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.
GoFundMe Request Based on Fake Claim of Racial Animus
Post 5199
Posted on October 2, 2025 by Barry Zalma
See the full video at and at
An Attempt to Profit the Public by Setting Fire to his Own Food Truck Fails
Avonte Ahikim Hartsfield burned down his own food truck and falsely reported that he was the victim of arson in October 2021. He then created a GoFundMe campaign titled “Rebuilding After a Series of Hate Crimes,” claiming he was a victim of hate crimes and arson. The campaign raised $102,276 from more than 2,000 donors.
In The People v. Avonte Ahikim Hartsfield, D084114, California Court of Appeals, Fourth District, First Division (September 24, 2025) affirmed the conviction.
FACTS
Investigation and Evidence:
The fire department and police conducted investigations and found that the fire was intentionally set by an open flame. Surveillance footage placed Hartsfield near the scene at the time of the fire. ...
ZIFL Volume 29, Issue 19
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Read the full article at https://lnkd.in/gXNZQBRy, sSee the full video at https://lnkd.in/gygJwCG9 and at https://zalma.com/blog.
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/
The Contents of the October 1, 2025 Issue of ZIFL Includes:
Another Anniversary -- October 1, 1979 - 2025 -
Forty five years ago today I left the world of the employed and became an entrepreneur by opening my own law firm. The law practice was incorporated shortly thereafter as Barry Zalma, Inc. When I opened for business on October 1, 1979, I had no clients and no certainty that I would have any in the future. I had borrowed money from the bank to carry me through the first six months and was concerned about my ...
Only Vehicles Listed on Policy as a “Covered Auto” Are Entitled to Defense or Indemnity
Post 5198
See the full video at https://rumble.com/v6zn0p0-unambiguous-policy-language-applied.html and at https://youtu.be/gWtoQfgbsok, and at https://zalma.com/blog plus more than 5150 posts.
ATV Not a Covered Auto
In Acuity, a Mutual Insurance Company v. Peak View Roofing Co., Jeffrey Pierce, and Ty Smith, Civil Action No. 24-cv-01300-MDB, United States District Court, D. Colorado (September 23, 2025) resolved an insurance coverage dispute concerning the duty of the insurer to defend a civil lawsuit.
KEY FACTS:
Parties Involved:
The case involves Plaintiff Acuity, Defendant Smith, Defendant Pierce, and Peak View Roofing Co. (PVRC).
Underlying Action:
Defendant Smith alleges he was injured on August 19, 2022, while riding as a passenger in a 2018 Polaris Rzr ATV owned by Bluethread Services, LLC d/b/a Peak View Roofing, LLC and operated by Defendant Pierce.
Insurance Policy:
The Rzr was insured under the Policy as ...
How a Need for Profit Led Health Care Providers to Crime
Post 5185
Posted on September 8, 2025 by Barry Zalma
See the full video at https://lnkd.in/gePN7rjm and at https://lnkd.in/gzPwr-9q
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.
The Dishonest Chiropractor/Physician
How a Need for Profit Led Health Care Providers to Crime
See the full video at and at
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help 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.
How Elderly Doctors Fund their ...
How a Need for Profit Led Health Care Providers to Crime
Post 5185
Posted on September 8, 2025 by Barry Zalma
See the full video at https://lnkd.in/gePN7rjm and at https://lnkd.in/gzPwr-9q
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.
The Dishonest Chiropractor/Physician
How a Need for Profit Led Health Care Providers to Crime
See the full video at and at
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help 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.
How Elderly Doctors Fund their ...
Barry Zalma: Insurance Claims Expert Witness
Posted on September 3, 2025 by Barry Zalma
The Need for a Claims Handling Expert to Defend or Prove a Tort of Bad Faith Suit
© 2025 Barry Zalma, Esq., CFE
When I finished my three year enlistment in the US Army as a Special Agent of US Army Intelligence in 1967, I sought employment where I could use the investigative skills I learned in the Army. After some searching I was hired as a claims trainee by the Fireman’s Fund American Insurance Company. For five years, while attending law school at night while working full time as an insurance adjuster I became familiar with every aspect of the commercial insurance industry.
On January 2, 1972 I was admitted to the California Bar. I practiced law, specializing in insurance claims, insurance coverage and defense of claims against people insured and defense of insurance companies sued for breach of contract and breach of the implied covenant of good faith and fair dealing. After 45 years as an active lawyer, I asked that my license to practice law be declared inactive ...
