ZALMA’S INSURANCE FRAUD LETTER January 15, 2019
Is Hard Labor for Insurance Fraud a Real Deterrent?
Louisiana takes Insurance Fraud Seriously
Insurance fraud is a crime that takes a great deal of money from the insurance buying public. Estimates – since most insurance frauds succeed no one really knows how much it takes – range from $80 billion to $300 billion a year. In most states, when an insurance fraud perpetrator is caught, arrested, prosecuted, tried and convicted sentences vary from probation and, if jail time is assessed, it is usually quite limited.
In State of Louisiana v. Anthony Scott Tubbs, No. 52,417-KA, Court of Appeal Second Circuit State of Louisiana (November 20, 2019) insurance fraud is taken seriously and the defendant not only is sentenced to prison, he or she is also, by statute, sentenced to hard labor. The defendant, Anthony Scott Tubbs, was convicted of insurance fraud. He was ordered to serve five years at hard labor, with all but one year suspended. He was placed on four years’ active, supervised probation and ordered to pay a fine of $1,500, along with restitution.
Insurer Should Never Make an Unsubstantiated Claim of Fraud by Insured
I have been involved in insurance claims since 1967 as an adjuster, a lawyer, a coverage lawyer and author. Most of my career has involved representing insurers. I never represented, as a lawyer, a policyholder in a suit against an insurer. As a consultant and expert witness, I serve the court in helping it understand how insurance claims are, and should be, investigated with the utmost good faith and fair dealing. In the Idaho case I was shocked to find that the insurer failed to deal fairly and in good faith with its insured who, eventually, obtained a favorable judgment from the court.
This case taught an insurer that if it felt it necessary to accuse an insured of fraud it needed convincing evidence of the insured’s conduct not just a suspicion. It is also a violation of the covenant of good faith to ignore evidence and legal precedent.
How to Create A Staff of Professional Claims Handlers
Business reporters complain every day that the United States is now at full employment. There are more than seven million jobs available and only six million people available to fill those jobs. Since insurance claims jobs are not the most desirable to recent high school or college graduates. Experienced and professional claims people are in a sellers’ market.
If you wish to keep up the quality of your claims staff you must start from scratch by hiring intelligent but totally ignorant of the business of insurance claims and train them to be professional.
Learn about the available property claims training program for property claims here. A similar course is available with regard to liability claims.
I Didn’t Know the Gun Was Loaded – A Lie to Get Insurance Benefits
Pre-Existing Condition Material to No Fault Claim
No fault insurance plans, like that in Michigan, provide benefits to an injured person regardless of fault. All the state asks from the injured party is that he or she is honest in the presentation of the claim. Misrepresenting material facts in the presentation of a no fault claim is considered fraud and deprives the person injured of the right to receive benefits.
In Mark Smith v. Michigan Automobile Insurance Placement Facility, No. 344023, State of Michigan Court of Appeals (December 26, 2019) Smith lied to the Placement Facility when making his claim and tried to avoid losing benefits by claiming he forgot his previous condition and did not intentionally lie.
Insurance Fraud Hall of Shame
Say hello to the Insurance Fraud Hall of Shame, home of the most-brazen insurance scammers of 2019. They’re America’s newest Commanders in Thief.
The No-Class of 2019 proves insurance fraud is hardly a victimless crime. Insurance fraud is a national epidemic. We’re all victims, with $80 billion stolen each year.
Honest Americans lose their lives. … Our bank accounts are drained. … Our credit is wrecked. … We endure painful and disfiguring surgeries. … Families face despair. … Scams drive up everyone’s premiums.
Fraud fighters are hunting hard. Let’s turn the corner on insurance fraud together – one criminal at a time.
Insurance Claims Library
Zalma on Insurance
The Zalma on Insurance blog has posted over 2850 digests of insurance appellate decisions and other important insurance materials and articles published five days or more a week and are available at http://zalma.com/blog.
The videoblog is adapted from my book, Insurance Claims: A Comprehensive Guide available at the Zalma Insurance Claims Library
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The Zalma on Insurance blog has posted over 2850 digests of insurance appellate decisions and other important insurance materials and articles published five days or more a week and are available at http://zalma.com/blog.
The videoblog is adapted from my book, Insurance Claims: A Comprehensive Guide available at the Zalma Insurance Claims Library
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Barry Zalma, Inc.
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ClaimSchool, Inc.
4441 Sepulveda Boulevard
CULVER CITY CA 90230-4847
310-390-4455
Fax: 310-391-5614
Fax: 310-391-5614
Insurance claims consultant and Expert Witness
zalma@zalma.com
(c) 2020 by Barry Zalma & ClaimSchool, Inc.