Evidence Needed to Use Staged Accident Claim as Defense
Post 5025
Read the full article at https://lnkd.in/gVJmjFtC, see the full video at https://lnkd.in/gxEUJruU and at https://lnkd.in/gnd2BfgN, and at https://zalma.com/blog plus more than 5000 posts.
In State Farm Fire And Casualty Company v. Felix A. Quinones, et al, INDEX No. 152505/2021, 2025 NY Slip Op 30754(U), MOTION SEQ. No. 002, Supreme Court, New York County (March 7, 2025) State Farm, sought to disclaim coverage for medical treatment provided to the defendants, who were involved in an automobile collision on February 26, 2020.
The court granted the plaintiff’s motion for summary judgment in part, declaring that State Farm has no obligation to pay claims submitted by Grand Medical Supply Corp. due to Quinones’s failure to appear for examinations under oath (EUOs).
FACTUAL BACKGROUND
In this declaratory judgment action, plaintiff seeks to disclaim coverage for medical treatment provided to defendants Felix A. Quinones, Miguel Burgos and Kevin Gonzalez for injuries Quinones, Burgos, and Gonzalez allegedly sustained in an automobile collision involving a car owned and operated by Quinones in which Burgos and Gonzalez were passengers.
In support of its motion, plaintiff submited an affidavit by Claim Specialist Dominique Wafer, transcripts from the EUOs of Burgos and Gonzalez, the certified police report and amended police report from the subject collision, and the declarations page of Quinones’s insurance policy with plaintiff.
THE DECISION
The court granted the plaintiff’s motion for summary judgment in part due to Felix A. Quinones’s failure to appear for examinations under oath (EUOs).
Additionally the purported inconsistencies and inaccuracies in these transcripts raised serious credibility issues they did not meet the heavy burden required to obtain summary judgment.
ZALMA OPINION
Insurers are faced with insurance fraud and claims from staged accidents on a regular basis. The insurers and their investigators are compelled by law to conduct a full and thorough investigation by its claims or special fraud investigative unit. In this case there were many elements of a staged accident produced in the motion for summary judgment but the court was not convinced – on a motion – that the insurer proved the accident was staged. Every insurer faced with this type of attempted fraud must do a thorough investigation and produce convincing evidence that the accident was staged recognizing that all of the available red flags exist that is not evidence of fraud or of a staged accident.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.
Subscribe to my substack at https://lnkd.in/gmmzUVBy
Go to X @bzalma; Go to the Insurance Claims Library – https://lnkd.in/gwEYkIn State Farm Fire And Casualty Company v. Felix A. Quinones, et al, INDEX No. 152505/2021, 2025 NY Slip Op 30754(U), MOTION SEQ. No. 002, Supreme Court, New York County (March 7, 2025) S
Go to the Insurance Claims Library – https://lnkd.in/gwEYk
No Right to Subrogation Against Tenant
Post 5231
Not Fair to Require Tenant to Pay for Damage Insured by LandlordSee the video at https://lnkd.in/gFkrp_6M and at https://lnkd.in/gQdFQBWj and at https://zalma.com/blog plus more than 5200 posts.
See the video at and at
For Insurer to Subrogate Lease Must Require Tenant to Obtain Insurance for the Benefit of the Landlord
In AmGUARD Insurance Co. v. Tyrone Ellis and Shakyra Ellis, U.S. District Court, District of Connecticut Civil No. 3:25-cv-946 (JCH) (November 19, 2025), Judge, Janet C. Hall the defendant’s Motion to Dismiss the Amended Complaint on the basis of Connecticut’s anti-subrogation doctrine required dismissal.
KEY FACTS
Landlord Michael Caldwell, a Connecticut citizen, owned a multi-family building in Windsor, Connecticut. Defendants Tyrone and Shakyra Ellis were residential tenants in the building. On or about March 1, 2025, a fire ...
Debt Resulting from Fraud is Not Dischargeable in Bankruptcy
Post 5230
Read the full article at https://lnkd.in/gpF3y7Vd, see the video at https://lnkd.in/gR5cVcbY and at https://lnkd.in/gch6Q4_V, and at https://zalma.com/blog plus more than 5200 posts.
Knowing Misappropriation and Conversion of Funds is Fraud
In re Matthew Jene Tubbs (Bankr. N.D. Tex., Fort Worth Div., No. 22-42728-MXM-7; Adv. No. 23-04019-mxm), October 15, 2025 .
Key Facts
Plaintiffs (Robles) and Defendant (Tubbs) met through their church; both held leadership roles. In Feb 2021 Robles home suffered major water damage from Winter Storm Uri and insurance paid $173,000.
In the Fall of 2021: Tubbs represented to Mr. Robles that he personally built a newer house and large barn on his parents’ property “with his own hands” (except foundation/insulation). That he had 10 years’ experience overseeing window/door installations at a major home-improvement chain, was a licensed contractor (false) and carried general contractor liability insurance.
Relying on ...
See full video at https://lnkd.in/gtnsH3SW and at https://lnkd.in/geJ4FseF, and at https://zalma.com/ and at https://lnkd.in/gC2wmzqZ.
ZIFL-Volume 29 Number 22
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post 5228
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/
Read the full 20 page issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-11-15-2025-1.pdf
Man Bites Dog Story – Hertz Sues Alleged Fraudsters
Hertz Successfully Refuses to Pay Alleged Fraudulent Health Care Providers
Proactive Victim of Fraud Defeats Health Care Providers
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty eighth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be ...
The Professional Claims Handler
Post 5219
Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
