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ZIFL \\u2013 May 15, 2021   

https://zalma.com/blog

The May 15, 2021 issue of Zalma\\u2019s Insurance Fraud Letter Includes  articles on the following subjects:   EUO Is A Condition Precedent  People who commit insurance fraud tend to run from serious insurers who  deny claims for fraud, misrepresentation, concealment or failure to  fulfill conditions precedent. State Farm filed an unopposed motion for  summary judgment against defendants All Med Merchandise and Trading,  Inc., Haar Orthopedics & Sports Medicine, P.C., Park Avenue  Orthopedics, P.C., and Anthony Vigorito, D.C., probably because the  defendants knew they had no case and placed their efforts to collect  from fraud by going against insurers who would rather pay than fight. Insurance Fraud Statutes  Insurance fraud laws have been enacted in 47 of the 50 states, the  District of Columbia and the United Kingdom. The statutes were not  written to give an unfair advantage to insurers, as some members of the  plaintiffs\\u2019 bar claim, but to protect the insurance buying public  against the enormous disadvantage insurers meet when faced with a  potentially fraudulent claim.   Unlike other victims of crimes, insurers are required by most of the  statutes, to staff Special Investigative Units (SIU) to investigate and  work to defeat insurance fraud attempts.   Ethics and the Public Insurance Adjuster   Some public insurers, acting alone or with the assistance of  unscrupulous lawyers, violated the standards set by NAPIA and the  covenant of good faith and fair dealing.   Health Insurance Fraud Convictions   Sentenced to Prison for Defrauding Medicaid Program Out of Hundreds of  Thousands of Dollars \\u2013 Folashade Adufe Horne, 52, of Laurel, Maryland,  was sentenced May 12, 2021 to 13 months in prison for defrauding the  D.C. Medicaid program out of more than $370,000. Plus many more  convictions.   Other Insurance Fraud Convictions  Former Madera Insurance Agent Convicted for Felony Grand Theft Because  she Embezzled over $20,000 of consumers\\u2019 insurance payments  Wendy Judd, 47, of Madera, a former insurance agent pleaded guilty to  felony grand theft after embezzling over $20,000 of insurance premium  payments from consumers. Plus many more convictions.