Qui Tam Case Without Evidence to Prove Fraud Fails
Post number 5369
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In People Of The State Of California Ex Rel. Heath & Yuen, APC v. Silver Bird Auto Leasing, LLC et al., B342847, California Court of Appeals, Second District, Eighth Division (June 5, 2026) Heath & Yuen, APC defended parties in an automobile collision case involving a McLaren and a tour van. After that case settled for $25,000, the firm filed a qui tam action under California’s Insurance Frauds Prevention Act (IFPA) against Silver Bird Auto Leasing, LLC, X-Law Group, PC, and Filippo Marchino. The firm alleged three fraudulent acts in the underlying litigation:
1. the complaint falsely stated the McLaren was making a “legal turn,”
2. respondents produced a fraudulent repair bill/estimate, and
3. respondents failed to disclose Marchino’s GEICO insurance and its payment for repairs.
FACTS
The California Insurance Guarantee Association (CIGA), which assumed the defense after the original insurer became insolvent, and ultimately funded the settlement, stated it did not view the claims as fraudulent and did not authorize the IFPA suit.
LAW
The court focused on Insurance Code section 1871.7 and Penal Code section 550, especially subdivision (b)(1), (b)(2), and (b)(3).
To establish an IFPA violation based on section 550, the alleged false statement or concealment must be material. A statement is material if a reasonable insurer would consider it important to the investigation or evaluation of the claim. Materiality is judged objectively, not by whether the insurer was actually misled.
DISCUSSION
The court held that Heath & Yuen failed to show any triable issue of material fact as to materiality.
“Legal turn” allegation:
The statement in the complaint was only a conclusory allegation in an unverified pleading. CIGA already believed Marchino was at fault, so the allegation did not materially affect the insurer’s evaluation.
Repair estimate:
Respondents showed the document was an estimate, not a fraudulent repair bill, and the repair-related damages claim had been withdrawn before settlement. Because the claim was no longer being pursued, the estimate was not material.
GEICO nondisclosure:
The court found this argument forfeited because it was not properly developed below. Even on the merits, there was no material concealment because Heath & Yuen and CIGA already knew about GEICO and its payment for repairs, and respondents had already withdrawn the repair-damage claim.
ANALYSIS
The opinion centers on materiality as the key limiting principle in insurance-fraud actions.
Even if a statement is false or incomplete, it does not support liability under section 550 unless it could significantly influence a reasonable insurer’s decision-making. The court relied heavily on CIGA’s declaration as evidence of how a reasonable insurer viewed the claim.
The case also reinforces procedural limits on appeal: parties cannot revive unpled theories or rely on post-ruling evidence to defeat summary judgment.
The Court of Appeals agreed with the trial court that summary judgment for respondents was appropriate because the alleged misrepresentations were not materially fraudulent.
CONCLUSION
The Court of Appeal affirmed summary judgment for respondents. The alleged misrepresentations and omissions were not materially fraudulent, and Heath & Yuen could not establish a predicate violation of Penal Code section 550 sufficient to support its IFPA claim.
Silver Bird sued and settled with the prior defendants, who were alleged tortfeasors, and did not sue CIGA.
The Court of Appeals affirmed the judgment. Respondents recovered their costs on appeal.
ZALMA OPINION
The California Insurance Frauds Protection Act, Insurance Code Section 550, allows a citizen to sue a fraud perpetrator on behalf of the state. To do so the qui tam plaintiff must allege and prove that the defendant was perpetrating an insurance fraud. They didn’t have the evidence and the qui tam case failed.
(c) 2026 Barry Zalma & ClaimSchool, Inc.
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Post number 5347
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Post number 5368
Posted on June 9, 2026 by Barry Zalma
In Prime Insurance Company, Inc. v. Medicab Transportation, LLC, Jason Rhodes, and Dale Johnson v. Prime Insurance Company, Inc and Prime Property & Casualty Insurance, Inc. No. 2:24-cv-421-SPC-KRH, United States District Court, M.D. Florida, Fort Myers Division (June 3, 2026) Medicab, a paratransit company, bought two policies in 2021: a Business Auto Policy from PPCI and a Commercial Liability Policy from Prime. Both policies, as originally written, appeared to cover injuries arising from loading and unloading patients from Medicab vans.
After a patient, Margaret St. Aubin, fell while being unloaded from a van and suffered injuries, her Estate made a $1 million demand. Prime and its claims administrator concluded that the Commercial Policy’s loading/unloading language had been included by mutual mistake, because...
Full Faith and Credit Act Controlled
Read the full article at https://lnkd.in/evHXiiFE and at https://zalma.com/blog.
Posted on June 9, 2026 by Barry Zalma
Post number 5368
Posted on June 9, 2026 by Barry Zalma
In Prime Insurance Company, Inc. v. Medicab Transportation, LLC, Jason Rhodes, and Dale Johnson v. Prime Insurance Company, Inc and Prime Property & Casualty Insurance, Inc. No. 2:24-cv-421-SPC-KRH, United States District Court, M.D. Florida, Fort Myers Division (June 3, 2026) Medicab, a paratransit company, bought two policies in 2021: a Business Auto Policy from PPCI and a Commercial Liability Policy from Prime. Both policies, as originally written, appeared to cover injuries arising from loading and unloading patients from Medicab vans.
After a patient, Margaret St. Aubin, fell while being unloaded from a van and suffered injuries, her Estate made a $1 million demand. Prime and its claims administrator concluded that the Commercial Policy’s loading/unloading language had been included by mutual mistake, because...
Detroit Immune From Tort Action
Post number 5367
City Leased to a Private Entity the Maintenance and Control of Sewer Systems and had no obligation for its failure.
In American Select Insurance Co., et al. v. Great Lakes Water Authority, et al., No. 23-cv-11942, United States District Court, E.D. Michigan, Southern Division (June 2, 2026) involved Plaintiff insurers who had paid claims to approximately 1,400 insured homeowners for flood damage caused by June 25–26, 2021 sewer overflows/backups in the Detroit metro area.
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FACTS
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