Mealey's Insurance Fraud : Mealey's : Legal News & Analysis

Mealey's Insurance Fraud

July 25, 2024
Insurer Fails To Show Insured’s Concealment Of Commercial Fireworks Was Intentional

BISMARCK, N.D. — A federal judge in North Dakota on July 24 ruled in favor of an insured in a homeowners insurer’s declaratory judgment lawsuit disputing coverage for underlying property damage and personal injuries caused by a fireworks explosion, finding that the policy’s misrepresentation provision does not bar coverage because the insured did not willfully conceal or misrepresent any material facts regarding his use and storage of commercial fireworks at his Bismark property.
July 24, 2024
U.S. Supreme Court Distributes Cert Petition Over FCA Suit, Settlement Agreement

WASHINGTON, D.C. — The U.S. Supreme Court on July 24 distributed for conference a petition for writ of certiorari filed in the U.S. Supreme Court by the owner of medical clinics seeking review of the Sixth Circuit U.S. Court of Appeals’ ruling upholding a district court’s orders enforcing a settlement agreement and compelling the owner to seek U.S. government consent to dismiss claims for federal False Claims Act (FCA) violations in a separate qui tam suit.
July 23, 2024
Judge Issues Standing Order In Negligence Suit Against Purported Insurer’s Counsel

ATLANTA — A Georgia federal judge issued a standing order outlining case management in a negligence suit against legal counsel for a purported health insurer now in liquidation regarding the law firm’s role in aiding and abetting in an alleged scheme to entice people to purchase health plans that ultimately left “members without coverage and with devastating medical bills.”
July 19, 2024
Judgment Granted For Broker In Coverage, Fraud Dispute With Insurance Agent

TRENTON, N.J. — A New Jersey federal judge on July 18 granted in part judgment for an insurance broker in a dispute among a commercial general liability insurer, a broker and wholesale insurance agent, finding that material facts are not in dispute regarding negligent misrepresentation and common-law indemnity claims but that fact disputes remain as to a fraud in the inducement claim.
July 18, 2024
State Farm Waives Response To Cert Petition Over FCA Suit And Settlement Agreement

WASHINGTON, D.C — State Farm Mutual Automobile Insurance Co. waived its right to respond to a petition for writ of certiorari filed in the U.S. Supreme Court by the owner of medical clinics seeking review of the Sixth Circuit U.S. Court of Appeals’ ruling upholding a district court’s orders enforcing a settlement agreement and compelling the owner to seek U.S. government consent to dismiss claims for federal False Claims Act (FCA) violations in a separate qui tam suit.
July 17, 2024
8th Circuit Reverses Judgment For Nationwide In Row Over Public Auction Definition

ST. LOUIS — The Eighth Circuit U.S. Court of Appeals on July 16 reversed a district court ruling granting summary judgment to Nationwide Mutual Insurance Co. in its suit seeking to void its insured’s homeowners policy and a declaration that it is not liable for a fire loss at the insured’s property, finding that Nationwide failed to meet its burden to show that the homeowner’s alleged misrepresentation in the policy application “was false in fact.”
July 16, 2024
Judge Grants Dismissal In FCA Violations Suit Against Calif. Specialty Laboratory

LOS ANGELES — Without providing explanation, a California federal judge on July 15 granted parties’ joint stipulation of dismissal in a relator’s qui tam suit against a California special laboratory, alleging violations of the federal False Claims Act and similar California statutory provisions for the lab’s role in inducing physicians and offering remuneration to them to refer government-insured patients to the lab.
July 11, 2024
Insurer Seeks To Void Policy, Deny Fire Damage Coverage For Code Violation Fraud

LOS ANGELES — A commercial insurer sued its insured limited liability company in a California federal court, seeking rescission of the insured’s policy and a declaration that the insurer is not obligated to pay for fire damage to the property due to the insured’s material misrepresentations in the policy application regarding the absence of safety code violations and liens on the property when an investigation revealed otherwise.
July 10, 2024
Insurer Granted Default Judgment In Row Over Absent Motorist’s Misrepresentations

TRENTON, N.J. — A New Jersey federal judge on July 9 granted default judgment in an insurer’s suit seeking a declaration that the auto insurance policies issued to its insured are rescinded and that it has no duty to defend and indemnify regarding an auto accident involving the insured where another man died, finding that the complaint sufficiently alleges fraud and that the insurer will be prejudiced without default judgment against the insured, who failed to appear.
July 10, 2024
9th Circuit Affirms Judgment For Insurer In Dispute Over Misrepresentation

SAN FRANCISCO — A split Ninth Circuit U.S. Court of Appeals panel on July 9 affirmed a district court’s grant of partial summary judgment to an insurer seeking a determination that a medical professions liability policy issued to its insured behavioral health provider provides no coverage for an underlying Oregon state court suit, finding that summary judgment was proper because the insured “made a material misrepresentation in its renewal application.”
July 09, 2024
8th Circuit Affirms Ruling Finding Sleep Disorder Clinic Liable For FCA Violations

ST. LOUIS — The Eighth Circuit U.S. Court of Appeals affirmed in part a district court’s ruling entering judgment in favor of a former employee of a sleep disorder clinic regarding his claims for False Claims Act (FCA) violations and related state law provisions as to the clinic’s overbilling of federal insurers and retaliation by firing him, finding that the lower court correctly rejected the “public disclosure defense” and did not abuse its discretion in admitting testimony pursuant to Daubert v. Merrell Dow Pharmaceuticals Inc. but that it erred in applying a punitive sanction that was “excessive.”
July 08, 2024
Judge Rejects Insurer’s Misrepresentation Argument In Duty-To-Defend Action

