Insurer is Required to Report Suspected Fraud to IFB

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4Кб

Perpetrator of Workers’ Compensation Fraud May Not Benefit From the Fraud


A PROMISE TO NOT REPORT A CRIME IS UNENFORCEABLE


Read the full article at https://www.linkedin.com/pulse/insurer-obligated-report-fraud-ifb-barry-zalma-esq-cfe and at https://zalma.com/blog plus more than 4100 posts.


After he was convicted of workers’ compensation fraud, plaintiff Daniel Wilson filed a civil complaint alleging that representatives of his former employer, Southworth-Milton, Inc. (SMI), conspired to extort him while negotiating the settlement of his workers’ compensation claim. The defendants in the civil action included Attorney Teresa Brooks Benoit, who represented Wilson during settlement negotiations; SMI; SMI’s workers’ compensation claims coordinator, Camille Kantorski; SMI’s insurer, Sentry Insurance a Mutual Company (Sentry); one of Sentry’s attorneys, Thomas G. Bradley; Attorney Bradley’s law firm; and a Sentry claims adjuster, Jodie Driscoll. The case brought by the workers’ compensation criminal, Daniel Wilson, was dismissed and he appealed.


In Daniel Wilson v. Sentry Insurance A Mutual Company & others, No. 21-P-399, Appeals Court of Massachusetts (February 25, 2022) the Appeals Court refused to allow Wilson to profit from his crime.


FACTUAL BACKGROUND


It was undisputed that Wilson fraudulently concealed his income so that he could receive workers’ compensation benefits, he cannot recover losses that flow from that wrongdoing.


As the workers’ compensation claims coordinator for her company, Kantorski was required to report Wilson’s fraud. The Massachusetts fraud statute mandates an insurer to file a report with the state when it has reason to believe that an insurance transaction may be fraudulent. Kantorski fulfilled the obligation imposed by law and had she not done so she would have been committing an offense.


ZALMA OPINION


It takes a great amount of gall to sue your lawyer, your insurer’s lawyer and your workers’ compensation insurer after being convicted of workers’ compensation fraud because of an illegal agreement not to report the criminal to the IFB. No court will support a case against a lawyer or an insurer who were charged with wrongfully refusing to commit a crime.


© 2022 – Barry Zalma


Subscribe to “Zalma on Insurance” at https://zalmaoninsurance.locals.com/subscribe and “Excellence in Claims Handling” at https://barryzalma.substack.com/welcome.


You can contact Mr. Zalma at https://www.zalma.com, https://www.claimschool.com, [email protected] and [email protected]

You may find interesting the podcast “Zalma On Insurance” at https://anchor.fm/barry-zalma; you can follow Mr. Zalma on Twitter at; you should see Barry Zalma’s videos on https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg/featured; or videos on https://rumble.com/zalma. Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims–library/ The last two issues of ZIFL are available at https://zalma.com/zalmas-insurance-fraud-letter-2/ 

 

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