ZIFL - Volume 26, Issue 17 – September 1, 2022
Posted on September 1, 2022 by Barry Zalma
The issue, available as a 25 page .pdf document here ZIFL-09-01-2022
See the full video at https://rumble.com/v1i44c7-zalmas-insurance-fraud-letter-september-1-2022.html and at
The issue includes articles including:
Public Adjuster Firm Accused of Pocketing $600,000 in Insurer Payouts in 2 States
Andrew Joseph Mitchell, according to the Texas Department of Insurance, who reported that a public adjusting firm that was sanctioned last month by Louisiana regulators has pocketed more than $300,000 in insurer payouts intended for Texas property owners.
Michigan Allows Fraudster to Receive PIP Benefits but no UM/UIM Benefits
Plaintiff appealed the trial court’s order granting summary disposition in favor of defendants Home-Owners Insurance Company (“Home-Owners”), American Country Insurance Company (ACIC), and Hartford Accident and Indemnity Company (“Hartford”), with respect to plaintiff’s claims for uninsured or underinsured motorist benefits and first-party personal protection insurance (PIP) benefits under the no-fault act, MCL 500.3101 et seq. Although defendants disputed their priority to pay PIP benefits, the trial court did not decide the priority issue, but instead dismissed all claims on the basis of antifraud provisions in defendants’ respective policies.
In Jonathan Jones v. Home-Owners Insurance Company, American Country Insurance Company, And Hartford Accident & Indemnity Company, and Sharneta Henderson, No. 355118, Court of Appeals of Michigan (August 18, 2022) the Court of Appeal produced a Solomon-like decision.
The Law Applies to Thee but not to Me – Insurance Fraud Pays in New York
Oneatha Swinton, the former acting principal of Port Richmond High school in Staten Island, New York, convicted of car insurance fraud kept her employment with the New York Department of Education – and even got a raise – despite what school investigators called her “pattern of dishonesty.”
The DOE gave Swinton, a deal to stay on despite the criminal conviction plus findings that she improperly funneled $100,000 in school funds to a vendor, and “failed to safeguard” 600 DOE computers, printers and laptops which vanished under her watch.
California Claims Regulations
Fair Claims Settlement Practices Regulations 2022
If You Haven’t Complied by Today You are in Violation
Insurers licensed or operating in California must ascertain that their entire claims staff has read, understood or be trained about the California Fair Claims Settlement Practices Regulations by September 1 of Each Year and be ready to swear under oath that the Regulation has been complied with by the insurer.
Before Electing to Rescind
Bases for Rescission
The primary bases for rescission are:
misrepresentation or material fact(s),
concealment of material fact(s),
mistake of material fact(s),
mistake of law, or
fraud.
New York StateWide Senior Action Council Announces It’s Medicare Fraud of the Month
Telemedicine Fraud.
“Telemedicine Fraud, often called Telehealth Fraud is a growing trend in Medicare. The COVID-19 pandemic created unprecedented challenges for how patients accessed health care with the need for social isolation leading to an explosion in remote Telemedicine care,” stated Maria Alvarez, Executive Director of StateWide in announcing this month’s Medicare Fraud of the Month.
The StateWide Fraud of the Month is a component of the Senior Medical Patrol, the definitive resource for New York State’s senior citizens and caregivers to help detect, prevent, and report Medicare fraud and waste. StateWide is New York’s grantee/administrator for this Federal Program.
Good News From the Coalition Against Insurance Fraud
Ricky Gonzales ran Ricky’s Construction Company, which supplied construction labor for contractors. The Tampa, Fla.-area man lied he paid workers’ compensation for the laborers he provided — who were undocumented immigrants. The contractors then sent Gonzales what they thought were payroll checks. Gonzales cashed the checks at banks to pay the workers. Gonzales lied that employees had full worker’s comp. In truth, he received and cashed more than $7M of checks from construction contractors for his employees. That far exceeded the limited payroll that Gonzales reported to his comp insurer. His employees thus worked at job sites without adequate insurance coverage. The insurers lost premiums they would’ve charged had they known the true number of workers their policies were being manipulated to cover. Gonzalez also illegally avoided state and federal payroll taxes. He pled federally guilty and faces up to 25 years in prison when sentenced.
And many more convictions.
Health Insurance Fraud Convictions
South Bay Chiropractor Sentenced to Prison for Receiving Kickbacks
A Redondo Beach chiropractor was sentenced to 14 months in prison for soliciting kickbacks from other hospitals. (Shutterstock)
Brian Carrico, 68, of Redondo Beach, was sentenced August 26, 2022 to 14 months in federal prison by U.S. District Judge Josephine L. Staton, who also ordered him to pay a fine of $25,000.
