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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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April 07, 2026
NO GOOD LAW GOES UNPUNISHED

Posted on April 7, 2026 by Barry Zalma

Alleged No Fault Fraudsters Enjoined from Claims, Arbitration or Suit to Collect Benefits

Post number 5318

See the full video at https://lnkd.in/gDVBjCn7 and at https://lnkd.in/g-MYNe8b and at https://zalma.com/blog plus more than 5300 posts.

In Allstate Insurance Company, Allstate Indemnity Company, Allstate Property & Casualty Insurance Company, and Allstate Fire & Casualty Insurance Company v. Jonathan S. Landow, M.D., Viviane Etienne, M.D., Atlantic Medical & Diagnostic, P.C., Birch Medical & Diagnostic, P.C., Eastern Medical Practice, P.C., Empire Medical Services, P.C., Macintosh Medical, P.C. Paramount Medical Services, P.C., Preferred Medical, P.C., Sovereign Medical Services, P.C., Spruce Medical & Diagnostic, P.C., Summit Medical Services, P.C., Urban Medical, P.C., Roman Matatov, Uriyel Mirzakandov, and Ruben Levy a/k/a Ruben Leviyev, No. 24-CV-2010 (DLI) (JRC), United States District Court, E.D. New York (March 30, 2026) Plaintiffs filed a 187-page complaint, including dozens of pages of exhibits, detailing a scheme of kickbacks for patient referrals, operation of clinics by laypersons, lack of medical care provided by the M.D. Defendants, and predetermined and trumped up medical treatments.

FACTS

Allstate Insurance Company and related entities (“Plaintiffs”) sued multiple defendants, including physicians, medical professional corporations, and managerial individuals (“Defendants”). The Plaintiffs alleged that Defendants collectively participated in a scheme to defraud them by exploiting New York’s No Fault insurance system, submitting illegal or inflated medical costs through various medical professional corporations. The action involves claims of violations of the Federal RICO Act, common law fraud, and unjust enrichment.

Allstate sued Jonathan S. Landow and multiple (“M.D. Defendants”), Urban Medical, P.C. (collectively, “PC Defendants”), Roman Israilov a/k/a Roman Matatov, (collectively, “Managerial Defendants”)The suit alleged violations of the Federal Racketeer Influenced and Corrupt Organizations (“RICO”) Act, common law fraud, and unjust enrichment. Plaintiffs alleged that all Defendants collectively engaged in a scheme to defraud Plaintiffs via New York’s No Fault insurance statutory framework (“No Fault”).

LAW

The case centers on New York’s No Fault statutory framework, which is designed to provide prompt compensation for necessary medical expenses resulting from motor vehicle accidents, up to $50,000 per person. The laws allow claimants to assign benefits to licensed healthcare providers, who then submit claims to insurers for payment. Providers must be operated by licensed professionals, and any fraudulent activity — including submitting materially false claims or receiving kickbacks — is prohibited under relevant New York statutes. Failure to comply with licensing requirements renders providers ineligible for reimbursement.

DISCUSSION

Plaintiffs sought a preliminary injunction to stay all current No Fault arbitrations and prevent Defendants from filing new arbitrations or state court collection suits during the litigation. The court reviewed the statutory requirements and allegations, focusing on whether Defendants’ conduct violated the No Fault laws and related regulations.

ANALYSIS

A party seeking a preliminary injunction must show:

1. irreparable harm;
2. either a likelihood of success on the merits or both serious questions on the merits and a balance of hardships decidedly favoring the moving party; and
3. that a preliminary injunction is in the public interest.

The court examined the statutory prerequisites for medical providers to claim No Fault benefits, emphasizing the necessity of licensure and prohibition of fraudulent practices. Plaintiffs’ allegations that Defendants operated unlicensed or fraudulently managed medical corporations and submitted improper claims were found to raise serious questions under both federal and state law. The procedural history and unopposed motion supported granting the requested relief.

CONCLUSION

The court granted Plaintiffs’ motion for a preliminary injunction in its entirety, staying pending No Fault arbitrations and state court litigation against Plaintiffs and enjoining Defendants from initiating new proceedings during the pendency of the action. The decision underscores the importance of compliance with New York’s No Fault laws and the legal consequences for fraudulent or unlicensed conduct in the insurance and medical services context.

