In addition, as required by California law he presented the information to the California Department of Insurance, Fraud Division.
Moseby was right, MacPherson was not in trouble with him. He simply would not collect on his claim. MacPherson was in serious trouble with the FBI and the U.S. Department of Justice.
The Special Agent of the Federal Bureau of Investigation was upset that MacPherson had fooled him. After verifying the results of Moseby’s investigation the FBI presented the information to a U.S. Attorney. Prosecution followed charging MacPherson with Bankruptcy Fraud, Mail Fraud — for the presentation of a false and fraudulent claim to an insurer by use of the U.S. Postal Service — and for loan fraud.
He went to trial in U.S. District Court in Sacramento on charges of Bankruptcy fraud. The trial took five hours to complete and the jury was instructed on the law at 4:00 p.m. They deliberated for three days and convicted MacPherson, who was sentenced to serve three years in federal prison.
ZALMA OPINION
It doesn’t pay to lie to an insurance company about a claim. Doing so can lose your claim. It is worse to lie to a bankruptcy court because that is a federal crime that could put the liar in jail for as much as five years. This case proves why it is best to always tell the truth.
(c) 2022 Barry Zalma & ClaimSchool, Inc.
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 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 [email protected].
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Jury’s Findings Interpreting Insurance Contract Affirmed
Post 5105
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Madelaine Chocolate Novelties, Inc. (“Madelaine Chocolate”) appealed the district court’s judgment following a jury verdict in favor of Great Northern Insurance Company (“Great Northern”) concerning storm-surge damage caused by “Superstorm Sandy” to Madelaine Chocolate’s production facilities.
In Madelaine Chocolate Novelties, Inc., d.b.a. The Madelaine Chocolate Company v. Great Northern Insurance Company, No. 23-212, United States Court of Appeals, Second Circuit (June 20, 2025) affirmed the trial court ruling in favor of the insurer.
BACKGROUND
Great Northern refused to pay the full claim amount and paid Madelaine Chocolate only about $4 million. In disclaiming coverage, Great Northern invoked the Policy’s flood-exclusion provision, which excludes, in relevant part, “loss or damage caused by ....
Failure to Name a Party as an Additional Insured Defeats Claim
Post 5104
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Contract Interpretation is Based on the Clear and Unambiguous Language of the Policy
In Associated Industries Insurance Company, Inc. v. Sentinel Insurance Company, Ltd., No. 23-CV-10400 (MMG), United States District Court, S.D. New York (June 16, 2025) an insurance coverage dispute arising from a personal injury action in New York State Supreme Court.
The underlying action, Eduardo Molina v. Venchi 2, LLC, et al., concerned injuries allegedly resulting from a construction accident at premises owned by Central Area Equities Associates LLC (CAEA) and leased by Venchi 2 LLC with the USDC required to determine who was entitled to a defense from which insurer.
KEY POINTS
Parties Involved:
CAEA is insured by Associated Industries Insurance Company, Inc. ...
Exclusion Establishes that There is No Duty to Defend Off Site Injuries
Post 5103
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Attack by Vicious Dog Excluded
In Foremost Insurance Company, Grand Rapids, Michigan v. Michael B. Steele and Sarah Brown and Kevin Lee Price, Civil Action No. 3:24-CV-00684, United States District Court, M.D. Pennsylvania (June 16, 2025)
Foremost Insurance Company (“Foremost”) sued Michael B. Steele (“Steele”), Sarah Brown (“Brown”), and Kevin Lee Price (“Price”) (collectively, “Defendants”). Foremost sought declaratory relief in the form of a declaration that
1. it owes no insurance coverage to Steele and has no duty to defend or indemnify Steele in an underlying tort action and
2. defense counsel that Foremost has assigned to Steele in the underlying action may withdraw his appearance.
Presently before the Court are two ...
ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional
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Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:
Health Care Fraud Trial Results in Murder for Hire of Witness
To Avoid Conviction for Insurance Fraud Defendants Murder Witness
In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...
Professional Health Care Services Exclusion Effective
Post 5073
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This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.
In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:
Insurance Coverage Dispute:
Travelers issued a Commercial General Liability ...
A Heads I Win, Tails You Lose Story
Post 5062
Posted on April 30, 2025 by Barry Zalma
"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime."
Immigrant Criminals Attempt to Profit From Insurance Fraud
People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.
The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...