The South Bay chiropractor was sentenced for taking kickbacks from Pacific Hospital — a medical center in Long Beach whose then-owner was later imprisoned — and for soliciting kickbacks from another Southern California hospital. Carrico pleaded guilty in February to one count of soliciting kickbacks — the same day his two Redondo Beach-based companies, Performance Medical & Rehab Center Inc. and One Accord Management Inc. — each pleaded guilty to one count of conspiracy to solicit kickbacks.
And dozens more convictions.
Zalma on Insurance at Locals.com
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Florida Sting Operation Busted 13 Contractors Without Workers’ Comp
In an attempt to save the few remaining insurers doing business in Florida, the state has taken aim at unlicensed contractors who some claim have increased the cost of repair to property in Florida.
Other Insurance Fraud Convictions
Florida Staffing Firm Head Sentenced to 24 Years for Off-Book Labor Scheme
Mykhaylo Chugay from 2007 to 2021 according to federal prosecutors said, operated a number of shady staffing companies in south Florida that avoided paying more than $25 million in federal taxes. Last week, a federal judge sentenced Chugay to 24 years in prison for his June conviction on crimes that included fraud, harboring illegal aliens and money laundering, according to prosecutors and news reports. Plus many more convictions.
Insurance Fraud in the U.K.
On August 25, 20200 the Association of British Insurers and the Insurance Fraud Bureau Announced:
The number and cost of fraudulent claims fell in 2021, but the average scam uncovered at a record level of over £12,000.
Motor insurance claim fraud still the most common insurance con.
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 [email protected].
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 [email protected];
; http://zalma.com/blog; I publish daily articles athttps://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
The Largest Residential Burglary of All Time
Post 5407
Fraud & the Fear of Bad Faith Suits
Posted on July 22, 2026 by Barry Zalma
See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.
After ...
Chutzpah is not Enough
Post 5397
Posted on July 20, 2026 by Barry Zalma
See the video and at https://lnkd.in/gNUs2XzT and at https://lnkd.in/g2MawyzX
Magistrate Issues a Search Warrant if there is a Fair Probability that Contraband or Evidence of a Crime will be Found in a Particular Place.
In United States Of America v. Frank Suess, et al., CRIMINAL No. 3:24-308, United States District Court, M.D. Pennsylvania (July 16, 2026) a federal grand jury indicted Frank Suess, Melissa Driscoll, and others in a 55-count health care fraud and anti-kickback prosecution arising from an alleged scheme involving medically unnecessary prescription “foot baths.”
As part of the investigation, the FBI obtained an August 19, 2022 warrant to search Driscoll’s Sterling Pharmacy Yahoo email account for emails from January 1, 2018 through December 31, 2020. Driscoll moved to suppress the resulting evidence, arguing that the warrant lacked probable cause, was overbroad, and rested on material misstatements and omissions.
LAW:
The ...
Fraud Shouldn’t Pay
Post 5396
See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.
The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.
One month after the policy was ...
Day Care Owner Loses Subsidies Because She Criticized State
Post 5421
Posted on August 11, 2026 by Barry Zalma
First Amendment Right Will be Allowed to Go to Trial
In Betsey J. Grant v. Maine State Department Of Heath And Human Services, No. 1:25-cv-00490-JAW, United States District Court, D. Maine (August 6, 2026), Betsey J. Grant, a licensed childcare provider and operator of Tiny Tikes Daycare in Trenton, Maine, sued Maine DHHS and several employees after she publicly criticized DHHS before Maine’s Government Oversight Committee and alleged that officials retaliated against her.
She claimed DHHS imposed and extended a conditional license, published stigmatizing information, interfered with subsidies and program funding, removed her from a food program, rescinded an expansion grant, and used biased or falsified evidence in licensing proceedings. Following the March 10, 2023, GOC testimony, Ms. Grant alleges that foster children's subsidies (approximately $30,000) were withheld; she was removed from the ...
Rescission for Material Misrepresentation
Post 5418
Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units. After an underlying personal injury action was filed, Union Mutual determined that the property actually contained three apartment units and rescinded the policies on the ground that the defendants had made a material misrepresentation in the applications.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true ...
Rescission for Material Misrepresentation
Post 5418
Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true facts been disclosed. To establish materiality as a matter of law, the insurer must submit documentation of its underwriting practices, such as manuals, guidelines, bulletins, or rules addressing similar risks.
DISCUSSION/ANALYSIS:
As a result, the...