MISSOULA, Mont. — A Montana federal judge granted summary judgment to an insured and related parties in an insurer’s suit seeking a declaration that it has no duty to defend and indemnify its insured in an underlying action related to injuries a man sustained when a 7,000-pound bundle of wood fell on him, finding that the insured did not “affirmatively” misrepresent “its business activities.”
July 03, 2024
Constructive Trust Claims Deadline Set In Liquidation Of Vesttoo And Affiliates

WILMINGTON, Del. — In the Chapter 11 liquidation of Vesttoo Ltd. and its dozens of affiliates, a Delaware federal bankruptcy judge set a July 22 deadline for asserting constructive trust claims and overruled the liquidating trustee’s objection regarding compensation for special counsel retained by the debtors.
July 02, 2024
Kentucky Panel Affirms Order Granting Allstate’s Bid For 2nd Examination Under Oath

FRANKFORT, Ky. — A split Kentucky appellate court affirmed a lower court’s orders requiring an individual purportedly injured in an auto accident while traveling in a vehicle insured by Allstate to undergo a second examination under oath (EUO), finding that the lower court did not abuse its discretion in its “good cause determination” to require the second EUO.
July 02, 2024
Insurer Amends Complaint Against Former Underwriter After Jurisdictional Toss

MIAMI — In an amended complaint dropping an initial plaintiff, an insurer sued a former underwriter in Florida federal court over conduct it alleges included greatly exceeding his authority by executing a facultative retrocession agreement to cover a risk of more than $44 million.
July 02, 2024
Appeal Over Confirmation Of Vesttoo’s Liquidation Is Voluntarily Dismissed

WILMINGTON, Del. — An appeal of the order confirming the Chapter 11 plan of liquidation for Vesttoo Ltd. and its dozens of affiliates has been voluntarily dismissed pursuant to a joint stipulation.
July 01, 2024
Magistrate Denies Motion To Quash Subpoena In Medicare Advantage Fraud Dispute

TAMPA, Fla. — One day after a Florida federal magistrate judge granted in part Medicare Advantage (MA) insurers’ motion to compel production of a litigation sharing agreement involving the relator in the instant case who alleged that medical providers and the insurers violated the False Claims Act (FCA), the magistrate judge on June 28 denied the insurers’ motion to quash a subpoena as untimely, finding that the delay in scheduling a deposition “will not prejudice” the insurers.
June 28, 2024
Jurisdictional Challenges Meet Mixed Fate In Suit Over Alleged Fraud Scheme

NEW YORK — Largely focusing on personal jurisdiction, a New York federal judge granted one refiled dismissal motion and partly granted another in an insurer’s suit over “an alleged massive and complex fraud that resulted in losses exceeding $135 million.”
June 28, 2024
Beneficiary’s Claims Fail Based On Proper Rescission Of Policy, Judge Says

SACRAMENTO, Calif. — A beneficiary’s breach of contract and bad faith claims cannot proceed against a life insurer because the beneficiary’s wife made a material misrepresentation on the policy application that justified the insurer’s rescission of the policy, a California federal judge said in granting the insurer’s motion for summary judgment.
June 27, 2024
Magistrate Denies Protective Order For Deposition In Fire Coverage Dispute

SCRANTON, Pa. — A Pennsylvania federal magistrate judge on June 26 denied an insurer’s motion for protective order regarding a proposed deposition in an insurance coverage dispute over fire damage, finding that the disputed deposition is relevant because it addresses whether the insurer knew of the alleged improper use of the covered space when previously investigating a water damage claim.
June 27, 2024
Suit Against Former Underwriter Gets Quick Toss Over Jurisdictional Issues

MIAMI — Outlining “two deficiencies” in the jurisdictional allegations, a Florida federal judge dismissed without prejudice a suit that two affiliated companies filed against a former underwriter over conduct they allege included greatly exceeding his authority by executing a facultative retrocession agreement to cover a risk of more than $44 million.
June 24, 2024
High Court Again Extends Response Deadline In Review Of 9th Circuit FCA Reversal

WASHINGTON, D.C. — The U.S. Supreme Court on June 21 granted a district court qui tam plaintiff’s second request for additional time to respond to pharmaceutical companies’ petition that seeks review of the Ninth Circuit U.S. Court of Appeals’ ruling reversing the district court’s dismissal of a suit accusing the companies of violating the False Claims Act (FCA) by artificially inflating drug prices.
June 24, 2024
Former Underwriter Is Sued Over Facultative Retrocession Deal, Other Allegations

MIAMI — Asserting claims for breach of contract and unjust enrichment, two affiliated companies sued a former underwriter in Florida federal court over conduct they allege included greatly exceeding his authority by executing a facultative retrocession agreement to cover a risk of more than $44 million.
June 21, 2024
Judge Deems $200,000 Life Policy Void For Insured’s Health Misrepresentations

TAKOMA, Wash. — A Washington federal judge on June 20 granted a life insurer’s motion for default judgment and declared a $200,000 life insurance policy void ab initio, finding that the insured’s misrepresentations in his insurance application weigh in favor of default judgment and that the insurer is entitled to rescind the policy due to the insured’s false statements about his health status.
June 21, 2024
Revised $195,000 Class Deal Gets Initial OK In Suit Alleging Fraudulent Policies

SANTA ANA, Calif. — Ruling various revisions sufficient, a California federal judge granted preliminary approval to a $195,000 settlement in a suit over alleged fraud involving captive reinsurance, also modifying the preliminarily certified settlement class.