Plaintiff Entitled to Know All Insurance Available to Defendants
Post 4795
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Pedro Fundora filed suit against Robert Dangond and Maria Guevara after sustaining injuries when Dangond struck Fundora with a vehicle owned by Guevara. On appeal, Fundora argued that the trial court erred by granting Robert Dangond and Maria Guevara's Motion to Enforce a Settlement Agreement.
In Pedro Fundora, etc. v. Roberto Dangond, No. 3D22-1749, Florida Court of Appeals, Third District (May 1, 2024) the plaintiffs sought to rescind a settlement agreement because the defendant's insurer did not tell Plaintiff's counsel about all insurance available to the Defendants.
FACTS
During litigation, Fundora sent Dangond and Guevara's insurer, Progressive Insurance Company, a demand letter pursuant to section 627.4137(1), Florida Statutes (2011), which provides that:
an 'insurer which does or may provide liability insurance coverage to pay all or a portion of a claim which might be made shall provide . . . a statement . . . setting forth [the information specified in this statute] with regard to each known policy of insurance ....' (Emphasis supplied).
In response, Progressive sent Fundora a letter disclosing only one policy, held by Dangond. Included in the disclosure was a statement "certify[ing] . . . that the contents of this disclosure made pursuant to Florida Statute 627.4137 are true and correct." Progressive did not disclose any other policies.
When Fundora later offered to settle with Dangond and Guevara, for limits based on the disclosures from Progressive, Fundora sent Progressive a demand letter, again requesting disclosure of information on additional known policies, and making the settlement offer contingent on verification that Progressive knew of no other policies. Two weeks later, Progressive sent Fundora's counsel a letter accepting the settlement offer. Progressive responded to the disclosure demand by attaching affidavits from Dangond and Guevara stating that there was no additional coverage.
On the same day that Progressive sent the letter accepting Fundora's settlement offer, it also sent a separate letter to Fundora disclosing an additional insurance policy held by Dangond and Guevara's codefendant, Dangond Construction, that potentially could provide coverage for the accident. Because Progressive disclosed this policy after accepting the settlement offer, Fundora did not have the benefit of reviewing the additional policy prior to offering to settle.
ANALYSIS
Fundora's request to Progressive for information on any known policies pursuant to section 627.4137(1) was an essential term of Fundora's offer to settle with which Progressive failed to comply. The Court of Appeals concluded that a settlement offer is unenforceable because, despite multiple demands pursuant to section 627.4137 and clearly establishing that compliance was a necessary and essential element of any settlement acceptance, Fundora was deceived.
Since the defendant's insurer did not provide the information until after one response and the acceptance of the settlement offer, the insurer's failure to provide the disclosure in accordance with section 627.4137 rendered the settlement unenforceable because the plaintiff made it clear that the insurance disclosure was an essential term and because the insurance disclosure is an essential term under case law.
The Court of Appeals agreed with Fundora that the settlement was unenforceable it reversed.
ZALMA OPINION
One of the greatest incentive for a plaintiff to accept a settlement offer from a defendant is the amount of insurance available when the defendant seems to be judgment proof. When an insurer violates the statute and fails to disclose that there is more insurance, the settlement agreement was made based on false information and it was unconscionable to accept a settlement offer based on a fraudulent statement of available insurance.
(c) 2024 Barry Zalma & ClaimSchool, Inc.
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Insurance for State of Delaware Waives Sovereign Immunity
Read the full article at https://lnkd.in/gUZqz9kE, see the full video at https://lnkd.in/gN_MYPbK and at https://lnkd.in/g-3Pn_-T, and at https://zalma.com/blog plus more than 4800 post.
Post 4803
On February 15, 2023, Kimberly Letke (“Plaintiff”) filed a pro se Complaint against Defendant Matthew Sprinkle (“Sprenkle”) for defamation and malicious prosecution. On October 3, 2023, Plaintiff filed another Complaint added Defendants Cpl. Tyler Beulter of the DNREC police (“Beulter”) and the Attorney General of Delaware, Kathleen Jennings (“Jennings”), in which she added three additional claims: false arrest and violations of public trust, unlawful detention, and violations of her rights under the Fourth Amendment to the United States Constitution.
In Kimberly Letke v. Matthew Sprenkle, CPL. Tyler Beulter, and Attorney General Kathleen Jennings, C.A. Nos. S23C-10-019 CAK, S23C-10-002 CAK, Superior Court of Delaware (May 6, 2024) the court was faced...
