Zalma’s Insurance Fraud Letter – January 15, 2023

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ZIFL – Volume 27, Issue 2- The Source For Insurance Fraud Professionals

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See the full video at https://rumble.com/v25pfnm-zalmas-insurance-fraud-letter-january-15-2023.html and at https://youtu.be/QP_SqcJJ9QQ

This, the second issue of 2023 of Zalma’s Insurance Fraud Letter contains multiple article that will be useful to all insurance fraud professionals, claims handlers, SIU investigators and insurance coverage counsel. First is an article explaining why tax returns must be produced and can be part of any potential fraud investigator.
The Insured Must Produce Tax Returns If the First Party Insurer Demands Production

Every first party property policy contains a provision requiring an insured to produce all relevant documents required to be produced by the Insurer and to appear for examination under oath [California Insurance Code § 2071; NY Standard Fire Insurance policy]. The language of the California and New York Standard Fire Insurance policy, mandated to be in all policies of fire insurance issued, provides:

When a finding that “no reasonable trier of fact could conclude that Herman cooperated in the investigation or settlement of the claim” where it was uncontroverted that insurer never received financial data, including tax returns and proof of income. When an insured refused to produce his income tax returns finding it was a substantial and material breach of his contractual duty to cooperate which clearly prejudiced the insurer’s investigation into possible motives for arson.

Free Insurance Videos

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Good News from the Coalition Against Insurance Fraud

Victims of a $600M disability scam — the largest-ever — may finally have their long-lost benefits restored. Attorney Eric Conn fooled Social Security into paying disability for thousands of perfectly healthy people. The Eastern Kentucky man built one of the nation’s largest disability practices through pushy self-promotion and dishonest dealings. Conn bribed a local judge, psychologist and doctors to rubber-stamp disability claims for clients, regardless of their health. Many patients weren’t even examined. Social Security stopped their disability payments while figuring out which clients were truly injured, and who was uninjured and making money from Conn’s scam. Hundreds of impoverished, truly injured people lost desperately needed disability money. Many victims were unemployed coal miners, scratching out a sparse living in pain. Conn promised he’d get them their disability checks to help pay for critical medical care. Social Security stopped coal miner Tim Dye’s checks after Conn was busted. Dye’s wife sold her jewelry and possessions from their home. She even begged for water from neighbors. Other Kentuckians lost their homes, and several committed suicide. Conn received 27 years in federal prison last year. Under a recent agreement, however, Conn’s former clients thankfully can have their disability benefits restored if they request new hearings.

How to Add to the Professionalism of Insurance Claims Professionals

Every insurer, insurance syndicate, insurance brokerage, insurance sales agency, insurer branch office, and vendors to the insurance industry should add to the libraries of their various offices or employees.

To add to the professionalism of the staff of insurance professionals, the insurer should make available to each the following books that are available at reasonable prices from amazon.com, the American Bar Association, Thomson Reuters, or Full Court Press, written by Barry Zalma. Details about each book are available at Barry Zalma’s Insurance Claims Library at https://zalma.com/blog/insurance-claims-library/

Why Insurance Fraud Succeed

It is Time for Insurers to be Proactive Against Fraud

There has been much hand wringing and wailing over the malfeasance of the corporate officers and directors of FTX Crypto Exchange, Enron, WorldCom and others. No one, however, has gone to the root causes of the situation. It should be a foremost duty of the insurance industry to do whatever it can to defeat insurance fraud and work to compel prosecutors, police officers, fraud division of fraud bureau investigators, SIU investigators, and claims handlers to work to deter or defeat insurance fraud.

Health Insurance Fraud Convictions

Doctor Pays $1,850,000 To Resolve Allegations That She Performed And Billed For Medically Unnecessary Cataract Surgeries And Diagnostic Tests

Aarti D. Pandya, M.D. and Aarti D. Pandya, M.D. P.C. (“Pandya Practice Group”) have agreed to pay approximately $1,850,000 to resolve allegations that they violated the False Claims Act by, among other things, billing the government for cataract surgeries and diagnostic tests that were not medically necessary, tests that were incomplete or of worthless value, and office visits that did not provide the level of service claimed.

The Great Jewel Theft

The following is a fictionalized true crime story of Insurance Fraud to explain why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. This story and the more than 80 similar stories help to Understand how insurance fraud in America is costing everyone who buys insurance millions, if not billions,  of dollars every year.

Twenty years later, after succeeding at insurance fraud, the insured was arrested, tried and convicted of being the leader of a terrorist and criminal organization called the Armenian Mafia. He is now serving a long term in federal penitentiary.

Other Insurance Fraud Convictions

Executed for Murder for Insurance Money

Robert Fratta, 65, received a lethal injection at the state penitentiary in Huntsville for the November 1994 fatal shooting of his wife, Farah. He was pronounced dead at 7:49 p.m.

Fratta, a former suburban Houston police officer was executed in January for hiring two people to kill his estranged wife nearly 30 years ago amid a contentious divorce and custody battle.

Prosecutors reported that Fratta organized the murder-for-hire plot in which a middleman, Joseph Prystash, hired the shooter, Howard Guidry. Farah Fratta, 33, was shot twice in the head in her home’s garage in the Houston suburb of Atascocita. Robert Fratta, who was a public safety officer for Missouri City, had long claimed he was innocent.

(c) 2023 Barry Zalma & ClaimSchool, Inc.

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Go to substack at substack.com/refer/barryzalma Consider subscribing to my publications at substack at substack.com/refer/barryzalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected]

Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library

and at https://youtu.be/QP_SqcJJ9QQ

Every first party property policy contains a provision requiring an insured to produce all relevant documents. https://lnkd.in/gxxMT4AT

How to Add to the Professionalism of Insurance Claims Professionals
Details about each book are available at Barry Zalma’s Insurance Claims Library at https://lnkd.in/gKCTg53
Read the full article at https://lnkd.in/gxxMT4AT

Why Insurance Fraud Succeeds

It is Time for Insurers to be Proactive Against Fraud
Read the full article at https://lnkd.in/gxxMT4AT

Health Insurance Fraud Convictions

You can read the full article and all convictions and read the full article at https://lnkd.in/gxxMT4AT

The Great Jewel Theft

Read the full article at https://lnkd.in/gxxMT4AT

Other Insurance Fraud Convictions(c) 2023 Barry Zalma & ClaimSchool, Inc.

Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe.

Go to substack at substack.com/refer/barryzalma Consider subscribing to my publications at substack at substack.com/refer/barryzalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected]

Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library
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