PIP Fraud Disputes Should Never be Limited to Arbitration
Post number 5269

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In Government Employees Insurance Co. et al v. Active Medical Care, P.C. et al, No. 2:24-cv-10909 (BRM) (JRA), United States District Court, D. New Jersey (January 9, 2026) Defendants moved to Compel Arbitration and Stay the Proceedings (“Motion”). Plaintiffs Government Employees Insurance entities opposed.

Defendants’ Motion to Compel Arbitration and Stay the Proceedings was administratively terminated, and it was further ordered that the parties shall jointly notify the Court as soon as a decision is issued by the New Jersey Supreme Court in the appeal of Allstate New Jersey Insurance Company, et al. v. Carteret Comprehensive Medical Care, P.C., et al. Supreme Court Docket No.: 090337.

ANALYSIS

The central dispute was whether GEICO’s IFPA claims ...

Insurer’s RICO Claim Against Fraudulent Health Insurance Claims Proper

Post number 5268

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Allstate Properly Asserted Fraud Claims Against Hospital and Doctors

In Allstate Indemnity Company et al. v. Memorial Heights Emergency Center et al., No. 25-20020 (5th Cir. Jan. 14, 2026) the Plaintiffs, a group of Allstate insurance entities, brought suit against several Defendants who own, manage, and operate Memorial Heights Emergency Center in Houston, Texas to recover monies paid to the listed fraud perpetrators only to have its case dismissed by the trial court and seek reversal at the Fifth Circuit.

FACTUAL BACKGROUND

In 2018, the Defendants entered into agreements with personal injury attorneys to refer ...

Fraudster Tries to Reduce His Sentence by Continuing His Fraud
Post number 5267

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In Spite of Defendants Claims He Will Spend Serious Time in Prison

In United States Of America v. Henry Ford, Criminal Action No. 23-130, United States District Court, E.D. Pennsylvania (January 5, 2026) Henry Ford (no relation to the creator of the Model T), also known as “Cleothus Lefty Jackson,” was indicted and pled guilty to one count of securities fraud and aiding and abetting, along with seven counts of wire fraud.

FACTUAL BACKGROUND

Defendant falsely represented to victims that a business he controlled, Fallcatcher, had “pilot approvals in writing” with two large insurance companies and that several states “want the [Fallcatcher] technology” [Count Five]. In reality, Fallcatcher did not have any pilot programs with insurance companies and the ...

Court Must Follow Judicial Precedent
Post 5252

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Insurance Policy Interpretation Requires Application of the Judicial Construction Doctrine

In Montrose Chemical Corporation Of California v. The Superior Court Of Los Angeles County, Canadian Universal Insurance Company, Inc., et al., B335073, Court of Appeal, 337 Cal.Rptr.3d 222 (9/30/2025) the Court of Appeal refused to allow extrinsic evidence to interpret the word “sudden” in qualified pollution exclusions (QPEs) as including gradual but unexpected pollution. The court held that, under controlling California appellate precedent, the term “sudden” in these standard-form exclusions unambiguously includes a temporal element (abruptness) and cannot reasonably be construed to mean ...

Lack of Jurisdiction Defeats Suit for Defamation

Post 5250

Posted on December 29, 2025 by Barry Zalma

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He Who Represents Himself in a Lawsuit has a Fool for a Client

In Pankaj Merchia v. United Healthcare Services, Inc., Civil Action No. 24-2700 (RC), United States District Court, District of Columbia (December 22, 2025)

FACTUAL BACKGROUND
Parties & Claims:

The plaintiff, Pankaj Merchia, is a physician, scientist, engineer, and entrepreneur, proceeding pro se. Merchia sued United Healthcare Services, Inc., a Minnesota-based medical insurance company, for defamation and related claims. The core allegation is that United Healthcare falsely accused Merchia of healthcare fraud, which led to his indictment and arrest in Massachusetts, causing reputational and business harm in the District of Columbia and nationwide.

Underlying Events:

The alleged defamation occurred when United ...

Zalma’s Insurance Fraud Letter

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ZIFL Volume 29, Issue 24

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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/

Zalma’s Insurance Fraud Letter

Merry Christmas & Happy Hannukah

Read the following Articles from the December 15, 2025 issue:

Read the full 19 page issue of ZIFL at ...