To Prove Fraud Admissible Evidence is Required
Post 5200
See the full video at https://lnkd.in/g9cmMseN and at https://lnkd.in/g5eAYwdN, and at https://zalma.com/blog plus more than 5200 posts.
Allegations That Health Care Providers Assist in No Fault Fraud Escape MSJ
In NATIONWIDE GENERAL INSURANCE COMPANY, NATIONWIDE MUTUAL INSURANCE COMPANY, and any and all of their subsidiaries, affiliates and/or parent companies. Plaintiffs v. BILLEESHA BROWN, MANUEL A. CRUZ, ALGELIS TATIS, The “Individual Defendants”, et al and the “Healthcare Provider Defendants”, Index No. 618243/2023, 2025 NY Slip Op 33374(U), Motion Seq. No. 003, Supreme Court, Nassau County (September 15, 2025) dealt with a motion for summary judgment (MSJ) filed by the insurers.
Case Overview:
This is a declaratory judgment action where the plaintiff, NATIONWIDE GENERAL INSURANCE COMPANY, seeks a determination that it is not obligated to provide first-party automobile insurance coverage, including No Fault benefits and/or uninsured/underinsured motorist benefits, in connection with a motor vehicle collision alleged to have occurred on August 7, 2022.
Incident Details:
The incident involved a NATIONWIDE insured vehicle driven by BILLEESHA BROWN, with passengers MANUEL A. CRUZ and ALGELIS TATIS. The vehicle was reportedly struck in the left rear by a hit-and-run vehicle, causing BROWN to lose control and hit the highway dividers.
Plaintiff’s Arguments:
The plaintiff argued that the Individual Defendants staged and/or intentionally caused the collision and made material misrepresentations and/or omissions of fact, and false and/or fraudulent statements in presenting their claims to NATIONWIDE. The plaintiff relies on discrepancies in BROWN’s representation and EZ Pass records to suggest that the Individual Defendants were not in the insured vehicle at the time of the incident.
COURT’S FINDINGS:
The court found that the discrepancies raised suspicion but were not sufficient to establish as a matter of law that the Individual Defendants made material misrepresentations about their presence in the vehicle. The court also noted that an intentional and staged collision caused in furtherance of an insurance fraud scheme is not a covered accident under a policy of insurance.
Legal Standards:
The court referenced several cases to articulate the standard of proof required for summary judgment. The court emphasized that the plaintiff must demonstrate, prima facie, entitlement to judgment as a matter of law and the absence of any issues of material fact.
ANALYSIS
Summary Judgment Decision:
The court denied the plaintiff’s motion for summary judgment, finding that the plaintiff failed to meet the higher burden of proof required for such a motion.
The Court acknowledges that on plaintiff s prior motion for a default judgment, the Court found plaintiffs prima facie proof sufficient for purposes of granting the motion. On a motion for a default judgment, however, the defaulting defendants are deemed to have admitted all of the allegations of the complaint and all reasonable inferences to be drawn from them, and the plaintiff heed only establish that a viable cause of action exists.
The standard of proof applicable upon a motion for summary judgment seeking a determination that the insurer is not required to pay No Fault claims submitted by provider defendants has been articulated consistently by the Second Department, and is controlling authority for any determination by this Court,
It is well settled that an intentional and staged collision caused in the furtherance of an insurance fraud scheme is not a covered accident under a policy of insurance. The Court’s analysis of the evidence as it pertains to the issues of the intentional nature of the occurrence or the fraudulent presentation of the claim is set forth in entire Summary Judgment Decision and need not be repeated here. As stated by the Court in the Summary Judgment Decision, most of the alleged discrepancies in the EUO testimony of the Individual Defendants were not material to the claim and that the incident was intentional or conclusive of a material misrepresentation in the presentation of the claim.
The EZ Pass records only demonstrate the location of the second vehicle on the night in question; they do not establish who occupied the second vehicle, or that the Individual Defendants did not occupy the subject vehicle. Plaintiffs investigator makes an inferential leap that is unsupported by admissible proof. Without more, the evidence presented raises issues of fact or credibility which are appropriately determined by the trier of fact and the motion for summary judgment was rejected.
ZALMA OPINION
Nationwide, like other no-fault insurers doing business in New York lose much money as a result of fraud and staged accidents, fight back by suing those who staged the accidents and the health care providers that faked treatment of non-injured fraudsters. Nationwide proved some of the fraud because the defendants defaulted but will need to produce more evidence of fraud at trial that is more than an unsupported inferential leap of fact.
