Several years ago at a PIA board meeting, we began to discuss an issue brought to us by a member through PIANY’s bi-annual Advisory Councils. Basically, when the New York State Department of Financial Services and Insurance transitioned its licensing requirements to an agent’s birthdate in 2012, the regulation had unintended consequences: While an agent’s […]
The FBI lists the following common insurance fraud schemes in its Insurance Fraud Report at https://www.fbi.gov/stats-services/publications/insurance-fraud: Premium Diversion Premium diversion is the embezzlement of insurance premiums. It is the most common type of insurance fraud. Generally, an insurance agent fails to send premiums to the underwriter and instead keeps the money for personal use. Another […]
Promise of Coverage Without Explanation of Coinsurance Can Be Fatal To Insurance Agent No one seems willing to read the insurance policy they purchased. When they have a loss and the failure to read the policy costs the insured money, he, she or it will always sue the insurance company and the insurance agent. Often, […]
Stupid and Vicious Attempt at Insurance Fraud Fails I have reported often that arson-for-profit is the most dangerous, deadly, and stupid way to steal money from insurance companies, because there is always evidence left after the fire and people are killed and injured as a result of the set fire. When the criminals are stupid, […]
Judgment In Favor of Qui Tam Plaintiff Insurer Can Be Enforced In California an insurer can, on its own behalf and on behalf of itself and the state, bring a qui tam action. When the state does not join in the action the insurer may try the action alone. In People ex rel. Allstate Insurance […]
A Rockfall is Earth Movement Bad facts create litigation. When a 2,700 ton mass of rock and earth fell 1,000 feet onto a house killing the occupants and totally destroying the house, garage and a car, insurance coverage was required to ease the pain of the survivors and the bank that issued the mortgage on […]
Insurance premiums are hard to pay. Anyone who owns a car would prefer to only pay insurance premiums until after they have a loss so that they can collect and pass the expense on to the insurer. That, of course, defeats the purpose of insurance to spread the risk to all insureds. When insurers issue […]
Every Interest in Property Where a Peril May Cause Damage to the Insured is an Insurable Interest Insurance is a contract of personal indemnity. It does not insure property. Rather it insures the person insured against the risk of loss of described property. Therefore if a person is not named as an insured, that person […]
It is a Crime to Cheat Insurers The government’s case against Theresa Fisher was strong, predicated in part on the following evidence: testimony by five witnesses who claimed to have been coached by Fisher; testimony by a co-conspirator that both she and Fisher were pressured to bring in patients for insurance-covered procedures; forged doctors’ notes […]
Latent Ambiguity Trumps Policy Wording Although the law allows an insurer to enter into any contract terms it desires that is agreeable to the insured, seriously injured people and a court’s desire to help the injured person raise a public policy guise to rewrite the language of the policy even after the court found the language […]
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