Fraud Perpetrators Will Have Judgment Entered in Favor of Insurer They Defrauded
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Allstate Effectively Proactive Against Insurance Fraud
Plaintiffs Allstate Insurance Company and other Allstate companies (collectively, “Plaintiffs”) sued seeking redress for losses incurred due to an alleged insurance fraud scheme. Plaintiffs alleged that Defendants Toshner, Lacey Davies, Michael Trinh, Roadside Response, LLC, and Responsible Billing, LLC’s (collectively, “Defendants”) submitted false reimbursement claims for hazardous material cleanups that were never actually performed, were unnecessary, or did not involve an Allstate insured.
In Allstate Insurance Company, et al. v. Daniel Toshner, et al., No. 1:24-CV-27-RP, United States District Court, W.D. Texas, Austin Division (July 9, 2025) Allstate moved for default to be entered against the defendants.
BACKGROUND
Although Defendants initially appeared in this lawsuit their counsel later moved to withdraw from his representation of Defendants. The Court granted counsel’s motion to withdraw and ordered Defendants to retain new counsel by a specific deadline, noting that while Defendants Toshner, Davies, and Trinh could represent themselves pro se, the corporate defendants could not. The Court also granted Plaintiffs’ motion to compel discovery responses from Defendants and afforded Defendants 60 days to respond to the at-issue discovery requests. When Defendants did not retain counsel or comply with their discovery obligations by the deadline the Defendants did not respond to the court.
DISCUSSION
Plaintiffs moved for entry of default against Defendants which the Clerk of Court entered. Toshner, proceeding pro se, then filed the instant motion to set aside the default entered against him.
Because no party has filed timely objections, the Court found no clear error and the Court denied Toshner’s motion to set aside the default entered against him.
Further, now that the Clerk of the Court has entered default against all Defendants, the next step in this litigation is for Plaintiffs to move for default judgment against Defendants. Plaintiffs have received an entry of default as to all Defendants.
Plaintiffs have yet to complete the second step in the process by moving for default judgment. Under the Court’s Local Rules, the Court ordered that Plaintiffs move for default judgment against Defendants on or before July 30, 2025.
ZALMA OPINION
Because state prosecutors are often unwilling to charge fraud perpetrators for their actions defrauding insurers, Allstate and other insurers are becoming proactive and sue the fraud perpetrators for major damages. In this case the fraudsters lawyer refused to represent them and withdrew and they did not get new counsel to defend. Default was entered and Allstate will produce evidence and receive a judgment against each of the fraudsters that they can then execute against any assets held by the fraudster defendants.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Zalma’s Insurance Fraud Letter – August 15, 2025
Posted on August 15, 2025 by Barry Zalma
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
ZIFL Volume 29, Issue 16
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See the full video at https://lnkd.in/gKmEeN7f and at https://lnkd.in/gV687Vt9
Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication. It is provided FREE to anyone who visits the site at https://lnkd.in/gVT5G9s
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Subscribe to the e-mail Version of ZIFL, it’s Free!
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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...
Award Signed by Two of Three Appraisers Binding on Insured and Insurer
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Kelly Mallady filed a lawsuit against Homeowners of America Insurance Company due to damages sustained from a nearby explosion in January 2020 that the insurer rejected in part.
In Kelly Mallady v. Homeowners Of America Insurance Company, No. 14-24-00147-CV, Court of Appeals of Texas, Fourteenth District (August 7, 2025) resolution was obtained of the disputes.
CASE BACKGROUND:
1 Mallady’s homeowners insurance policy was effective from September 15, 2019, to September 15, 2020 .
2 The initial claim was acknowledged, and an independent adjuster estimated the property damage to be $13,014.79, covering only the dwelling and fence.
3 Mallady invoked appraisal, demanding $247,860.40 for property and contents damages, plus...
Exclusions Defeat Claim for Defense & Indemnity
Genuine Dispute Dispels Claim of Bad Faith
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In Diversified Restaurant Group, LLC, et al. v. Houston Casualty Company, et al., No. 25-cv-02344-EMC, United States District Court, N.D. California (July 31, 2025) Diversified Restaurant Group, LLC (DRG) and Golden Gate Bell, LLC (GGB) sued Houston Casualty Company (HCC), Pennsylvania Manufacturers Indemnity Company (PMIC), and Manufacturer’s Alliance Insurance Company (MAIC) around the denial of insurance coverage for a lawsuit filed by a former employee who alleged sexual harassment and assault by a supervisor.
Insurance Policies and Denial of Coverage:
DRG and GGB had insurance policies with PMIC and MAIC, which included general liability, workers’ compensation, and employer’s liability coverage. Both PMIC and MAIC denied coverage for the underlying lawsuit, citing various exclusions in their policies.
Exclusions:
The PMIC policy ...
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
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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 ...
