PIP Fraud Disputes Should Never be Limited to Arbitration
Post number 5269
Read the full article at https://lnkd.in/gn7YmPny, see the video at https://lnkd.in/g4HzAf2r and at https://lnkd.in/gTFNBc_Z, and at https://zalma.com/blog plus more than 5250 posts.
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 are subject to arbitration and, if so, whether the proceedings for both arbitrable and non-arbitrable claims should be stayed. Because of the grant of certification in Carteret Comprehensive the USDC and others administratively terminated similar actions brought by GEICO pending a decision from the New Jersey Supreme Court.
The Attorney General for the state of New Jersey, in his amicus brief concluded, as follows:
“In sum, a fair reading of the Appellate Division’s published decision shows that it thoroughly considered the statutes, the trial court’s orders, and all of Defendants’ arguments before rejecting them. That Defendants disagree with its decision does not constitute a sufficient basis for certification. Nor is certification warranted in the interests of justice or for any “special reasons.”
Defendants repeat arguments that were presented to and considered by the Appellate Division. The Appellate Division addressed those challenges below
and correctly applied the plain language of statutes and well-settled law to the facts in this matter. Thus, further review by this Court is unwarranted.”
The statute the Supreme Court is considering provides:
“The purpose of this act is to confront aggressively the problem of insurance fraud in New Jersey by facilitating the detection of insurance fraud, eliminating the occurrence of such fraud through the development of fraud prevention programs, requiring the restitution of fraudulently obtained insurance benefits, and reducing the amount of dollars used to pay fraudulent claims.”
It seems obvious to me from the AG’s arguments in its brief that making an insurer arbitrate every potentially fraudulent claim when there is evidence of a conspiracy and multiple fraudulent claims, to allow litigation to fulfill the purpose of the statute, is to eliminate the occurrence of such fraud.
The AG’s brief also concluded:
“In short, a rule channeling affirmative insurance fraud claims to PIP arbitration would negatively impact insurance fraud prevention and weaken the ability of insurance carriers, the Department, and OIFP to each combat insurance fraud. The Legislature did not so intend.”
ZALMA OPINION
The intent of the IFPA is to deter and/or defeat insurance fraud. It makes no sense to make it difficult for the AG and the insurers to fulfill the requirements of the statute.
Because GEICO and Allstate have moved to take the profit out of the crime by suing the fraud perpetrators for damages the fraudsters continue to seek arbitration of each individual claim to make the cost of fighting the fraud too expensive for the insurer and the state of New Jersey. The Supreme Court of New Jersey has not yet ruled in Carteret Comprehensive so those who deal with insurance fraud must patiently wait for the decision and do everything possible to convince the Supreme Court that defeating fraud is more important than allowing individuals to arbitrate the fraud defense without the access to the discovery available in a tort or RICO lawsuit.
(c) 2026 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.
Insurer’s RICO Claim Against Fraudulent Health Insurance Claims Proper
Post number 5268
Read the full article at https://www.linkedin.com/pulse/allstate-works-take-profit-out-crime-fraud-barry-zalma-esq-cfe-xu89c, See the video at and at and at https://zalma.com/blog plus more than 5250 posts.
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 ...
Insurer’s RICO Claim Against Fraudulent Health Insurance Claims Proper
Post number 5268
Read the full article at https://www.linkedin.com/pulse/allstate-works-take-profit-out-crime-fraud-barry-zalma-esq-cfe-xu89c, See the video at and at and at https://zalma.com/blog plus more than 5250 posts.
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
Read the full article at https://lnkd.in/gn6SUUqV, see the video at https://lnkd.in/g4PiYrAp and at https://lnkd.in/giHCPFAw, and at https://zalma.com/blog plus more than 5250 posts.
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
Read the full article at https://www.linkedin.com/pulse/sudden-opposite-gradual-barry-zalma-esq-cfe-h7qmc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.
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
See the video at and at
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
Read the full article at https://lnkd.in/dG829BF6; see the video at https://lnkd.in/dyCggZMZ and at https://lnkd.in/d6a9QdDd.
ZIFL Volume 29, Issue 24
Subscribe to the e-mail Version of ZIFL, it’s Free! https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D
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 ...
