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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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10 hours ago
Man Bites Dog Story – Allstate Sues 42 Defendants for Fraud

Lawyer Representing 35 Defendants in Fraud Case Has Insurmountable Conflict
Post 5110

Alleged Fraudsters have Obvious Conflicts with Each Other

See the full video at https://lnkd.in/gGC6FcAx and at https://lnkd.in/gJVjACnq and at https://zalma.com/blog plus more than 5100 posts.

In Allstate Insurance Company, et. al v. Robert Matturro, D.C., et al.; New Jersey Department Of Banking And Insurance, Intervenor, No. A-0711-24, Superior Court of New Jersey, Appellate Division (June 16, 2025) Allstate and several related entities sued forty-two defendants, including medical practices, their owners, administrators, and various corporate entities. The plaintiffs alleged that the defendants engaged in an insurance fraud scheme involving unlawfully structured medical practices, self-referrals, kickbacks, and medically unnecessary treatments and tests.

The Allstate plaintiffs sought damages for personal injury protection (PIP) benefits paid to the defendants, compensatory damages for investigating fraudulent bills, arbitration-related costs, a declaratory judgment, treble damages, injunctive relief, and attorneys’ fees.

DEFENSE COUNSEL

The Randolph Firm represents approximately thirty-five of the forty-two defendants, including several medical practices and corporate entities. Plaintiffs moved to disqualify the Randolph Firm from representing these defendants due to significant risks of conflicts of interest.

The Appellate Division found that there are significant risks of conflicts developing among the defendants represented by the Randolph Firm, especially as the case proceeds and liability and damages may need to be apportioned under the Comparative Negligence Act (CN Act).

DISCUSSION

A determination of whether counsel should be disqualified the burden is on the movant to prove a basis for disqualification.

When deciding a motion to disqualify counsel, courts must balance competing interests, weighing the need to maintain the highest standards of the profession against a client’s right freely to choose his or her counsel. Motions for disqualification should be viewed skeptically in light of their potential abuse to secure tactical advantage.

Nevertheless, if there is “any doubt as to the propriety of an attorney’s representation of a client, such doubt must be resolved in favor of disqualification.”

Risk of Conflicts

The Appellate Division concluded that trial court erroneously found that there was no significant risk that potential conflicts could arise among the approximately thirty-five defendants represented by the Randolph Firm.

The Appellate Division held there are significant risks that conflicts will develop among defendants represented by the Randolph Firm. Even more there is evidence that significant conflicts of interest have already developed between and amongst the numerous defendants represented by the Randolph Firm.

The certifications and depositions provided by plaintiffs support that conclusion. Moreover, there are significant risks certain defendants may, as the facts develop further, assert that other defendants had a greater role in the alleged fraud schemes or compelled them to participate in the schemes. If those situations arise, the Randolph Firm could not ethically advise all defendants because of those conflicting interests. Fundamentally, at least some defendants maintain that Rosania or Matturro managed the Rosania entities, and they controlled the finances of the Rosania entities.

In response to plaintiffs’ interrogatories, the Randolph Firm served the expert report of Gary S. Stetz, a certified public accountant. In his report, Stetz made two findings, which are potentially detrimental to the positions advanced by the physicians represented by the Randolph Firm. First, Stetz noted his “investigation found that none of the [Rosania] entities . . . would require a [medical doctor] or [doctor of osteopathic medicine] to perform examinations and procedures [which] were controlled by [doctors of chiropractic.] “Second, Stetz determined there were no medical doctors or osteopaths who were employed by Matturro or Rosania.

In seeking to minimize the liability of some defendants it represents, the Randolph Firm would have to argue that the other defendants it represents were more at fault, or perhaps more involved in the alleged fraud scheme. The record in this matter establishes that there are significant risks that conflicts will develop among defendants. As stated, defendants have a common interest in disputing the allegations against them, but as the case develops, they also may have an interest in seeking to minimize their own liability and maximize their co-defendants’ liability. If plaintiffs’ claims proceed to trial and there is a verdict against defendants, the liability and damages will have to be apportioned among defendants under statute.

Therefore, the Appellate Division held that there are significant risks of conflict arising among the thirty-five defendants represented by the Randolph Firm, especially in light of a pending trial date, requires disqualification of the Randolph Firm.

