To Prove Fraud Admissible Evidence is Required
Post 5200
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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.
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Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.
Posted on September 18, 2026 by Barry Zalma
See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html
In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.
The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.
Law
The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...
150 Months in Prison for Tax Fraud
Post 4846
Posted on September 17, 2026 by Barry Zalma
See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.
The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...
Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution
Post 5489
Posted on September 14, 2026 by Barry Zalma
Fraudster Refuses to Answer Questions About His Alleged Fraud
See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr
In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.
Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.
After Great American ...
Claims of Res Judicata and Procedural Default Defeats Habeas
Post 5543
Posted on November 13, 2026 by Barry Zalma
A Health Insurance Fraud Conviction Rested On Knowingly Submitting Materially False Or Misleading Claim Information With Specific Intent To Defraud.
A Health Insurance Fraud Conviction Rested On Knowingly Submitting Materially False Or Misleading Claim Information With Specific Intent To Defraud.
In Tariq Mustafa Abdulaziz v. Commissioner Of Correction, No. CV 26-5002432-S, Superior Court of Connecticut, Judicial District of Tolland, Habeas Docket (October 29, 2026) Tariq Mustafa Abdulaziz submitted 114 claims for in-home, face-to-face services purportedly provided to thirty program participants during four one-week periods. The department paid Neurostrategies, Inc., $13,650.
FACTS
The defendant waived his right to a jury trial and elected a trial to the court, D'Addabbo, J. Trial occurred over the course of eight days in August, 2022. The state presented testimony from ten witnesses and introduced thirty-three exhibits into ...
Theft of Confidential Information
Post 4581
Posted on November 12, 2026 by Barry Zalma
In People Center, Inc. v. Deel, Inc., et al., No. 25-cv-02576-CRB (LJC), United States District Court, N.D. California (November 7, 2026) People Center, doing business as Rippling, and Deel compete in payroll and human-resource management software. Rippling alleges that Deel and its executives recruited Rippling employee Keith O’Brien, based in Ireland, to disclose confidential information and trade secrets.
THE IRISH SUIT
Rippling sued O’Brien in Ireland and Deel in the United States. O’Brien subsequently retained separate counsel, supplied an affidavit describing the alleged espionage, and entered into a Cooperation Agreement with Rippling. In exchange for his cooperation, Rippling agreed to provide financial assistance, indemnification, and conditional dismissal of the Irish proceedings. The agreement also permitted renewed proceedings or a monetary judgment upon a material breach.
The Irish proceedings against O’Brien were dismissed...
A Proposed Amended Complaint That Includes New Factual Allegations to Remedy Pleading Deficiencies
Posted on November 11, 2026 by Barry Zalma
After Dismissal Fraud Victim May Amend Complaint After Dismissal
Post 4580
If A Proposed Amendment Is Not Clearly Futile, Then Denial Of Leave To Amend Is Improper
In John Hancock Life & Health Insurance Company v. Caring Connections LLC, Arthur Feldheim, and Blime a/k/a Vera Feldheim, Civ. No. 25-7574 (MAS)(JBD), United States District Court, D. New Jersey (November 6, 2026) John Hancock sued Caring Connections LLC, Arthur Feldheim, and Blime a/k/a Vera Feldheim on June 5, 2025, asserting thirteen claims, including fraud, breach of contract, and aiding and abetting fraud.
On March 26, 2026, this Court entered an order granting Caring Connections’ motion to dismiss and granting in part and denying in part the Feldheims’ motion to dismiss. The dismissed claims were dismissed without prejudice, and John Hancock timely sought leave to amend.
They also argued that the New ...
