ZIFL Volume 29, Issue 7
The Source for the Insurance Fraud Professional
See the full video at https://lnkd.in/gQM9yR3n and at https://lnkd.in/gZDkH7RU, and at https://zalma.com/blog plus more than 5000 posts.
April 1, 2025
Post 5035
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 April 1, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf.
This issue contains the following articles about insurance fraud:
Lawyers Sanctioned for Tricking a Witness With a False Document
The United States District Court Eastern District Of Texas Marshall Division, Civil Action No. 2:23-CV-00160-JRG in a case entitled Cognipower, LLC v. Samsung Electronics Co., Ltd et al, a report was filed by David Folsom, Special Master a motion for sanctions filed by Samsung.
One of the bases of the decision reached by the Mr. Folsom was the requirement that lawyers are required to deal fairly and in good faith with their adversaries and act honorably in all their actions.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
Guilty of Forgery Affirmed
8 Years in Prison for Forgery to Establish Non-Existent Counseling
Jail House Lawyer Fails
In The People Of The State Of Illinois v. Robert A. Moylan, 2025 IL App (3d) 230248-U, No. 3-23-0248, Court of Appeals of Illinois (March 11, 2025) Robert A. Moylan was found guilty of seven counts of forgery for signing and delivering false documents stating that his clients had successfully completed court-ordered counseling services.
Moylan was sentenced to an aggregate term of eight years’ imprisonment. He appealed, claiming several errors by the court, including the denial of his motions to suppress eavesdrop recordings and evidence seized from his offices, and the denial of his request for a public defender at sentencing.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
Staged Accident is One Where Claimed Collision Was Intentional
Evidence Needed to Use Staged Accident Claim as Defense
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). However, the court denied the plaintiff’s motion for summary judgment on the basis that the collision was staged, citing insufficient evidence.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
Heath Insurance Fraud Convictions
$5 Million False Claims Act Settlement With Providers Of Programs For Adults With Developmental Disabilities
Community Options, Inc. and New York Affiliate admit Billing Medicaid for Services Without Accurate and Adequate Supporting Documentation and Failing to Report and Return Overpayments to Medicaid.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
MORE MCCLENNY MOSELEY & ASSOCIATES ISSUES
This is ZIFL’s forty-fourth 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 an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
The proposed settlement agreement in the MMA bankruptcy raises several red flags of which all legal professionals should take serious notice.
March 19, 2025
Disproportionate Fee Allocation to EAJF
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
CONVICTIONS OF OTHER THAN HEALTH INSURANCE FRAUD
Miami Insurance Broker Sentenced to 3.5 Years in Condo Premium Finance Scheme
Heleonel Gonzalez, known as Leo, a Miami insurance broker was sentenced to 41 months in prison by a federal judge and more than $5 million in restitution for defrauding a Georgia credit union by obtaining loans for condominium associations’ premium financing, then using the loans for personal gain.
BARRY ZALMA
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Write to Mr. Zalma at [email protected]; https://www.zalma.com; https://zalma.com/blog.
He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
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Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
Concurrent Cause Doctrine Does Not Apply When all Causes are Excluded
Post 5119
Death by Drug Overdose is Excluded
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Southern Insurance Company Of Virginia v. Justin D. Mitchell, et al., No. 3:24-cv-00198, United States District Court, M.D. Tennessee, Nashville Division (October 10, 2024) Southern Insurance Company of Virginia sought a declaratory judgment regarding its duty to defend William Mitchell in a wrongful death case pending in California state court.
KEY POINTS
1. Motion for Judgment on the Pleadings: The Plaintiff moved for judgment on the pleadings, which was granted in part and denied in part.
2. Duty to Defend: The court found that the Plaintiff has no duty to defend William Mitchell in the California case due to a specific exclusion in the insurance policy.
3. Duty to Indemnify: The court could not determine at this stage whether the Plaintiff had a duty to ...
GEICO Sued Fraudulent Health Care Providers Under RICO and Settled with the Defendants Who Failed to Pay Settlement
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Post 5119
Default of Settlement Agreement Reduced to Judgment
In Government Employees Insurance Company, Geico Indemnity Company, Geico General Insurance Company, and Geico Casualty Company v. Dominic Emeka Onyema, M.D., DEO Medical Services, P.C., and Healthwise Medical Associates, P.C., No. 24-CV-5287 (PKC) (JAM), United States District Court, E.D. New York (July 9, 2025)
Plaintiffs Government Employees Insurance Company and other GEICO companies (“GEICO”) sued Defendants Dominic Emeka Onyema, M.D. (“Onyema”), et al (collectively, “Defendants”) alleging breach of a settlement agreement entered into by the parties to resolve a previous, fraud-related lawsuit (the “Settlement Agreement”). GEICO moved the court for default judgment against ...
ZIFL – Volume 29, Issue 14
Post 5118
See the full video at https://lnkd.in/geddcnHj and at https://lnkd.in/g_rB9_th, and at https://zalma.com/blog plus more than 5100 posts.
You can read the full 20 page issue of the July 15, 2025 issue at https://lnkd.in/giaSdH29
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
This issue contains the following articles about insurance fraud:
The Historical Basis of Punitive Damages
It is axiomatic that when a claim is denied for fraud that the fraudster will sue for breach of contract and the tort of bad faith and seek punitive damages.
The award of punitive-type damages was common in early legal systems and was mentioned in religious law as early as the Book of Exodus. Punitive-type damages were provided for in Babylonian law nearly 4000 years ago in the Code of Hammurabi.
You can read this article and the full 20 page issue of the July 15, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-07-15-2025.pdf
Insurer Refuses to Submit to No Fault Insurance Fraud
...
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
See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.
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 ...
