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LexisNexis® Mealey's™ Insurance Fraud Legal News
Headline Insurance Fraud Legal News from LexisNexis®

• Insurers Must Produce SIU Files, But Not Fraud Detection Plan In New York RICO Action
  BROOKLYN, NY - Two automobile insurers must produce the contents of their Special Investigative Unit (SIU) files relating to a racketeering and common-law fraud action alleging fraudulent claims for acupuncture services, with the exception of "information that divulges plaintiffs' fraud detection plan and materials protected by attorney-client and work-product privilege," a federal magistrate judge held Aug. 5 (State Farm Mutual Automobile Insurance Co., et al. v. Eastern Medical, P.C., et al., No. 05-CV-3804, E.D. N.Y.; 2008 U.S. Dist. LEXIS 59891). Full story on lexis.com
• Insurance Department Investigation File Is Confidential, Not Privileged, Federal Magistrate Judge Holds
  MUSKOGEE, Okla. - Finding that an Oklahoma Insurance Department's investigation file is confidential but not privileged, a federal magistrate judge on Aug. 8 ruled that "the risk of interference with an ongoing fraud investigation is good cause to protect the Department from annoyance or undue burden" and limited the policyholder's discovery of the file to the fraud report submitted by the insurer in accordance with Oklahoma law (American Commerce Insurance Co. v. Jackie Craig Harris, No. 07-423, E.D. Okla.; 2008 U.S. Dist. LEXIS 60845). Full story on lexis.com
• New York No-Fault Law Precludes Fraud Defense For Untimely Claim Denial
  ALBANY, NY - While an insurer is entitled to contest a claim as fraudulent, it is required to do so within the tight deadlines imposed by the no-fault system, the New York Court of Appeals held June 5, affirming in answer to a certified question that a Supreme Court Appellate Division panel ruled correctly in affirming summary judgment for a medical equipment supplier (Fair Price Medical Supply Corp. as assignee of Cesar Nivelo v. Travelers Indemnity Co., 2 No. 105, N.Y. App.). Full story on lexis.com
• Insurers Relieved Of $20M In Pending Claims; Medical Facility Was Fraudulently Incorporated
  STATEN ISLAND, NY - Numerous New York automobile insurers are not responsible for paying $20 million in pending claims as the result of a jury's July 17 determination that a medical facility was fraudulently incorporated because a physician did not own and control the professional medical corporation under whose name the physician sought to collect first-party no-fault benefits from the insurers (In the Matter of Andrew Carothers, M.D., P.C., v Insurance Companies represented by Bruno, Gerbino & Soriano et al., No. 2217/06, N.Y. Sup., Richmond Co., 2nd Dist.). Full story on lexis.com
• Summary Judgment For Insurer In Suit By Chiropractor, Clinic
  MINNEAPOLIS - State Farm Mutual Automobile Insurance Co. was granted summary judgment on July 24 dismissing an action by a chiropractor and clinic alleging breach of contract, negligence, defamation, tortious interference with contract and product disparagement based on the insurer's refusal to pay claims for services provided to its policyholders (Dr. Arthur Guzhagin, et. al. v. State Farm Mutual Automobile Insurance Co., No. 07-4650, D. Minn. 2008 U.S. Dist. LEXIS 57322). Full story on lexis.com
• Court Grants Turnover Of Shares In Law Practice, Appointment Of Receiver
  HOUSTON - A federal judge on July 28 granted State Farm Mutual Automobile Insurance Co.'s application for turnover after judgment of attorney Ralphaell V. Wilkins' shares in his law practice and his contingent fee interests, and for appointment of a receiver and master in chancery to recover on a nearly $3 million judgment (State Farm Mutual Automobile Insurance Co. v. Ralphaell V. Wilkins, et al., No. H-99-2822, S.D. Texas; 2008 U.S. Dist. LEXIS 56933; See August 2007, Page 18). Full story on lexis.com
• Misrepresentation Of Material Fact Defeats Breach Of Contract, Bad Faith Claims, Judge Rules
  PITTSBURGH - An insured's lies during the processing of a claim provided a contractual basis upon which an insurer could reasonably deny coverage, a Pennsylvania federal judge found July 14, granting summary judgment to the insurer on the insured's claims for breach of contract and bad faith (Brandon Tuschak v. State Farm Mutual Automobile Ins. Co., No. 07-589, W.D. Pa.; 2008 U.S. Dist. LEXIS 55020). Full story on lexis.com
• New Jersey Appeals Court Affirms Judgments Under Insurance Fraud Prevention Act
  TRENTON, N.J. - Ruling on consolidated appeals of civil actions filed under the New Jersey Insurance Fraud Prevention Act (IFPA) involving claims for personal injury protection (PIP) benefits for diagnostic tests billed over an eight-year period, a New Jersey Superior Court Appellate Division panel on July 2 affirmed awards of more than $1.8 million in compensatory damages to an insurer and a civil penalty of more than $1 million in favor of the state (Liberty Mutual Insurance Co. v. Healthcare Integrated Services Inc, et al., No. A-5599-04T3 and A-2174-05T3, N.J. Super., App. Div.). Full story on lexis.com
• Staged Accident Conspiracy Conviction Affirmed For Medical Center Operator
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