Zalma’s Insurance Fraud Letter – January 15, 2022

ZIFL January 15, 2022 Volume 26, Issue 2

See the full video at https://rumble.com/vsl8pc-zalmas-insurance-fraud-letter-january-15-2022.html and at https://youtu.be/n6McP2y2_lI

A ClaimSchool™ Publication © 2022, Barry Zalma & ClaimSchool, Inc., Go to my blog & Videos at: Zalma on Insurance, And at https://zalma.com/blog, Go to the Insurance Claims Library, Listen to the Podcast: Zalma on Insurance, Videos from Zalma on Insurance, Subscribe to Barry Zalma on Substack.com, Subscribe to e-mail Version of ZIFL, it’s Free! Read last two issues of ZIFL here. Go to the Barry Zalma, Inc. web site here, Videos from “Barry Zalma on YouTube”  Go to Barry Zalma videos at Rumble.com at https://rumble.com/zalma

Some Articles from the Current Issue

Convicted Insurance Fraudster Loses Appeal

In The People of The State Of New York v. Kevin A. Ashby, No. 2021-07434, Supreme Court of New York, Fourth Department (December 23, 2021) after he was convicted, Kevin A. Ashby appealed the jury verdict of insurance fraud in the third degree and attempted grand larceny in the third degree.

Ashby contended that the indictment was jurisdictionally defective. The failure of the first count of the indictment to recite all the elements of the crime in full. However, the appellate court found that the failure did not constitute a jurisdictional defect because that count specifically referred to the applicable section of the Penal Law.

Although defendant further contended that each count of the indictment was legally insufficient because the counts do not set forth sufficient factual allegations, he failed to preserve his contention for the court’s review.

Ashby also contended that count one of the indictment was impermissibly amended.

Contrary to defendant’s contention, he was required to preserve that contention for appellate review. Although past cases of this Court have not required preservation of such a contention defendant failed to preserve his contention for review and the court declined to exercise its power to review it as a matter of discretion in the interest of justice.

After Insurance Fraud Indictment Dismissed Defendants Sue Police Officer

Arrest Warrant Issued Fairly Defeats Malicious Prosecution Suit

Evidence Required to Support Malicious Prosecution Against Police

Vicki Davis and Robin Trawick filed suit against Defendants State Farm Fire and Casualty Company (“State Farm”), Don Allen, and the Georgia Office of Insurance and Safety Fire Commissioner (“OCI”) because they were arrested for insurance fraud which charges were later dismissed. Defendants Allen and OCI moved the court to dismiss the malicious prosecution action in Vicki H. Davis and Robin R. Trawick v. State Farm Fire and Casualty Company, et al., No. 1:21-cv-2988-MLB, United States District Court, N.D. Georgia, Atlanta Division (December 23, 2021).

Read the rest of the article at https://zalma.com/zalmas-insurance-fraud-letter-2/

Workers’ Compensation Board Improperly Ignored Evidence of Fraud

NEW YORK WORKERS’ COMPENSATION BOARD ABUSED ITS DISCRETION

After the Workers’ Compensation Board ruled, among other things, that the application of Everest National Insurance Company was required to pay benefits it appealed seeking review of the decision of the Workers’ Compensation Law Judge that its actions were untimely, and from a decision of said Board, filed October 28, 2019, which denied an application by Everest National Insurance Company for reconsideration and/or full Board review. Everest appealed because it was not provided proper notice, was not the insurer and because the allegedly injured worker was perpetrating a fraud.

In the Matter of the Claim of Michel Salinas v. Power Services Solutions LLC et al., and South Side Services Inc. et al. Workers’ Compensation Board, No. 2021-0732, Supreme Court of New York, Third Department (December 23, 2021) the appellate court resolved the dispute.

Read the rest of the article at https://zalma.com/zalmas-insurance-fraud-letter-2/

A Proposal to Defeat Insurance Fraud

A Proposal that Every Insurer Should Establish a Corporate Position to Refuse to Pay a Fraud

See the full video of this proposal at https://rumble.com/vs8qes-how-to-defeat-insurance-fraud.html and at https://youtu.be/USCEdOuXs2A Every first party property policy of insurance contains the following language mandated by the statutory New York Standard Fire Policy.