(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://barryzalma.substack.com/subscribe
Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the InsuranceClaims Library – https://lnkd.in/gwEYk.
Convicted Criminal Seeks to Compel Receiver to Protect his Assets
Post number 5291
See the video at and at and at https://www.zalma.com/blog plus more than 5250 posts.
The Work of a Court Appointed Receiver is Constitutionally Protected
In Simon Semaan et al. v. Robert P. Mosier et al., G064385, California Court of Appeals, Fourth District, Third Division (February 6, 2026) the Court of Appeals applied the California anti-SLAPP statute which protects defendants from meritless lawsuits arising from constitutionally protected activities, including those performed in official capacities. The court also considered the doctrine of quasi-judicial immunity, which shields court-appointed receivers from liability for discretionary acts performed within their official duties.
Facts
In September 2021, the State of California filed felony charges against Simon Semaan, alleging violations of Insurance Code section 11760(a) for making...
When There are Two Different Other Insurance Clauses They Eliminate Each Other and Both Insurers Owe Indemnity Equally
Post number 5289
In Great West Casualty Co. v. Nationwide Agribusiness Insurance Co., and Conserv FS, Inc., and Timothy A. Brennan, as Administrator of the Estate of Pat- rick J. Brennan, deceased, Nos. 24-1258, 24-1259, United States Court of Appeals, Seventh Circuit (February 11, 2026) the USCA was required to resolve a dispute that arose when a tractor-trailer operated by Robert D. Fisher (agent of Deerpass Farms Trucking, LLC-II) was involved in a side-impact collision with an SUV driven by Patrick J. Brennan, resulting in Brennan’s death.
Facts
Deerpass Trucking, an interstate motor carrier, leased the tractor from Deerpass Farms Services, LLC, and hauled cargo for Conserv FS, Inc. under a trailer interchange agreement. The tractor was insured by Great West Casualty Company with a $1 million policy limit, while the trailer was insured by Nationwide Agribusiness Insurance Company with a $2 million ...
Opiod Producer Seeks Indemnity from CGL Insurers
Post number 5288
Read the full article at https://lnkd.in/guNhStN2, see the full video at https://lnkd.in/gYqkk-n3 and at https://lnkd.in/g8U3ehuc, and at https://zalma.com/blog plus more than 5250 posts.
Insurers Exclude Damages Due to Insured’s Products
In Matthew Dundon, As The Trustee Of The Endo General Unsecured Creditors’ Trust v. ACE Property And Casualty Insurance Company, et al., Civil Action No. 24-4221, United States District Court, E.D. Pennsylvania (February 10, 2026) Matthew Dundon, trustee of the Endo General Unsecured Creditors’ Trust, sued multiple commercial general liability (CGL) insurers for coverage of opioid-related litigation involving Endo International PLC a pharmaceutical manufacturer.
KEY FACTS
Beginning as early as 2014, thousands of opioid suits were filed by governments, third parties, and individuals alleging harms tied to opioid manufacturing and marketing.
Bankruptcy & Settlements
Endo filed Chapter 11 in August 2022; before bankruptcy it ...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lost the ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah. Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and wonder how did all these wonderful things come into being. Jews believe the force we call G_d created the entire universe and everything in it. Jews feel G_d is all seeing and knowing and although we can’t see Him, He is everywhere and in everyone.We understand...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
Read the full article at https://www.linkedin.com/pulse/passover-americans-barry-zalma-esq-cfe-5vgkc.
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lostthe ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah.
Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and ...
You Get What You Pay For – Less Coverage Means Lower Premium
Post number 5275
Posted on January 30, 2026 by Barry Zalma
See the video at and at
When Experts for Both Sides Agree That Two Causes Concur to Cause a Wall to Collapse Exclusion Applies
In Lido Hospitality, Inc. v. AIX Specialty Insurance Company, No. 1-24-1465, 2026 IL App (1st) 241465-U, Court of Appeals of Illinois (January 27, 2026) resolved the effect of an anti-concurrent cause exclusion to a loss with more than one cause.
Facts and Background
Lido Hospitality, Inc. operates the Lido Motel in Franklin Park, Illinois. In November 2020, a windstorm caused one of the motel’s brick veneer walls to collapse. At the time, Lido was insured under a policy issued by AIX Specialty Insurance Company which provided coverage for windstorm damage. However, the policy contained an exclusion for any loss or damage directly or indirectly resulting from ...
