Lie About Criminal Background & Insurer Will Try to Rescind
Post number 5277
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Pro Se Defendant Admits Misrepresentation but Claimed no Intent to Defraud
In Metropolitan Life Insurance Company v. Sheba S. Gopaul, Civil Action No. 1:21-cv-02454-LKG, United States District Court, D. Maryland (January 15, 2026) Metropolitan Life Insurance Company (“MetLife”) filed a declaratory judgment action against Sheba S. Gopaul, who represented herself (pro se).
FACTUAL BACKGROUND
MetLife alleged that Ms. Gopaul made fraudulent material misrepresentations, misstatements, and/or omissions about her criminal history in her 2015 application for a disability income insurance policy. The company claimed that it would not have issued the policy had it known the true facts.
Ms. Gopaul completed the application on June 18, 2015, and agreed in writing that all statements were true and complete, and that MetLife could rely on them in deciding whether to issue the policy.
Ms. Gopaul submitted an initial claim for disability benefits form to MetLife. In the disability claim, Ms. Gopaul claimed total disability from her occupation as the CEO/CFO of a healthcare company, due to moderate to severe pain in her pelvis, knee and hip when standing, climbing, walking, bending and lifting, due to a series of falls in June and August of 2019, along with postpartum depression and anxiety after delivering a baby in December of 2019.
The crimes misrepresented were the following crimes for which she was convicted: Theft, Prostitution, U/U use of livestock, Grand Larceny-credit cards (Felony), Obtaining Money Under False Pretense and auto theft.
LEGAL ISSUES
The court reviewed the matter as a declaratory judgment action, applying principles governing insurance contracts, including the legal standards for rescission due to material misrepresentation. Under Maryland law, an insurer may rescind a policy if it can prove that a material misrepresentation was made in the application and that the misrepresentation affected the company’s decision to issue the policy.
ANALYSIS
After reviewing the evidence, the court concluded that MetLife had established a basis for some, but not all, of its claims for summary judgment. Specifically, the court found sufficient evidence supporting MetLife’s contention that Ms. Gopaul made material misrepresentations regarding her criminal history, which were significant to MetLife’s decision-making process but did not prove that the misrepresentations were fraudulent.
MetLife contended that it would not have issued the Policy to Ms. Gopaul had it known about these three prior felony convictions and the multiple misdemeanor convictions sounding in fraud, because she would have been deemed an unacceptable insured due to both a medical and financial risk.
MetLife’s Rescission Of The Policy
There must be sufficient evidence favoring the nonmoving party for a jury to return a verdict for that party. If the evidence is merely colorable, or is not significantly probative, summary judgment may be granted.
The Omitted Convictions Are Material
The undisputed material facts show that Ms. Gopaul’s misrepresentations and/or omissions about her criminal history were material, because MetLife would not have issued the Policy had it known about these prior convictions.
Material And Fraudulent Misrepresentations
The burden is on the insurer to establish fraud or misrepresentation by the insured in the application for insurance. The undisputed material facts in this case show that Ms. Gopaul’s misrepresentations and/or omissions about her criminal history were material. But, the Court concluded there is a genuine dispute of material fact as to whether Ms. Gopaul’s misrepresentations and/or omissions about her criminal history were fraudulent.
Made Fraudulent Misrepresentations Regarding Her Criminal History
The Court was not satisfied that the undisputed material facts establish that Ms. Gopaul’s material misrepresentations and/or omissions to MetLife about her criminal history were fraudulent. Ms. Gopaul’s misrepresentations and/or omissions about her criminal history were not established as made for the purpose of defrauding MetLife.
ZALMA OPINION
Making a material misrepresentation in an application is usually sufficient to prove an insurer’s right to rescind. The USDC, perhaps giving the benefits of all doubt to a pro se defendant, found that although she admitted she lied on the application she did not do so to defraud the insurer. A trial before a reasonable jury who do not feel sorry for a pro se defendant should confirm the rescission.
(c) 2026 Barry Zalma & ClaimSchool, Inc.
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Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.
Posted on September 18, 2026 by Barry Zalma
See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html
In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.
The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.
Law
The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...
150 Months in Prison for Tax Fraud
Post 4846
Posted on September 17, 2026 by Barry Zalma
See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.
The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...
Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution
Post 5489
Posted on September 14, 2026 by Barry Zalma
Fraudster Refuses to Answer Questions About His Alleged Fraud
See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr
In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.
Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.
After Great American ...
Inadequately Briefed Issues Defeats Appeal
Post 4852
Issues on Appeal Must be Adequately Briefed
Posted on September 25, 2026 by Barry Zalma
In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.
According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair. The defendant denied negligence and alleged comparative negligence. After a two-day jury trial in November 2023, the jury returned a defense verdict.
The trial court denied Ojekwe’s motion to set aside the verdict and for a new trial, and he appealed.
LAW
A trial court’s refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of ...
Inadequately Briefed Issues Defeats Appeal
Post 4852
Issues on Appeal Must be Adequately Briefed
Posted on September 25, 2026 by Barry Zalma
In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.
According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair.
LAW
Refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of discretion.
Appellate claims receiving only cursory treatment, without record citations, supporting authority, or legal analysis, are inadequately briefed.
DISCUSSION
Improper opening remarks.
Defense counsel referred to Ojekwe’s national origin,...
Psychiatrist Who Was Convicted of Fraud Asked the First Circuit to Reduce his Punishment
Post 4851
Posted on September 24, 2026 by Barry Zalma
Fraud to Private and Public Health Insurers Doesn’t Pay
In United States v. Gustavo Kinrys, Nos. 24-1592, 24-1716, United States Court of Appeals, First Circuit (September 21, 2026) Gustavo Kinrys, a Massachusetts psychiatrist, submitted fraudulent claims to private and public health insurers from 2015 through 2018, including bills for more than 1,000 sessions when he or the purported patient was outside the country. When insurers requested supporting records, he delayed through a fictitious office manager and created false documentation.
A jury convicted Kinrys on fourteen counts. The district court imposed a 99-month sentence, calculated intended loss at slightly more than $19 million based on billed amounts, ordered $6,537,309.59 in restitution, and ordered $6,527,391.19 in forfeiture.
At sentencing, the district court calculated Kinrys’s base offense level to be ...
