Courts that construe submission to an EUO as a condition precedent to recovery generally do not require the insurer to prove that it suffered actual prejudice from an insured’s unexcused refusal to submit to an examination. Lorenzo-Martinez v. Safety Ins. Co., 58 Mass. App. Ct. 359, 790 N.E.2d 692, 695-96 (2003). The EUO provides a mechanism for the insurer to corroborate the claim by obtaining information that is primarily or exclusively within the possession of the insured.
From the Coalition on Immunity for Fraud Reporting
AMICUS BRIEF: NY IMMUNITY LAW IS SHIELD AGAINSTDEFAMATION LAWSUITS, NOT USED AS A SWORD
The decision could affect all states with similar immunity laws.
“Protecting good-faith immunity reporting is vital to a rigorous system of physician discipline that fights fraud and ensures consumers receive honest medical care from ethical providers,” says Matthew Smith, the Coalition’s director of government affairs.
New York law grants insurers and others immunity from defamation suits for reporting suspected medical provider misconduct in good faith to the state medical board, the Coalition and NICB counter.
Starr Insurance Sues to Rescind Coverage for Plane Used by Lawyer Avenatti
Staged Collision not an Accident
Health Insurance Fraud Convictions
West Virginia Physician Sentenced for Illegal Opioid Distribution to Patients
The controlled substances illegally distributed by Brizuela included Oxycodone, Fentanyl, and Oxymorphone. They were distributed without legitimate medical purpose and outside the scope of professional practice in Monongalia County, West Virginia between 2013 and 2015. settlement were originally alleged in two cases filed under the whistleblower, or qui tam, provision of the False Claims Act. The act permits private parties to sue for fraud on behalf of the United States and to share in any recovery. The act also permits the government to intervene in such actions, as the government previously did in the two whistleblower cases.
Other Insurance Fraud Convictions
Houston Woman Found Guilty in 2012 Capital Murder of Arlington Couple, Sentenced to Life
A Tarrant County, Texas jury found 47-year-old Wright guilty of capital murder. Wright received the automatic life sentence.
Insurance Claims Library
Everything Needed by the Insurance Claims Professional
- The Reason for the Examination Under Oath
- Barry Zalma
- From the Coalition on Immunity for Fraud Reporting
- Starr Insurance Sues to Rescind Coverage for Plane Used by Lawyer Avenatti
- Good News from the Coalition Against Insurance Fraud
- Staged Collision not an Accident
- Health Insurance Fraud Convictions
- Other Insurance Fraud Convictions
- Excellence in Claims Handling Courses From Experfy.com
- Insurance Claims Library
Zalma on Insurance blog
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