This One Isn’t Fiction Because No One Would Believe It
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I received a copy of findings of fact and conclusions of law in a case filed in the U.S. District Court for the Central District of California entitled CIGNA Property and Casualty Insurance Company v. Polaris Pictures Corporation, U.S. Inbanco, Ltd., Continental Pictures Corporation, Paul Ebeling, Kendall Earl Capps, Adrien Wirz, and Jacob Wizman there docketed as case number CV 93-2259 JSL.
On February 20, 1997 United States District Judge J. Spencer Letts found a lawyer and others had committed fraud and purchased a policy of Marine Insurance for the sole purpose of sinking a boat. The findings of Judge Letts read better than I could ever imagine. Here are parts of what Judge Letts concluded:
The evidence presented to the court …convinces the Court that, according to the overwhelming weight of the evidence, that defendants Polaris Pictures Corp. (‘Polaris’), and U.S. Inbanco Ltd. (‘Inbanco’), … conspired with at least one of the named defendants in this action, and a non-party lawyer (the ‘lawyer conspirator’), to engage in a very sophisticated fraud to collect insurance proceeds from plaintiff, Cigna Property and Casualty Insurance Company (‘Cigna’), a marine insurer.
In essence, the fraud intentionally concealed from Cigna the material fact that the conspirator’s purpose in purchasing the insurance from Cigna was not to protect themselves against the risk of an unknown future event, but rather to precipitate an accident which would allow them to collect on it. As a result, a judgment of rescission of [the policy] … issued to Polaris and Inbanco is warranted.…
On June 9, 1992, the lawyer conspirator signed an Order Contract to purchase a brand new 76’ Azimut motor yacht for $1.9 million.
Prior to June 1992, the lawyer conspirator had sustained three total losses of yachts that he either owned or held ownership interests in. Each of these prior yacht losses was insured and each prior yacht loss was paid in full by the respective insurer.
The lawyer conspirator then arranged for Continental to ‘sell’ the yacht to Polaris. The Continental-Polaris transaction was a stock transaction between a company about which little evidence was presented (Continental) and a company with virtually no assets (Polaris).
Polaris was formed by the lawyer conspirator and completely controlled by him at all relevant times. It was also located at the same address as the lawyer conspirator’s residence.
The evidence showed that Polaris never did business of any kind or substance. In addition, the evidence showed that Polaris was placed between the principals of this fraud as a diversion in order to disguise the identity of the person who would get the money in the event of a loss – namely, the lawyer conspirator.
[T]he court finds that defendants’ fraudulent scheme consisted in part of using the insurance proceeds to pay to Inbanco, as a ‘creditor,’ the sham ‘debt’ secured by the vessel.…
[T]he court finds …a conscious plan to defraud Cigna by temporarily distancing the lawyer conspirator from Polaris until the insurance proceeds had been paid.… “All of the ostensible transactions discussed above, with the exception of the purchase of the boat, were among parties all closely tied to the lawyer conspirator, and the corporate parties did not have any meaningful assets.
[T]he reason the lawyer conspirator took such extensive measures to distance himself from these corporations and transactions was to divert attention away from his own personal loss history of sinking vessels.…
Polaris and Inbanco eventually purchased marine insurance for the yacht, named “Principe Di Pictor,” from Cigna… The Application [for the insurance] also failed to state the material fact that Polaris and Inbanco’s purpose for purchasing this insurance was to collect on it, and that a preplanned event for the destruction of the yacht and collection of the insurance was soon and certain to occur. …
The yacht was scuttled on November 7, 1992 [two weeks after the policy was issued] off the Coast of Italy during its maiden voyage. The lawyer conspirator … [was] on board at the time.…
The account of the scuttling from the lawyer conspirator … was that the yacht, allegedly worth $3.5 or $3.62 million, and the lives and bodies of the people on it, was entrusted to a person met for the first time in a dockside restaurant in Naples. This person, whose documents were written in a foreign language, brought with him two other persons who did not speak English and six black duffel bags with undisclosed contents. The three strange men were allegedly applicants for the jobs of Captain and crew.
The Court finds defendants’ claim …to be wholly preposterous. The Court finds the account of the scuttling so incredible that standing alone it would raise serious questions as to whether the boat was deliberately scuttled.…
[P]urchasing insurance, not for the purpose of insuring a risk, but rather for the purpose of collecting the insurance for an event that is being planned, is a highly material fact that should be stated to the insurer.…
The lawyer conspirator was without any credibility as a witness, and he looked, acted and sounded very much like a conspirator in a dishonest scheme. …The lawyer conspirator’s testimony was not cogent and his financial records were very difficult to follow.
The news report did not name the lawyer conspirator. I had dealt with him several times with regard to fraudulent insurance claims so I called the trial lawyer and just asked:
“Is the lawyer conspirtor’s name Rex?
The trial lawyer, Neil S. Lerner was shocked. “How did you know?”
I explained my history with lawyer Rex and wanted to thank Mr. Lerner and all the lawyers at Sands Narwitz Forgie Leonard & Lerner who tried the case on behalf of CIGNA, for finally defeating a fraudulent claim presented by Rex, a long-time nemesis of the insurance industry in California.
I also wish to thank Judge Letts for seeing through an insurance fraud and recognizing that an insurance company can be a victimized by an insured. At the direction of Judge Letts, the lawyer – Rex DeGeorge – was prosecuted by the U.S. Attorney and convicted of mail and wire fraud.
He is now serving a long sentence in federal prison.
ZALMA OPINION
This case is important, and unusual, because it affirmed a rescission based on blatant fraud in obtaining insurance that allowed the insurer, CIGNA, to rescind the policy from its inception. It is more important because the Judge Letts referred to the U.S. Attorney the conspirator who was arrested, tried, convicted and sentenced to federal prison for fraud. Although I held out hope for other judges to emulate Judge Letts, but I have been disappointed.
(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...