Plaintiffs’ motion for a preliminary injunction was granted.

ZALMA OPINION

The “No Fault Law” was created to avoid litigation, make benefits available promptly and avoid fraud. Unfortunately, it created a cottage industry for fraud perpetrators who created fake medical bills to obtain the maximum recovery for people who were uninjured and for health care providers who had no morals nor a willingness to follow the law. Allstate, and other insurers are using injunctions to take the profit out of the fraud since the authorities have failed to prosecute the scofflaws.

(c) 2026 Barry Zalma & ClaimSchool, Inc.

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00:07:08
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September 18, 2026
Expert May Only Testify to What Experience Supports

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...

00:03:10
September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

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 ...

00:05:23
September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

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 ...

00:05:14
16 hours ago
Habeas Relief Requires Cognizable Responses to State Defenses

Claims of Res Judicata and Procedural Default Defeats Habeas

Post 5543

Posted on November 13, 2026 by Barry Zalma

A Health Insurance Fraud Conviction Rested On Knowingly Submitting Materially False Or Misleading Claim Information With Specific Intent To Defraud.

A Health Insurance Fraud Conviction Rested On Knowingly Submitting Materially False Or Misleading Claim Information With Specific Intent To Defraud.

In Tariq Mustafa Abdulaziz v. Commissioner Of Correction, No. CV 26-5002432-S, Superior Court of Connecticut, Judicial District of Tolland, Habeas Docket (October 29, 2026) Tariq Mustafa Abdulaziz submitted 114 claims for in-home, face-to-face services purportedly provided to thirty program participants during four one-week periods. The department paid Neurostrategies, Inc., $13,650.

FACTS

The defendant waived his right to a jury trial and elected a trial to the court, D'Addabbo, J. Trial occurred over the course of eight days in August, 2022. The state presented testimony from ten witnesses and introduced thirty-three exhibits into ...

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November 12, 2026
Common Interest Doctrine Protects Confidentiality

Theft of Confidential Information

Post 4581

Posted on November 12, 2026 by Barry Zalma

In People Center, Inc. v. Deel, Inc., et al., No. 25-cv-02576-CRB (LJC), United States District Court, N.D. California (November 7, 2026) People Center, doing business as Rippling, and Deel compete in payroll and human-resource management software. Rippling alleges that Deel and its executives recruited Rippling employee Keith O’Brien, based in Ireland, to disclose confidential information and trade secrets.
THE IRISH SUIT

Rippling sued O’Brien in Ireland and Deel in the United States. O’Brien subsequently retained separate counsel, supplied an affidavit describing the alleged espionage, and entered into a Cooperation Agreement with Rippling. In exchange for his cooperation, Rippling agreed to provide financial assistance, indemnification, and conditional dismissal of the Irish proceedings. The agreement also permitted renewed proceedings or a monetary judgment upon a material breach.

The Irish proceedings against O’Brien were dismissed...

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November 11, 2026
After Dismissal Fraud Victim May Amend Complaint After Dismissal

A Proposed Amended Complaint That Includes New Factual Allegations to Remedy Pleading Deficiencies

Posted on November 11, 2026 by Barry Zalma
After Dismissal Fraud Victim May Amend Complaint After Dismissal
Post 4580

If A Proposed Amendment Is Not Clearly Futile, Then Denial Of Leave To Amend Is Improper

In John Hancock Life & Health Insurance Company v. Caring Connections LLC, Arthur Feldheim, and Blime a/k/a Vera Feldheim, Civ. No. 25-7574 (MAS)(JBD), United States District Court, D. New Jersey (November 6, 2026) John Hancock sued Caring Connections LLC, Arthur Feldheim, and Blime a/k/a Vera Feldheim on June 5, 2025, asserting thirteen claims, including fraud, breach of contract, and aiding and abetting fraud.

On March 26, 2026, this Court entered an order granting Caring Connections’ motion to dismiss and granting in part and denying in part the Feldheims’ motion to dismiss. The dismissed claims were dismissed without prejudice, and John Hancock timely sought leave to amend.

They also argued that the New ...

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