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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Arsonist Tried To Represent Himself, Failed, and Sought Habeas Relief
Post number 5357
Read the full article at https://www.linkedin.com/pulse/he-who-acts-his-own-lawyer-has-idiot-client-barry-zalma-esq-cfe-d4bwc, See the full video at and at and at https://zalma.com/blog.
Karacson’s Arson for Profit Attempt Required Skill & Experience to Succeed
In Steve Ellis Karacson v. David Shaver, Warden, No. 25-1089, United States Court of Appeals, Sixth Circuit (May 20, 2026) Steve Karacson was convicted in Michigan state court of arson and insurance fraud after evidence showed he burned his own insured home. Investigators found multiple points of origin, gasoline odor, and evidence tying him to the scene, including cell-phone location data and a receipt showing he had purchased a gas can and gloves shortly before the fire.
FACTS
Karacson initially had appointed counsel, but his relationships with both appointed attorneys ...
Foolish to Repeatedly Disobey Court Orders
All That Remains For Trial Is Plaintiff’s Damages On Each Of These Claims And Establishing Proximate Causation Of Those Damages.
Post number 5348
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In Linh Wang v. Esurance Insurance Company, No. C24-0447-JCC, United States District Court, W.D. Washington, Seattle (May 1, 2026) John C. Coughenour, United States District Judge, found that throughout this case, culminating with its briefing on Plaintiff’s renewed motion and that Defendant has subjected Plaintiff to unnecessary motion practice for clearly discoverable information and made dubious representations (including to the Court).
FACTUAL BACKGROUND
This case involves an underinsured/uninsured motorist insurance bad faith claim arising from a 2017 motor vehicle collision. The plaintiff, Linh Wang, alleges that Esurance Insurance ...
The Right to Negotiate with Insurer is Not an Assignment of Claims
Post number 5347
Read the full article at https://www.linkedin.com/pulse/ambiguous-contract-repair-assignment-barry-zalma-esq-cfe-2xppc, see the full video at https://rumble.com/v79is1s-ambiguous-contract-to-repair-not-an-assignment.html and at and at https://zalma.com/blog plus more than 5300 posts.
Nebraska Requires an Actual Assignment to Allow Contractor to Sue Insurer
In Millard Gutter Company, a corporation doing business as Millard Roofing and Gutter v. Farmers Mutual Insurance Company of Nebraska, also known as Farmers Mutual Insurance, also known as Farmers Mutual, No. A-24-818, Court of Appeals of Nebraska (May 5, 2026) Millard sued Farmers as an assignee of Jane Anzalone who had hired Millard Gutter to repair the roof of her home and agreed to allow Millard Gutter to coordinate with her insurer, Farmers Mutual, concerning reimbursement for repairs authorized under her insurance policy.
FACTUAL BACKGROUND
In ...
Qui Tam Case Without Evidence to Prove Fraud Fails
Post number 5369
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In People Of The State Of California Ex Rel. Heath & Yuen, APC v. Silver Bird Auto Leasing, LLC et al., B342847, California Court of Appeals, Second District, Eighth Division (June 5, 2026) Heath & Yuen, APC defended parties in an automobile collision case involving a McLaren and a tour van. After that case settled for $25,000, the firm filed a qui tam action under California’s Insurance Frauds Prevention Act (IFPA) against Silver Bird Auto Leasing, LLC, X-Law Group, PC, and Filippo Marchino. The firm alleged three fraudulent acts in the underlying litigation:
1. the complaint falsely stated the McLaren was making a “legal turn,”
2. respondents produced a fraudulent repair bill/estimate, and
3. respondents failed to disclose Marchino’s GEICO insurance and its payment for repairs....
Full Faith and Credit Act Controlled
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Posted on June 9, 2026 by Barry Zalma
Post number 5368
Posted on June 9, 2026 by Barry Zalma
In Prime Insurance Company, Inc. v. Medicab Transportation, LLC, Jason Rhodes, and Dale Johnson v. Prime Insurance Company, Inc and Prime Property & Casualty Insurance, Inc. No. 2:24-cv-421-SPC-KRH, United States District Court, M.D. Florida, Fort Myers Division (June 3, 2026) Medicab, a paratransit company, bought two policies in 2021: a Business Auto Policy from PPCI and a Commercial Liability Policy from Prime. Both policies, as originally written, appeared to cover injuries arising from loading and unloading patients from Medicab vans.
After a patient, Margaret St. Aubin, fell while being unloaded from a van and suffered injuries, her Estate made a $1 million demand. Prime and its claims administrator concluded that the Commercial Policy’s loading/unloading language had been included by mutual mistake, because...
Full Faith and Credit Act Controlled
Read the full article at https://lnkd.in/evHXiiFE and at https://zalma.com/blog.
Posted on June 9, 2026 by Barry Zalma
Post number 5368
Posted on June 9, 2026 by Barry Zalma
In Prime Insurance Company, Inc. v. Medicab Transportation, LLC, Jason Rhodes, and Dale Johnson v. Prime Insurance Company, Inc and Prime Property & Casualty Insurance, Inc. No. 2:24-cv-421-SPC-KRH, United States District Court, M.D. Florida, Fort Myers Division (June 3, 2026) Medicab, a paratransit company, bought two policies in 2021: a Business Auto Policy from PPCI and a Commercial Liability Policy from Prime. Both policies, as originally written, appeared to cover injuries arising from loading and unloading patients from Medicab vans.
After a patient, Margaret St. Aubin, fell while being unloaded from a van and suffered injuries, her Estate made a $1 million demand. Prime and its claims administrator concluded that the Commercial Policy’s loading/unloading language had been included by mutual mistake, because...
