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ZIFL - Volume 26 Issue 21  

In this the 21st issue of the 26th year of publication of Zalma\'s  Insurance Fraud Letter you will find articles that discuss the following  insurance fraud issues:  

When an Insured Lies to his Insurer the Claim May Be Denied  In Cesar Benitez v. Universal Property And Casualty Insurance Company,  No. 4D21-3281, Florida Court of Appeals, Fourth District (October 12,  2022) Cesar Benitez appealed the trial court\\u2019s entry of final summary  judgment in favor of Universal Property and Casualty Insurance Company  (\\u201cInsurer\\u201d) in a first-party property insurance dispute over a water  damage claim.  In his application for a policy with the Insurer, Benitez reported no  previous losses on his property. However, after Benitez filed a claim  for new damage, the Insurer\\u2019s inspector found signs of pre-existing  damage and repairs. The Insurer denied Benitez\\u2019s claim but continued to  collect premiums from him for several years. Benitez then sued for  breach of contract, and Insurer asserted an affirmative defense based on  section 627.409, Florida Statutes (2019).  Read the full article and the full issue at: ZIFL-11-01-2022   

Chutzpah: Insurance Criminals Conduct on Release Must Stay in Jail Conduct After Post Conviction Relief Requires Jail.  In Monnie Villareal v. State Of Mississippi, No. 2021-CP-00440-COA,  Court of Appeals of Mississippi (October 11, 2022), the Court of Appeals  of Mississippi dealt with a request to avoid jail after conviction for  insurance   Read the full article and the full issue at: http://zalma.com/blog/wp-content/uploads/2022/10/ZIFL-11-01-2022.pdf   Good News From the Coalition Against Insurance Fraud   This issue includes information about convictions like: Roshanak Khadem ran clinics that provided beauty and spa services.   Read the full article and the full issue at: http://zalma.com/blog/wp-content/uploads/2022/10/ZIFL-11-01-2022.pdf  How to Add to the Professionalism of Your Claims Staff  The insurance industry has been less than effective in training its  personnel. Their employees, whether in claims, underwriting or sales,  are hungry for education and training to improve their work in the  industry.  Read the full article and the full issue at:http://zalma.com/blog/wp-content/uploads/2022/10/ZIFL-11-01-2022.pdf    How To Defeat or Deter Insurance Fraud Insurers Must be Proactive Against Insurance Fraud Insurers Must Stop the Logarithmic Growth of Insurance Fraud  Read the full article and the full issue at :http://zalma.com/blog/wp-content/uploads/2022/10/ZIFL-11-01-2022.pdf   Health Insurance Fraud Convictions New York Doctor Settles Improper Billing and Controlled Substance Act Claims  Physician Admits Upcoding of Services [Plus dozens of other convictions]  Read the full article and the full issue at: http://zalma.com/blog/wp-content/uploads/2022/10/ZIFL-11-01-2022.pdf   A False Statement at EUO Voids Coverage  Where a plaintiff admits to making false statements with the intent that  his insurer relies on those statements, the issue of whether such false  statements were made need not be tried to a judge or jury. Similarly,  whether a false statement was made knowingly and with the intent to  deceive the insurer is usually a question of fact but may be decided as a  matter of law where the insured admits that he made knowingly false  statements with the intent that the insurer rely upon them because that  is, by definition, fraud. [Ram v. Infinity Select Ins., 807 F. Supp. 2d  843 (N.D. Cal. 2011)]  Read the full article and the full issue at: http://zalma.com/blog/wp-content/uploads/2022/10/ZIFL-11-01-2022.pdf   Other Insurance Fraud Convictions