Posted on January 26, 2026 by Barry Zalma
Insurance Fraud Should Not be a Retirement Plan
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You’re reading, until you reach the paywall, from the free part of Excellence in Claims Handling until you reach the paywall. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the “subscribe” button below.
Health Insurance Providers Are Attempting Insurance Fraud to Fund Retirement
Every insurer is required by its shareholders, members, state statutes and state regulations to do everything possible to deter and defeat attempts at insurance fraud. Most insurers, therefore, have a staff of fraud investigators working under their Special Investigative Unit (SIU) and the SIU works to train the claims handlers to recognize the indicators or red flags of fraud.
Much to the surprise of the public, lawyers, and even some judges, defrauding an insurance company is a crime. In most states, insurance fraud is a felony that could subject the perpetrator to as many as five years in state prison plus serious fines. If the fraud is attempted by use of the mail or telephone, internet, e-mail or against a federal insurance program like Medicare, Medicaid and the National Flood Insurance Program (NFPA) it can also be a federal felony.
Insurance fraud is a crime that should be easy for a prosecutor to prove since all that is required is to prove the insurance criminal knowingly presented a claim for the payment of insurance contract benefits to which the perpetrator is not entitled or the submission of a single false document or oral statement in support of the crime. However, state prosecutors are reluctant to prosecute the crime, regardless of the state where it is committed, because they believe it is their duty to prosecute violent crimes. Financial crimes, like insurance fraud, they believe only hurts rich insurance companies and are not worthy of their efforts.
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Coverage is Available for Bicycle Rentals not Excluded
Post number 5271
See the video at and at and at https://zalma.com/blog plus more than 5250 posts.
The Insurance Contract Never Indicated that Coverage was Limited to Activities Specifically Described
In Mollie R. Lerner v. Bela LLC d/b/a The Perch Hotel, et al., CIVIL No. 25-1546 (FAB), United States District Court, D. Puerto Rico (January 21, 2026) Plaintiff Mollie R. Lerner, a North Carolina resident visiting Puerto Rico, rented a bicycle from The Perch Hotel while staying at a nearby Airbnb. While riding the bicycle back, she encountered a steep hill and, upon attempting to brake, was unable to slow down. She lost control, fell over the handlebars, and was subsequently struck by a truck, resulting in serious injuries.
ALLEGATIONS
Lerner alleged that her injuries were caused by the Hotel’s negligence in maintaining...
Subrogation Limited to What Was Paid by Insurer to Insured
Post number 5270
Posted on January 23, 2026 by Barry Zalma
See the video at https://lnkd.in/gGpPXhu2 and at https://lnkd.in/g6h3_aNR
In Erie Insurance Exchange A/S/O Bates Collision, Inc. James Myers, Anita Morgan, Lossie Auto Service, And Benedictine Sisters Of Erie, Inc. v. United Services Automobile Association v. Bates Collision, Inc., No. 19 WAP 2024, No. J-23-2025, Supreme Court of Pennsylvania (January 21, 2026) Erie attempted to obtain coverage for spoiliation of evidence against the property insurer.
FACTUAL BACKGROUND
On January 22, 2017, a fire broke out at Bates Collision, Inc., resulting in substantial damage to both the facility and several vehicles stored inside. Erie Insurance Exchange, as insurer for Bates and the affected vehicles, paid more than $1.6 million to its insureds under its insurance policy, which allowed Erie to pursue reimbursement for its payments.
Erie, acting as subrogee for Bates and the other insured parties, ...
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 ...
Posted on January 26, 2026 by Barry Zalma
Insurance Fraud Should Not be a Retirement Plan
More from Excellence in Claims Handling Substack for Subscribers Only
You’re reading, until you reach the paywall, from the free part of Excellence in Claims Handling until you reach the paywall. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the “subscribe” button below.
Health Insurance Providers Are Attempting Insurance Fraud to Fund Retirement
Every insurer is required by its shareholders, members, state statutes and state regulations to do everything possible to deter and defeat attempts at insurance fraud. Most insurers, therefore, have a staff of fraud investigators working under their Special Investigative Unit (SIU) and the SIU works to train the claims handlers to recognize the indicators or red flags of fraud.
Much to the surprise ...
Insurance Fraud Should Not be a Retirement Plan
More from Excellence in Claims Handling Substack for Subscribers Only
If you are a subscriber you can see the full article at https://lnkd.in/gafFt_x3, if not a subscriber you can see a preview at https://lnkd.in/gP9ETSVb, and at https://zalma.com/blog.
"You’re reading, until you reach the paywall, from the free part of Excellence in Claims Handling until you reach the paywall. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the “subscribe” button below."
Every insurer is required by its shareholders, members, state statutes and state regulations to do everything possible to deter and defeat attempts at insurance fraud. Most insurers, therefore, have a staff of fraud investigators working under their Special Investigative Unit (SIU) and the SIU works to train the claims handlers to ...
Insurance Fraud Should Not be a Retirement Plan
More from Excellence in Claims Handling Substack for Subscribers Only
If you are a subscriber you can see the full article at https://lnkd.in/gafFt_x3, if not a subscriber you can see a preview at https://lnkd.in/gP9ETSVb, and at https://zalma.com/blog.
"You’re reading, until you reach the paywall, from the free part of Excellence in Claims Handling until you reach the paywall. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the “subscribe” button below."
Every insurer is required by its shareholders, members, state statutes and state regulations to do everything possible to deter and defeat attempts at insurance fraud. Most insurers, therefore, have a staff of fraud investigators working under their Special Investigative Unit (SIU) and the SIU works to train the claims handlers to ...