Force Placed Insurance Charges Allow Special Defense to Foreclosure
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Post 4802
In an action to foreclose a mortgage the trial court granted in part the plaintiff’s motion to strike the defendant’s special defenses and counterclaim; subsequently, the court, Cirello, J., granted the plaintiff’s motion for summary judgment as to liability only; thereafter, the court, Spader, J., rendered judgment of foreclosure by sale, and the defendant appealed.
In M&T Bank v. Robert R. Lewis, No. SC 20817, Supreme Court of Connecticut (April 30, 2024) the appeal of a foreclosure judgment presented one question important to insurance professionals: Whether allegations of impropriety in a mortgagee’s force placement of property insurance arise from the making, validity or enforcement of the mortgage for purposes of a special defense to a foreclosure ...
Read the full article at https://lnkd.in/dAKdNkM8, see the full video at https://lnkd.in/dbNmmGji and at https://lnkd.in/ddU7NHaH, and https://zalma.com/blog plus more than 4800 posts.
Post 4801
The Source for the Insurance Fraud Professional
Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th 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/ This issue contains the following articles:
Incompetent Insurance Fraud Claim Results in Conviction
Fraudster Pawns Jewelry & Then Claims it Stolen
The defendant, Vincent Chaney, appealed two orders from Superior Court denying his motions to suppress and for a new trial. In State of New Hampshire v. Vincent Chaney, No. 2022-0718, Supreme Court of New Hampshire (May 3, 2024) resolved the dispute over Chaney’s conviction.
Read the full 23 page issue here in Adobe pdf format ...
After Health Provider Entity's Management is Arrested for Fraud Reporting Suspicion to Beneficiaries is not Defamation
Read the full article at https://lnkd.in/gvC28cS4, see the full video at https://lnkd.in/giQW_bJK and at https://lnkd.in/gYSqE46x, and https://zalma.com/blog plus more than 4750 posts.
BrainBuilders, LLC appealed from an order granting summary judgment in favor of defendants Optum, Inc., et al (collectively, defendants) in Brainbuilders, LLC v. Optum, Inc., Optum Services, Inc., et al, No. A-0621-22, Superior Court of New Jersey, Appellate Division (April 19, 2024) resolved claims of defamation.
FACTS
Letters dated July 25, 2017 and August 2017 sent by the Optum entities to BrainBuilders' patients following an investigation into purported fraud by individuals associated with BrainBuilders.
BrainBuilders provides healthcare services to children on the autism spectrum. As an out-of-network or non-participating healthcare provider, BrainBuilders receives reimbursement for claims only if a patient's health ...
Read the full article at https://lnkd.in/gvKdq6Qc and at https://zalma.com/blog and the full article in pdf at https://lnkd.in/gBj_3yVw plus more than 4750 posts.
ZIFL-04-01-2024 Volume 28, Number 7
Post 4766
Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th 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.
This month's issue contains multiple articles for the insurance fraud professional and the insurance claims professional. The current issue can be read in full at https://lnkd.in/gBj_3yVw and includes the following articles:
Prison Employee Commits a Crime She Was Employed to Prevent
GUILTY OF WORKERS’ COMPENSATION FRAUD
On January 10, 2022, defendant Tiffinie Marvell Jones was convicted by a jury of one count of insurance fraud. Jones filed a motion for a new trial, which was denied. On appeal, Jones argued that there was insufficient evidence to support the verdict, that her trial counsel provided ...
Indicators of Insurance Fraud are Investigative Tools
Barry Zalma
Mar 27, 2024
Read the full article at https://lnkd.in/gvtv9gCz where you can see more red flags, see the full video at https://lnkd.in/gMirVfZc and at https://lnkd.in/g2ndng5r and at https://zalma.com/blog plus more than 4750 posts.
Post 4763
Suspicious claims have common attributes. Insurers and their anti-fraud organizations have collated the common attributes into lists of indicators or red flags of fraud. The lists were created as training aids and to be used to determine whether further investigation is required to determine if a claim is legitimate or false and fraudulent. Continually growing, these lists are known as the “red flags” or “indicators” of fraud lists. There are many different categories, ranging from those associated with the claim itself or with insureds to indicators of specific types of fraud, such as bodily injury fraud or arson for profit.
If, when assessing a claim, three or more red flags are found the need for further investigation should be considered and evaluated by the claims person, a supervisor and the insurer’s special investigative unit. The...