Read the rest of the article at https://zalma.com/zalmas-insurance-fraud-letter-2/

Insurance Fraud Conviction Affirmed

Conviction Deserved When Perpetrator Admits He Was Not Injured

In State of Utah v. Julio Ayala, No. 20170928-CA, 2022 UT App 1, Court of Appeals of Utah (January 6, 2022) the prosecution proved that Julio Ayala was involved in multiple automobile accidents while driving his truck and trailer. Ayala filed claims with several insurance companies, and those insurers paid for, among other things, numerous chiropractic treatments and property damage claims. Ayala later admitted to a private investigator that he had not been injured in the accidents but nonetheless believed he had a right to receive insurance benefits.

Read the rest of the article at https://zalma.com/zalmas-insurance-fraud-letter-2/

Health Insurance Fraud Convictions

UC San Diego Health Pays $2.98 Million To Resolve Allegations of Ordering Unnecessary Testing

UC San Diego Health, the academic health system of the University of California, San Diego, paid $2.98 million to the U.S. to resolve allegations that it violated the False Claims Act by ordering medically unnecessary genetic testing reimbursed by Medicare.

The settlement resolves allegations that, from December 2015 to October 2019, UC San Diego Health ordered and submitted referrals for medically unnecessary genetic testing performed by CQuentia Arkansas Labs, CQuentia NGS and Total Diagnostic II (collectively “the CQuentia labs”). The government alleged that this conduct led to the submission of false claims for payment to Medicare for these tests.

Read the rest of the article at https://zalma.com/zalmas-insurance-fraud-letter-2/

Guilty Verdict Stands for Failure to Preserve Issue for Appeal

Guilty Verdict of Insurance Fraud Stands for Lack of Appellate Issues

The appellate courts of the state of New York are noted for the ability to write a succinct, clear and unambiguous decision on an appeal by a convicted criminal. In The People of The State Of New York v. Kevin A. Ashby, No. 2021-07434, Supreme Court of New York, Fourth Department (December 23, 2021) Kevin A. Ashby appealed from a judgment that convicted him upon a jury verdict of insurance fraud in the third degree and attempted grand larceny in the third degree.

Read the rest of the article at https://zalma.com/zalmas-insurance-fraud-letter-2/

Other Insurance Fraud Convictions

Louisiana Woman 30th Guilty Plea in Staged Auto Crash Cases

Donisha Lee, age 30, admitted that on September 6, 2017, on the I-10 near the Almonaster exit, she was a passenger in Erica Lee’s 2015 RAV4 being driven by their former co-defendant, when he intentionally crashed into a tractor-trailer owned by Averitt Express. After the staged accident, the driver exited the RAV4 and told Erica Lee to get behind the wheel of the RAV4 to make it appear that Erica Lee was driving the vehicle at the time of the staged accident. The defendants contacted the New Orleans Police Department and falsely claimed that Erica Lee was the driver at the time of the collision. Passenger A falsely claimed to the NOPD that she was Thompson.

Read the rest of the article at https://zalma.com/zalmas-insurance-fraud-letter-2/

Excellence in Claims Handling

A Series of Video Presentations and Text on Insurance Claims

Go to “Excellence in Claims Handling” and subscribe at https://barryzalma.substack.com/welcome and go to https://zalmaoninsurance.locals.com/subscribe subscribe to my locals account. See the introductory video at https://youtu.be/kLSSBG7kZy0 and at https://rumble.com/vrhaka-excellence-in-claims-handling.html

Read the rest of the article at https://zalma.com/zalmas-insurance-fraud-letter-2/

© 2022 – Barry Zalma

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 also serves as an arbitrator or mediator for insurance related disputes. 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.

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, zalma@claimschool.com and zalma@zalma.com . Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

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 YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; or videos on https://rumble.com/zalma. Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claimslibrary/ The last two issues of ZIFL are available at https://zalma.com/zalmas-insurance-fraud-letter-2/ 

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