When a Policy Is Void
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In almost every policy of insurance, there is a clause declaring the policy void if the insured misrepresents or conceals material facts or commits fraud. For example:
We do not pay for bodily injury or property damage which is expected by, directed by, or intended by an insured. This exclusion does not apply to bodily injury that arises out of the use of reasonable force to protect people or property. (AAIS Form BP-200, (c) 1987 AAIS).
or:
This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other “insured,” at any time, intentionally conceal or misrepresent a material fact concerning: a. This Coverage Form; b. The covered “auto”; c. Your interest in the covered “auto”; or d. A claim under this Coverage Form. (Insurance Services Office form CA 00 01 01 87).
The policy wording requires that the insurer prove, not only that the insured misrepresented or concealed a material fact but must also prove that the insured did so with the intent to deceive.
Absent the rare confession it is often difficult to prove intentional deceit. The insured will usually claim that he or she was mistaken and had no intent to deceive. In more than 50 years of investigation of fraudulent insurance claims I only once received from an insured an under oath statement that the insured intentionally deceived the insurer and then, not in person, but by correcting false testimony in the transcript of an examination under oath.
If fraud or mutual mistake is an issue, insurers and insureds doing business in Oklahoma must resort to courts of general jurisdiction for a determination of contractual rights.[1] In Oklahoma, the Workers’ Compensation court does not have the right to rescind or declare a policy of Workers’ Compensation insurance void. However, where there is a misrepresentation with intent to deceive and the putative insured recognized the materiality of the misrepresentation the insurance policy is void from its inception.[2]
In Florida, Florida Statutes (2006), state in pertinent part: any insurance fraud shall void all coverage arising from the claim related to such fraud under the personal injury protection coverage of the insured person who committed the fraud.
In harmony with this statutory provision, the fraud provision in an insurance policy set forth: “any insurance fraud shall void all personal injury protection coverage arising from the claim with respect to the insured who committed the fraud” is appropriate and enforceable. [Bosem v. Commerce & Indus. Ins. Co., 35 So.3d 944 (Fla. App., 2010)]
Plaintiff, by her Litigation Appears to Establish the Report for a Mental Health Evaluation Was Appropriate
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Post 4950
In Samreen Riaz v. State Of California, et al., F087504, California Court of Appeals, Fifth District (December 2, 2024) the California Court of Appeals found itself asked to resolve suits against an individual and the state of California from an inadequate but excessively litigious plaintiff.
FACTS
Samreen Riaz was a licensed dentist – she lost her license to practice because of the facts underlying this case. According to her, there is an elaborate conspiracy to harass, stalk, threaten, and ultimately prevent her from testifying in a separate “whistleblower” case involving “OSHA and HIPPA Violations” at a medical facility.
Riaz sued raising numerous claims against numerous individuals and government entities. The opposing parties challenged the ...
To Sue for Business Disparagement Evidence is Required
Post 4951, Posted on December 17, 2024 by Barry Zalma
Read the full article at https://www.linkedin.com/pulse/falsely-claiming-insurer-can-criminal-barry-zalma-esq-cfe-3bwrc, see the full video at and at and at https://zalma.com/blog plus more than 4950 posts.
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Plaintiff Route App, Inc.’s (“Route”) moved the USDC to Dismiss two counterclaims asserted by OrderProtection.com, Inc. (“OrderProtection”). In Route App, Inc. v. Orderprotection.Com, Inc.; Julian Wilson, et al, No. 2:23cv606 DAK, United States District Court, D. Utah (December 9, 2024) found no evidence supporting a claim of business disparagement or business defamation.
BACKGROUND
This case involves a dispute between Route, a post-purchase ...
ZIFL Volume 28 Issue 24
Merry Christmas & Happy Hannukah
Read the full article at https://lnkd.in/gkPK-7um, see the full video at https://lnkd.in/gBdYtnB5 and at https://lnkd.in/g4ja8wk4; and at https://zalma.com/blog plus more than 4900 posts.
Zalma’s Insurance Fraud Letter
Posted on December 16, 2024 by Barry Zalma
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A Christmas Fable of Fraud
This, the last issue of Zalma’s Insurance Fraud Letter for its 28th year, 2024, contains articles on the following subjects:
ZIFL publishes this story at Christmas time every year. I hope you like it again.
[The story that follows is fiction based, in part, on a true case worked on by me. Any similarity to real people is unintentional. It is meant only to educate fraud professionals about how some unscrupulous people use the crime of insurance fraud for fun and profit during the Christmas season.]
Raymond Alexander had no religion. He cared only for himself and the money he could ...
What is the Meaning of “Void”
An article For Subscribers to Excellence in Claims Handling You can Subscribe for only $5 a month to Excellence in Claims Handling at https://barryzalma.substack.com/subscribe
“Void” can mean either void or voidable. Void is defined as “of no legal force or effect and so incapable of confirmation or ratification.”
Voidable is defined as “capable of being adjudged void, invalid and of no force (a voidable contract may be set aside usually at the option of one party).”[1] The Restatement 2d of Contracts defines a “voidable contract” as a valid transaction with legal consequences until the power of avoidance is exercised.
Although jurisdictions are split as to the meaning of void in this context the distinction is largely semantic since the actions required of insurers wishing to dispose of a void or voidable insurance contract are ultimately the same.
The full article is available only to subscribers to Excellence in Claims ...
What is the Meaning of “Void”
An article For Subscribers to Excellence in Claims Handling You can Subscribe for only $5 a month to Excellence in Claims Handling at https://barryzalma.substack.com/subscribe
“Void” can mean either void or voidable. Void is defined as “of no legal force or effect and so incapable of confirmation or ratification.”
Voidable is defined as “capable of being adjudged void, invalid and of no force (a voidable contract may be set aside usually at the option of one party).”[1] The Restatement 2d of Contracts defines a “voidable contract” as a valid transaction with legal consequences until the power of avoidance is exercised.
Although jurisdictions are split as to the meaning of void in this context the distinction is largely semantic since the actions required of insurers wishing to dispose of a void or voidable insurance contract are ultimately the same.
The full article is available only to subscribers to Excellence in Claims ...
ZIFL Volume 28 No. 22
Post 4939
Read the full article at Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdfand at https://zalma.com/blog.
The Source for the Insurance Fraud Professional https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf
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 about insurance fraud:
The EUO is a Material Condition Precedent
A Key Tool in the Effort to ...
