Insurer Sues Fraud Perpetrators to Defeat Fraudulent Claim only to Find They Did Not Respond
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Post 4829
Plaintiff is an insurance company authorized to transact business in South Carolina. Plaintiff issued insurance policies in South Carolina to Defendant Boyce and nonparty Williams Elite Trucking, LLC, which are the subject of this lawsuit. Plaintiff served Johnson, Hay, Boyce, Hugue, and Transou. Defendants have not appeared or participated in this action.
In Progressive Northern Insurance Company v. Jamari Williams, et al., Civil Action No. 9:24-465-RMG, United States District Court, D. South Carolina (July 1, 2024) the District Court was asked by Progressive to enter judgment based on the default.
BACKGROUND
On May 3, 2024, the Clerk entered default against Defendants and Plaintiff filed a motion for default judgment against Defendants seeking declaratory relief as articulated in the complaint.
LEGAL STANDARD
Federal Rule of Civil Procedure 55(b) permits the Court to enter a default judgment upon motion by a party and to conduct a hearing to determine the amount of damages, if necessary. A Rule 55(b) Default Judgment is appropriate where the Court determines that the well-pleaded allegations in the complaint support the relief sought in the action. The appropriate inquiry is whether or not the face of the pleadings supports the default judgment and the causes of action therein. Since a defendant’s default does not in itself warrant the court in entering a default judgment it must determine that there is a sufficient basis in the pleadings for the judgment entered.
DISCUSSION
Plaintiff’s complaint and accompanying motion contain well-pleaded allegations of fact and proper claims such that Defendants admit the allegations in the complaint, simply put that:
(1) as to Boyce, the 2017 Ford U-Haul truck involved in Accident #2 is not an “auto” under the Boyce Policy,
(2) that, as to Boyce and Hugue, the defendants involved in said accident knew each other prior to Accident #2 and that Accident #2 was staged for purposes of insurance fraud,
(3) as to Transou, Johnson, and Hay, the defendants involved in said accident knew each other prior to Accident #3 and staged said accident for the purposes of insurance fraud; and
(4) as to all Defendants, Plaintiff is entitled to recover payments made and costs incurred because of Defendants’ fraud and misrepresentations.
CONCLUSION
Therefore, the Court granted Plaintiff’s motion for default judgment against Johnson, Hay, Boyce, Hugue, and Transou and grants Plaintiff the declaratory relief requested in Plaintiff’s complaint as to these individuals.
ZALMA OPINION
Insurance fraud perpetrators are not brave. When an insurer, like Progressive, gathers evidence that it can prove it was the victim of fraud, it may act proactively as did Progressive in this case seeking a judgment refusing to pay further and for money judgments against the fraudsters. They refused to respond, allowed a default to be entered, and a money judgment. Hopefully Progressive will take the profit out of their crime by collecting on the judgment.
(c) 2024 Barry Zalma & ClaimSchool, Inc.
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Chutzpah: After Criminal Prosecution Defendant Sues USA
Post 5164
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Dr. Segun Patrick Adeoye, a medical doctor, filed a lawsuit against the United States of America, seeking damages for alleged violations during his criminal prosecution. He was acquitted by a jury but claims to have suffered significant harm, including financial losses, damage to his professional reputation, and personal distress.
In Dr. Segun Patrick Adeoye v. The United States Of America, Civil Action No. 4:25-cv-83, United States District Court, E.D. Texas, Sherman Division (July 23, 2025) the USDC dismissed Adeoye’s suit.
FACTUAL BACKGROUND
Dr. Adeoye was indicted on charges of conspiracy to commit wire fraud and money laundering. The indictment alleged that he and his co-conspirators obtained at least seventeen million dollars through various fraudulent schemes. Despite being acquitted, Dr. Adeoye claims that his ...
Payment of Appraisal Award Defeats Claim of Bad Faith
Post 5163
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Hurricane Damage to Dwelling Established by Appraisal Award
In Homeowners Of America Insurance Company v. Emilio Menchaca, No. 01-23-00633-CV, Court of Appeals of Texas, First District (July 31, 2025) after a hurricane Homeowners of America Insurance Company (“HAIC”) estimated that the cost of covered repair to Menchaca’s house was $3,688.54, which was less than his deductible, and therefore no payment would be made.
FACTS
After Menchaca retained counsel HAIC advised that, under the terms of the policy, Menchaca was required to first invoke the appraisal process prior to filing suit, and that HAIC reserved the right to request that Menchaca and any adjuster hired on his behalf submit to an Examination Under Oath (“EUO”).
On August 23, 2018, Menchaca’s counsel ...
Payment of Appraisal Award Defeats Claim of Bad Faith
Post 5163
Read the full article at https://lnkd.in/dNpKKcYx, see the full video at https://lnkd.in/dNgwRP8q and at https://lnkd.in/dA9dvd-D, and at https://zalma.com/blog plus more than 5150 posts.
Hurricane Damage to Dwelling Established by Appraisal Award
In Homeowners Of America Insurance Company v. Emilio Menchaca, No. 01-23-00633-CV, Court of Appeals of Texas, First District (July 31, 2025) after a hurricane Homeowners of America Insurance Company (“HAIC”) estimated that the cost of covered repair to Menchaca’s house was $3,688.54, which was less than his deductible, and therefore no payment would be made.
FACTS
After Menchaca retained counsel HAIC advised that, under the terms of the policy, Menchaca was required to first invoke the appraisal process prior to filing suit, and that HAIC reserved the right to request that Menchaca and any adjuster hired on his behalf submit to an Examination Under Oath (“EUO”).
On August 23, 2018, Menchaca’s counsel ...
Rulings on Motions Reduced the Issues to be Presented at Trial
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CASE OVERVIEW
In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.
FACTS
Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.
Prior to trial Bernier had three remaining claims against State Farm:
1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.
Both Bernier and State Farm dispositive motions before ...
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 ...
