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Published: Oct. 15, 2020, 1 p.m.

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Zalma\'s Insurance Fraud Letter

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See the full article, and the previous Fraud Letter, in Adobe pdf format at https://zalma.com/zalmas-insurance-fraud-letter-2/

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On or Before November 3, 2020 It is Imperative That Everyone Votes. 

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Unlicensed Doctor Convicted of Insurance Fraud and Other Crimes

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After Patrick E. Usanga (Usanga) was convicted for many crimes of fraud he appealed his convictions unsuccessfully and then filed Post Conviction Relief Act motion to set aside the conviction in Commonwealth of Pennsylvania v.  Patrick E. Usanga, J-S29031-20, No. 1946 EDA 2019, Superior Court of Pennsylvania (July 13, 2020).

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Usanga appealed pro se (proving the old saying that he had a fool for an attorney) from the order denying his first petition filed pursuant to the Post Conviction Relief Act (PCRA) in the Court of Common Pleas of Philadelphia County (PCRA court).

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ZIFL OPINION

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Those who defraud insurers are people with unmitigated gall and even when they have been caught, have been tried, and convicted by a jury of their peers, they will continue to bother and annoy the court system until they get so annoyed that they let him out of jail. The Pennsylvania court refused to honor the stupidity of the claim for PCRA relief but still had to take the time to review the pleadings and briefs and write an opinion. If he has any of his ill-gotten gains still available, he should be assessed sanctions to remove from his control all of the monies he took from the insurers and pay indemnity to those who allowed him to treat them as if he was a licensed physician.

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Judgment Against Insurance Fraud Perpetrators is not Dischargeable in Bankruptcy

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When a person is convicted of the crime of insurance fraud and is assessed a judgment by a state court, the defendant will attempt to discharge that debt, in this case, $222,556.39, in bankruptcy. The victim of the fraud, Great Northern Insurance Company (GNIC) sought to recover from the fraud perpetrators and moved, in the bankruptcy proceeding for an order finding the debt not subject to discharge in Bankruptcy.

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Good News From the Coalition Against Insurance Fraud

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The Adjuster or SIU Investigator\\u2019s Use of An Expert

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Catastrophes invariably result in multiple lawsuits claiming that insurance companies, claims adjusters, and engineers acted unfairly and directed their investigations to deprive the persons insured from the benefits of the insurance policies to which they are entitled. Local prosecutors, looking to move forward in politics cause adjusters to find themselves not only the subject to civil litigation but criminal charges. It is important, therefore that claims people be aware of the appropriate method of using experts to properly investigate an insurance claim needing the assistance of an expert whether because of potential fraud or simply a difficult factual situation.

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When retaining an expert, it is essential that the expert understand that the insurer and its representatives are only concerned with determining the actual, proximate and predominant cause of the loss. It is not, nor should it ever be, interested in instructing the expert on what the insurer wants the expert to find. Doing so can be grounds for a claim for a bad faith suit and the insurer will risk assessment of tort damages including punitive damages.

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Health Insurance Fraud Convictions

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Other Insurance Fraud Convictions

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