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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THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post number 5276
Posted on February 2, 2026 by Barry Zalma
ZIFL – Volume 30, Issue 3
See the video at https://rumble.com/v752e4i-zalmas-insurance-fraud-letter-february-1-2026.html and at https://youtu.be/UmnGuRcLsz8
Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th 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/ This issue contains the following articles about insurance fraud:
Read the full 23 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-02-01-2025.pdf.
Disappearance of Defendant is Not Evidence of Death
In United States v. Marvin Moy, No. (S3) 22 Cr. 19 (PGG), United States District Court, S.D. New York (January 7, 2026) Defendant Marvin Moy, a medical doctor, was charged in the Southern District of New York with conspiracy to ...
Insurer Must Pay Damages Caused by its Insureds Negligence
Post number 5273
Read the full article at https://www.linkedin.com/pulse/defendant-started-fire-bed-liable-ensuing-damage-zalma-esq-cfe-ngjcc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.
Smoking in Bed Can be Very Expensive
In Spires Of Sherwood Owner, LLC v. Jackie Baker, Joseph Baker And First American Property & Casualty Insurance Company, No. 2025 CA 0541, Court of Appeals of Louisiana, First Circuit (January 24, 2026) Spires of Sherwood Owner, LLC owned the Spires of Sherwood Apartments and sued Jackie Baker, Joseph Baker, and First American Property & Casualty Insurance Company following a fire that occurred on June 19, 2019, in the Bakers’ apartment.
The fire caused damage to multiple units. Investigations by both parties concluded that the fire originated in Joseph Baker’s bedroom and ...
See the video at https://lnkd.in/grQRRWa5 and at https://lnkd.in/gH8gtAr2, and at https://zalma.com/blog plus more than 5250 posts.
Insurance Policy Exclusions Must be Enforced as Written
Post number 5272
Pollution With a State Permit is Still Excluded
In Griffith Foods International, Inc., et al. v. National Union Fire Insurance Company Of Pittsburgh, Pa, No. 131710, Supreme Court of Illinois, 2026 IL 131710 (January 23, 2026) Griffith Foods International, Inc., and its successor Sterigenics U.S., LLC, operated a medical-equipment sterilization facility in Willowbrook, Illinois. Local residents alleged that for over 35 years, the facility emitted ethylene oxide (EtO), which they claimed caused cancer and other serious illnesses.
The policyholders sought a declaration that National Union Fire Insurance Company of Pittsburgh, PA, was obligated to defend them in the underlying mass tort litigation, based on two CGL policies issued for the facility between September 1983 and September 1985.
The two policies required the ...
You Get What You Pay For – Less Coverage Means Lower Premium
Post number 5275
Posted on January 30, 2026 by Barry Zalma
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When Experts for Both Sides Agree That Two Causes Concur to Cause a Wall to Collapse Exclusion Applies
In Lido Hospitality, Inc. v. AIX Specialty Insurance Company, No. 1-24-1465, 2026 IL App (1st) 241465-U, Court of Appeals of Illinois (January 27, 2026) resolved the effect of an anti-concurrent cause exclusion to a loss with more than one cause.
Facts and Background
Lido Hospitality, Inc. operates the Lido Motel in Franklin Park, Illinois. In November 2020, a windstorm caused one of the motel’s brick veneer walls to collapse. At the time, Lido was insured under a policy issued by AIX Specialty Insurance Company which provided coverage for windstorm damage. However, the policy contained an exclusion for any loss or damage directly or indirectly resulting from ...
Declaratory Relief Available to an Insurer from USDC
Post number 5274
Read the full article at https://www.linkedin.com/pulse/resolution-coverage-issues-appropriate-under-federal-barry-wfpoc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.
Insurer Seeks Limitation of Liability of Child Killed by Foster Dogs
In the Cincinnati Specialty Underwriters Insurance Company, an Ohio corporation v. Dennis Murphy, as Personal Representative of the Wrongful Death Estate of Avery Colin Jackson-Dunphy, Deceased; Patrick Admiral Dunphy, an Individual; Danika Thompson, an Individual; and Animal Services Center Of The Messila Valley, a New Mexico limited Liability Company, No. CIV 24-1039 JB/JFR, United States District Court, D. New Mexico (January 23, 2026) resolved the issues raised about the court's jurisdiction.
Cincinnati Specialty Underwriters Insurance Company ...
Posted on January 26, 2026 by Barry Zalma
Insurance Fraud Should Not be a Retirement Plan
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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...
