Zalma's Insurance Fraud Letter - December 15, 2022

ZIFL Volume 26 Number 24

Merry Christmas, Happy Hanukah & May The Winter Solstice be Peaceful & Mild

A Christmas Fable of Fraud

ZIFL Publishes This Story At Christmas Time Every Year. I Hope You Like It Again.

The story that follows is fiction based, in part, on a true case worked on by me. Any similarity to real people is unintentional. It is meant only to educate fraud professionals about how some unscrupulous people use the crime of insurance fraud for fun and profit during the Christmas season.

Raymond Alexander had no religion. He cared only for himself and the money he could take from good-hearted people.

Raymond loved the Christmas season.

The marks were in such a kind and giving mood it wasn’t even work to take their money.

Read the full ZIFL

English Solicitor Jailed For 12 Years After Private Prosecution for Fraud

Stephen Jones, 63, senior partner at London firm Jirehouse Partners, pleaded guilty at Southwark Crown Court to two counts of fraud by abuse of his position of trust as a solicitor in relation to money intended to be used by his clients to buy a Scottish castle.

Sentencing Jones at Southwark Crown Court this week, Judge Martin Griffith said he had acted with ‘rank dishonesty’ and caused immense damage. The judge said that Jones’s conduct was ‘obviously prosecutable’ and crying out for a prosecution that the police and CPS had left for the private prosecutor to conduct.

Read the full ZIFL

Editorial – Anti-Fraud Resolutions

In 2009 ZIFL posted an editorial with New Year’s Resolutions for every person involved in the business of insurance. I repeat it again, with some modification, in this issue and add some thoughts for 2023.

Insurance fraud of all types continues to grow to epidemic levels. It is perpetrated by people of every race, religion, national origin, financial situation, sexual orientation, age, or physical condition.

Read the full Newsletter here.

How to Defeat Insurance Fraud

An Article I Wrote for the CPCU Society’s “Insights” Magazine

The preponderance of attempted insurance fraud is staggering and costly. But perhaps even more startling, and certainly more avoidable, is the often-muted response to such crime. The Coalition Against Insurance Fraud estimates that insurance fraud costs the industry more than $308 billion a year. No one knows the full amount because most insurance fraud attempts succeed.

Read the full story at CPCUSociety_INSIGHTS_Winter2022_Insurance_Fraud

Good News from The Coalition Against Insurance Fraud

My client duped me, a banker desperately contended in court after helping disbarred personal-injury attorney Alex Murdaugh steal money from insurance settlements of clients in South Carolina. Russell Laffitte was convicted anyway. He was CEO of Palmetto State Bank, and the embattled Murdaugh’s personal banker. Laffitte loaned Murdaugh and himself money stolen from the insurance settlements — diverting the money from personal injury or death cases. Lafitte lied in court that he just followed the instructions of one of his biggest clients, who lied to and manipulated him. Except that Murdaugh gave Laffitte checks written to the bank instead of clients. This allowed Murdaugh to divert the clients’ insurance funds to others to whom he owed money — his law firm, clients he cheated, or family members. Laffitte was convicted and could spend decades in federal prison when sentenced. Murdaugh is the scion of a prominent legal family in South Carolina.

Read the full Newsletter here.

Florida Session Agenda Calls for Claims Process Changes, More Oversight of Insurers

Florida legislative leaders, working with the proclamation from Sen. President Kathleen Passidomo and House Speaker Paul Renner notes that the five-day special session of the Florida Legislature will consider ways to reduce the cost of property insurance claims litigation, improve the availability of reinsurance, limit assignment-of-benefits agreements, and reduce the size of the state-created Citizens Property Insurance Corp.

Read the full Newsletter here.

Suspended Florida Claim Center Lawyer Agrees to Interim Probation

Jennifer Perez, a partner with the Gauthier Murphy & Houghtaling law firm, agreed to the terms of an “interim probation” imposed by the Florida Bar, according to court records. She closed down the tent and trailer that the firm had set up in the parking lot of a defunct North Fort Meyers motel and agreed to provide the bar with a copy of a signed lease agreement for the law firm’s Florida office.

Perez, a Florida lawyer whose law license was suspended after setting up a “mobile claim center” near Fort Myers is now able to resume the practice of law under the terms of an agreement she reached with the Florida Bar.

Read the full Newsletter here.

Health Insurance Fraud Convictions

Settlement Against Contra Costa Facility Resolving Allegations of Patient Abuse and Neglect

San Miguel Villa subjected its patients to poor care due to understaffing and effectively rendered a number of its services useless. Today’s settlement amounts to a total of $2.3 million, with California receiving $1.2 million.

California secured a settlement against the Contra Costa County skilled nursing facility resolving allegations of understaffing and patient abuse and neglect. The settlement resolves claims that for five years, corporate profits should never be placed above patient needs and care. Every patient is entitled to humane care, and skilled nursing facilities should always have the appropriate level of staffing to ensure this standard of dignity is met.

Read the full Newsletter here.

Other Insurance Fraud Convictions
Guilty of Life Insurance Fraud

Daniel Banete a man living in Coventry, U.K. was sentenced to three years imprisonment after fraudulently trying to claim £520,000 in life insurance payments after his brother died from Covid-19.

Just eight days after his brother died in hospital in Romania on July 8, 2020, 30-year-old Daniel Banete took out four different life insurance policies in his brother’s name between July 16 and 21. The City of London Police’s Insurance Fraud Enforcement Department said Banete provided fake death certificates to the insurance companies with different dates of death between November 2020 to January 2021 to try and claim the settlements.

Read the full Newsletter here.

Coalition Against Insurance Fraud Hall of Shame
Dentist Kills Wife On Safari.

A rich, unscrupulous Pennsylvania dentist planned to murder his wife during a safari trip in Africa without her having a clue, such a nice husband indeed. Why, you ask? Take a wild guess. If you thought money, then you are correct. It was silly since he really did not need a $5 million insurance payout, but the “loving” husband’s premeditated cover plan was that they were hunting a leopard in Kafue National Park in 2016 so his wife could attain her goal of shooting a leopard, husband of the year… NOT!

And Nine more fraudsters.

Read the full Newsletter here.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

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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 zalma@zalma.com

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