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July 05, 2024
Insurer Not Required to Take on the Burden of the Insured's Fraud

Rescission Appropriate When Insured Lies on Application

Read the full article at https://lnkd.in/gU2gHyfv, see the full video at https://lnkd.in/gYpWwNrw and at https://lnkd.in/gTm--tTM and https://zalma.com/blog plus more than 4800 posts.

Post 4827

Progressive Michigan Insurance Company (Progressive) appealed the order denying its motion for summary disposition and ordering reformation of plaintiff's, Janice Sherman's, automobile insurance policy even when reformation was not requested by Sherman.

In Janice Sherman v. Progressive Michigan Insurance Company and JOHN DOE, No. 364393, Court of Appeals of Michigan (June 20, 2024) the Court of Appeals explained the importance of the equitable remedy of rescission.

BACKGROUND FACTS

On November 12, 2020, Sherman applied to Progressive for a no-fault insurance policy for two vehicles-a 2006 Cadillac DTS sedan and a 1993 Chrysler New Yorker sedan. In the application, she identified her address as 16845 Tremlett Drive, Clinton Township, MI 48035, and confirmed that the vehicles were garaged at this address. The application also failed to disclose the total number of resident relatives, 14 years of age or older, and "all regular drivers" of her vehicles then residing in her household.

Progressive's litigation underwriting specialist, Janeen Copic, submitted an affidavit stating that Progressive would have charged a 7.7% higher premium had Sherman accurately disclosed the number of drivers and resident-relatives at the reported address, and a 75.5% increased premium had Sherman disclosed her permanent Detroit residence.

THE ACCIDENT

On July 14, 2021, Sherman was a passenger in one of the vehicles when it was hit from behind by John Doe. She was injured in this accident and asked Progressive for personal protection insurance (PIP) benefits. Progressive refused while rescinding the policy ab initio because of misrepresentations in her application. Sherman lied about the location where the cars were garaged and other individuals resided with her who she did not list on her application. Progressive estimated that, had Sherman included this additional information, it would have increased her premium by 83.2%.

THE SUIT

Sherman then sued Doe and Progressive claiming it unlawfully refused to pay PIP benefits and had breached her insurance contract. Sherman claimed the remedy should be tailored to the equities of the situation and needed to produce a fair result for all parties. The trial ordered that the policy be reformed to reflect the "insurance premium that [Progressive] believes it would have been entitled to had the insured listed Detroit as the residence.".

SUMMARY DISPOSITION

Summary disposition is appropriate if there is no genuine issue regarding any material fact and the moving party is entitled to judgment as a matter of law.

An insurer has a reasonable right to expect honesty in the application for insurance. Indeed, it is well settled that an insurer is entitled to rescind a policy ab initio on the basis of a material misrepresentation made in an application for no-fault insurance. A misrepresentation is material if the insurer would have rejected the risk or charged an increased premium and would not have issued the same contract had it been given the correct information.

Even if fraud is not established rescission is justified in cases of innocent misrepresentation if a party relies upon the misstatement, because otherwise the party responsible for the misstatement would be unjustly enriched if he were not held accountable for his misrepresentation.

There was no reason in law or policy for the burden of such a risk to be placed on the insurer in preference to the insured who made the intentional material misrepresentations. The trial court's balance of the equities should have revealed misconduct by Sherman, but none by Progressive.

The Court of Appeals concluded that the trial court erred by failing to recognize this distinction.  By ordering the policy reformed, the trial court placed the financial burden of paying PIP benefits on Progressive, notwithstanding the fact that Sherman obtained those very same benefits by way of fraud. The trial court erred when it ordered reformation, rather than rescission and its order was reversed.

ZALMA OPINION

Rescission is an ancient equitable remedy that exists because it would be unfair to allow one party to a contract to profit from fraud in the obtaining of a contract of insurance. Sherman lied in the application  requesting an offer of insurance about the location and available drivers which, had she told the truth, would have resulted in much higher premiums.  The trial court trying to be fair wrongfully refused rescission but used another equitable remedy: reformation to require the victim of Sherman's fraud, Progressive, with the medical expenses. Neither Ms. Sherman nor anyone should be allowed to profit from their fraud.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:09:03
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See the video at https://lnkd.in/gAfNUN82 and at https://lnkd.in/gFxYpCmR, and at https://zalma.com/blog plus more than 5250 posts.

