Tag Archives: fraud

Misrepresentation Results in Loss of Coverage

One of the best ways for a policyholder to lose its insurance coverage is to conceal or misrepresent material facts and circumstances about the claim.  In a recent case, the Sixth Circuit Court of Appeals affirmed summary judgment in favor of the insurance company dismissing a policyholder’s claims against its insurance carrier for not paying … Continue Reading

Fore! Golf Sponsor’s Claims Against Insurance Agency on Hole-in-One Insurance Dismissed

Prize sponsors often procure insurance policies to reimburse them for prize payouts.  Generally, those policies are pretty specific about the criteria that allows for the reimbursement.  Hole-in-one insurance is particularly popular.  In a recent case a policyholder sought relief against its insurance agent on various theories after it lost its coverage battle because of an … Continue Reading

No Fraud In Structured Settlement Payments Because of Broker Commissions

When insurance companies settle cases they often enter into structured settlements where they take a certain amount of money to purchase an annuity to fund the settlement.  The annuity then provides the periodic settlement payments to the settling party over time.  The principle amount used to purchase an annuity is generally the amount necessary today … Continue Reading

Ratification and Rescission of Insurance Policies

Rescission of an insurance contract is a drastic remedy. It generally requires a showing of fraud or material misrepresentation in the policy application and underwriting process.  Once an insurance company obtains the requisite knowledge of the policyholder’s fraud, it must seek rescission in a timely fashion. If, after obtaining that requisite knowledge, the insurance company commits … Continue Reading

When Insurance Coverage, Computer System Fraud and Medicare Fraud Collide

Cybersecurity is all the rage and rightly so. Companies are being hacked and information is being compromised and stolen every day. Medicare fraud is also rampant, with phony claims and improper payments being made daily. In a case just handed down by the New York Court of Appeals these problems converged in the context of a … Continue Reading