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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Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Proof of Highly Contaminated Water is Required for Extra Payments
Post number 5300
Read the full article at https://www.linkedin.com/pulse/acting-your-own-lawyer-foolish-barry-zalma-esq-cfe-mbg0c, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Acting as Your Own Lawyer is Foolish
Evidence of Breach of Contract Survives Dismissal of All Other Charges
In Lee Lifeng Hsu and Jane Yuchen Hsu v. State Farm Fire And Casualty Company, C. A. No. N24C-09-020 CLS, Superior Court of Delaware (February 27, 2026) a claim to State Farm who paid approximately $61,000 after assessments but denied coverage for additional items including ceramic tiles, the kitchen floor ceiling, underlayment plywood, and numerous personal property items resulted in suit by the Hsu’s acting in pro per.
Facts
Lee Lifeng Hsu and Jane Yuchen Hsu (“Plaintiffs”) purchased a homeowners’ insurance policy from State Farm Fire...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