ZALMA OPINION

A law firm that represents 35 different defendants who are claimed to have defrauded the plaintiff using various schemes where one can, and must, have different interests than other defendants. Disqualification was required since the lawyers, to represent their clients properly, will necessarily find one client adverse to the other and will be unable to fairly represent each of its clients. In the best of all possible worlds each of the 42 defendants should have separate counsel with one lawyer or law firm representing each defendant to the best of each client’s rights.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:09:54
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June 27, 2025
Prisoner’s Loses Suit Against Sheriff for Failure to Exhaust Administrative Remedies

Creative Litigation Fails Because Crime Does not Pay
Post 5109

See the full video at https://lnkd.in/gWgSsVgE and at https://lnkd.in/g9ng3A3M, and at https://zalma.com/blog plus more than 5100 posts.

Prisoner Acting as His Own Lawyer Misses Prerequisite to His Suit

In this pro se prisoner case brought under 42 U.S.C. § 1983, United States Magistrate Judge Bradley W. Rath’s Report and Recommendation recommends that Defendants Sheriff John Ledbetter, Geneva Drummond, and VitalCore’s Motions for Summary Judgment be granted, that Plaintiff Monnie Villarreal’s Motion to Amend be denied as moot, and that the Court dismiss this case without prejudice for failure to exhaust administrative remedies.

In Monnie Villarreal v. Vitalcore, et al. No. 1:24-cv-99-HSO-BWR, United States District Court, S.D. Mississippi, (June 18, 2025) the District Judge adopted Magistrate Judge’s Report and Recommendation as the opinion of the Court.

BACKGROUND

Plaintiff Monnie Villarreal (“Plaintiff”) pled guilty to conspiracy to ...

00:07:41
June 27, 2025
Prisoner’s Loses Suit Against Sheriff for Failure to Exhaust Administrative Remedies

Creative Litigation Fails Because Crime Does not Pay
Post 5109

See the full video at https://lnkd.in/gWgSsVgE and at https://lnkd.in/g9ng3A3M, and at https://zalma.com/blog plus more than 5100 posts.

Prisoner Acting as His Own Lawyer Misses Prerequisite to His Suit

In this pro se prisoner case brought under 42 U.S.C. § 1983, United States Magistrate Judge Bradley W. Rath’s Report and Recommendation recommends that Defendants Sheriff John Ledbetter, Geneva Drummond, and VitalCore’s Motions for Summary Judgment be granted, that Plaintiff Monnie Villarreal’s Motion to Amend be denied as moot, and that the Court dismiss this case without prejudice for failure to exhaust administrative remedies.

In Monnie Villarreal v. Vitalcore, et al. No. 1:24-cv-99-HSO-BWR, United States District Court, S.D. Mississippi, (June 18, 2025) the District Judge adopted Magistrate Judge’s Report and Recommendation as the opinion of the Court.

BACKGROUND

Plaintiff Monnie Villarreal (“Plaintiff”) pled guilty to conspiracy to ...

00:07:41
June 26, 2025
Health Insurance Benefit Not Available Forever

Medicare Supplement Plan Properly Discontinued by City

Post 5108

Read the full article at https://lnkd.in/gfHSn7nx, see the full video at https://lnkd.in/g-hkvd3h and at https://lnkd.in/gcN7BP5u, and at https://zalma.com/blog plus more than 5100 posts.

New York’s Highest Court Approves Change in Medicare Plan

The City of New York decided to discontinue its Medicare supplemental plan, Senior Care, and enroll all retirees in a custom-designed Medicare Advantage Plan (MAP) managed by Aetna Life Insurance Company. Petitioners, consisting of nine retirees and one organization, initiated legal proceedings to prevent the City from eliminating their existing health insurance plans. They argued that the City had repeatedly promised to provide and pay for a Medicare supplemental plan upon retirement, and that they relied on these promises when making financial, employment, and retirement decisions.

In the Matter of Robert Bentkowski, et al. v. City of New York, et al., 2025 NY Slip Op 03690, No. 57, New York Court of Appeals ...

00:07:17
May 15, 2025
Zalma's Insurance Fraud Letter - May 15, 2025

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 ...

May 15, 2025
CGL Is Not a Medical Malpractice Policy

Professional Health Care Services Exclusion Effective

Post 5073

See the full video at https://lnkd.in/g-f6Tjm5 and at https://lnkd.in/gx3agRzi, and at https://zalma.com/blog plus more than 5050 posts.

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 ...

April 30, 2025
The Devil’s in The Details

A Heads I Win, Tails You Lose Story
Post 5062

Posted on April 30, 2025 by Barry Zalma

"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ­­­Perpetrators than any Other Crime."

Immigrant Criminals Attempt to Profit From Insurance Fraud

People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.

The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...

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