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Post number 5279

See the video at https://lnkd.in/gAfNUN82 and at https://lnkd.in/gFxYpCmR, and at https://zalma.com/blog plus more than 5250 posts.

GEICO Successfully Fights No Fault Auto Insurance Claims Fraud by Fraudsters Seeking Independent Trials or Arbitrations for Each Suspected Fraudulent Claim

In Government Employees Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company, GEICO Casualty Company v. Bhargav Patel, MD, Patel Medical Care, P.C., John Doe Defendants 1 through 10, No. 24-191, United States Court of Appeals, Second Circuit (February 3, 2026) Government Employees Insurance Company (GEICO) and its subsidiaries, brought a civil action under the Racketeering Influenced and Corrupt Organization Act (“RICO”) against Dr. Bhargav Patel, Patel Medical Care, P.C., and other associated defendants.

GEICO alleged that the defendants orchestrated a scheme to exploit New York’s no-fault automobile insurance laws, ...

00:07:32
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Inability to Access, or Manipulate Electronic Data Excluded

An Assignment of Rights to Sue an Insurer Was a Poor Decision

Internet Failure Causes Loss to On Line Auction

See the video at https://lnkd.in/gQ-VMf6b and at https://lnkd.in/gfmkwby7, and at https://zalma.com/blog plus more than 5250 posts.

In Auto-Owners Insurance Company v. Halo Foundation: Helping Art Liberate Orphans, No. 25-1275, United States Court of Appeals, Eighth Circuit (January 27, 2026) the Helping Art Liberate Orphans Foundation challenges Auto-Owners Mutual Insurance Company’s denial of liability under its insurance policy. HALO argued that a broken YouTube link for its virtual auction caused losses covered by the policy. The district court disagreed, granting summary judgment to AutoOwners.

FACTUAL BACKGROUND

HALO, a non-profit organization, hosts an annual art auction. In 2022, it was virtual. To livestream it, HALO contracted with Paradise Productions KC, LLC and Qtego Fundraising Services. Paradise would handle the visual feed, Qtego the bidding software. Paradise created a YouTube link for ...

00:09:01
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Anti-Concurrent Cause Exclusion Effective

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Post number 5275

Posted on January 30, 2026 by Barry Zalma

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When Experts for Both Sides Agree That Two Causes Concur to Cause a Wall to Collapse Exclusion Applies

In Lido Hospitality, Inc. v. AIX Specialty Insurance Company, No. 1-24-1465, 2026 IL App (1st) 241465-U, Court of Appeals of Illinois (January 27, 2026) resolved the effect of an anti-concurrent cause exclusion to a loss with more than one cause.

Facts and Background

Lido Hospitality, Inc. operates the Lido Motel in Franklin Park, Illinois. In November 2020, a windstorm caused one of the motel’s brick veneer walls to collapse. At the time, Lido was insured under a policy issued by AIX Specialty Insurance Company which provided coverage for windstorm damage. However, the policy contained an exclusion for any loss or damage directly or indirectly resulting from ...

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January 29, 2026
Resolution of Coverage Issues Appropriate Under Federal Declaratory Judgment Act

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Post number 5274

Read the full article at https://www.linkedin.com/pulse/resolution-coverage-issues-appropriate-under-federal-barry-wfpoc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.

Insurer Seeks Limitation of Liability of Child Killed by Foster Dogs

In the Cincinnati Specialty Underwriters Insurance Company, an Ohio corporation v. Dennis Murphy, as Personal Representative of the Wrongful Death Estate of Avery Colin Jackson-Dunphy, Deceased; Patrick Admiral Dunphy, an Individual; Danika Thompson, an Individual; and Animal Services Center Of The Messila Valley, a New Mexico limited Liability Company, No. CIV 24-1039 JB/JFR, United States District Court, D. New Mexico (January 23, 2026) resolved the issues raised about the court's jurisdiction.

Cincinnati Specialty Underwriters Insurance Company ...

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January 26, 2026
Insurance Fraud Gets You Three Squares and a Cot

Posted on January 26, 2026 by Barry Zalma
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Health Insurance Providers Are Attempting Insurance Fraud to Fund Retirement

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