The Quality of Insurance Fraud Perpetrators is Declining
Post 5162
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Insured Admits Fake Theft and Shows Allegedly Stolen Item to Insurance Investigator
Christie Paolino an investigator for Westfield Insurance Company testified that appellant Matthew McGrath reported the theft of his vehicle and equipment to Westfield, including the VIN for the GMC truck. Paolino met with McGrath at his residence in Cleveland. She asked if they could move to a quieter spot such as the backyard. As they walked up the driveway towards the backyard, Paolino noticed “two snowplows sitting in the driveway” and recognized one as the snowplow “that he had reported stolen.” She asked appellant “if that was, in fact, the snowplow,” and he admitting to the falsity of his claim he responded that it was.
In STATE OF OHIO v. MATTHEW MCGRATH, 2025-Ohio-2600, No. 114758, Court of Appeals of Ohio, Eighth District, Cuyahoga (July 24, 2025) affirmed the trial court verdict finding him guilty at trial.
THE TRIAL
McGrath waived his right to a jury trial, opting instead for a bench trial held on August 26 and 27, 2024. The state presented five witnesses. The evidence showed that on June 21, 2023, McGrath reported his truck, plow, salt spreader, and crack filler stolen to the University Heights Police, an interaction documented on body camera. McGrath was found guilty at trial of falsification, attempted grand theft, and insurance fraud. On January 13, 2025, he was sentenced to the minimal one year of community-control sanctions.
The appellate court found no merit to his appeal and affirmed the trial court’s decision.
ANALYSIS
An appellate court views the evidence in a light most favorable to the prosecution to determine whether any rational trier of fact could have found the essential elements of the crime proven beyond a reasonable doubt. Appellate courts are not to assess whether the State’s evidence is to be believed, but whether, if believed, was the evidence against a defendant sufficient to support a conviction. In essence, sufficiency is a test of adequacy. Whether the evidence is legally sufficient to sustain a verdict is a question of law.
The Court of Appeals concluded that the state’s evidence was sufficient to support the trial court’s verdicts because the evidence was sufficient to prove that McGrath knowingly made false statements and that his purpose was to commit or facilitate a theft offense, and that he was thereby attempting, by deception, to knowingly deprive his insurer of a sum exceeding $7,500.
The evidence was sufficient to establish that appellant’s statements reporting the theft of his vehicle were false and that appellant knew it.
To warrant reversal from a bench trial under a manifest weight of the evidence claim, the Court of Appeals must review the entire record, weigh the evidence and all reasonable inferences, consider the credibility of witnesses and determine whether in resolving conflicts in evidence, the trial court clearly lost its way and created such a manifest miscarriage of justice that the judgment must be reversed, and a new trial ordered.
Here, the State introduced substantial evidence to establish, beyond a reasonable doubt, that appellant committed the offenses of falsification and attempted grand theft. He initiated a claim with Westfield Insurance for the lost property. The testimony and the State’s exhibits established that appellant’s report was false and that he made the deceptive report in a thwarted effort to collect insurance proceeds from Westfield. The judgment was affirmed.
ZALMA OPINION
It seems people believe that insurance fraud is so easy that anyone can do it and profit from the fraud with ease. Mr. McGrath was a believer but was so stupid as to invite an investigator from his insurance company into his back yard where the allegedly stolen property was parked and admitted it was the same item that was the subject of his claim, admitting to the fraud. With such damning evidence McGrath, who received a light sentence and no jail time, had the unmitigated gall to appeal the verdict and waste the time of the Court of Appeals affirming the trial court’s verdict.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Payment of Appraisal Award Defeats Claim of Bad Faith
Post 5163
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Hurricane Damage to Dwelling Established by Appraisal Award
In Homeowners Of America Insurance Company v. Emilio Menchaca, No. 01-23-00633-CV, Court of Appeals of Texas, First District (July 31, 2025) after a hurricane Homeowners of America Insurance Company (“HAIC”) estimated that the cost of covered repair to Menchaca’s house was $3,688.54, which was less than his deductible, and therefore no payment would be made.
FACTS
After Menchaca retained counsel HAIC advised that, under the terms of the policy, Menchaca was required to first invoke the appraisal process prior to filing suit, and that HAIC reserved the right to request that Menchaca and any adjuster hired on his behalf submit to an Examination Under Oath (“EUO”).
On August 23, 2018, Menchaca’s counsel ...
Selling Office of US Senator is an Unforgivable Crime
Post 5161
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Go Directly to Jail, Do Not Pass Go, Claim of Innocence Unbelievable
SUMMARY OF THE CASE
Nadine Menendez, along with then-Senator Robert Menendez, Wael Hana, Jose Uribe, and Fred Daibes, was indicted for participating in a bribery scheme. The charges included conspiracy to commit bribery, honest services wire fraud, extortion under color of official right, and obstruction of justice. Both were found guilty at trial. Mrs. Menendez moved to overturn the jury verdict.
In UNITED STATES OF AMERICA v. NADINE MENENDEZ, No. (S4) 23-Cr-490 (SHS), United States District Court, S.D. New York (July 31, 2025) the USDC upheld the convictions after a lengthy analysis of issues raised by Ms. Menendez.
KEY POINTS
-
Bribery and Corruption:
The evidence presented was sufficient to prove a corrupt quid pro quo involving official ...
Selling Office of US Senator is an Unforgivable Crime
Post 5161
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Go Directly to Jail, Do Not Pass Go, Claim of Innocence Unbelievable
SUMMARY OF THE CASE
Nadine Menendez, along with then-Senator Robert Menendez, Wael Hana, Jose Uribe, and Fred Daibes, was indicted for participating in a bribery scheme. The charges included conspiracy to commit bribery, honest services wire fraud, extortion under color of official right, and obstruction of justice. Both were found guilty at trial. Mrs. Menendez moved to overturn the jury verdict.
In UNITED STATES OF AMERICA v. NADINE MENENDEZ, No. (S4) 23-Cr-490 (SHS), United States District Court, S.D. New York (July 31, 2025) the USDC upheld the convictions after a lengthy analysis of issues raised by Ms. Menendez.
KEY POINTS
-
Bribery and Corruption:
The evidence presented was sufficient to prove a corrupt quid pro quo involving official ...
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 ...
