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No PIP Benefits for Staged Collision

An insurer proved that it was faced with claims for injuries from staged accidents. The medical care providers of the fraud perpetrators who claimed to be injured in the staged accidents claimed a right to be paid for their services. The insurer disagreed.

In National General Insurance Online, Inc., et al. v. Franklin Blasco, et al., AB Medical Supply, Inc., et al., 2022 NY Slip Op 06252, No. 2019-13906, Index No. 605852/18, Supreme Court of New York, Second Department  (November 9, 2022) the New York appellate court dealt with an action for a judgment declaring that the plaintiffs are not obligated to pay certain no-fault claims, to the defendants AB Medical Supply, Inc., AB Quality Health Supply Corp., ACH Chiropractic, P.C., Energy Chiropractic, P.C., FJL Medical Services, P.C., JFL Medical Care, P.C., JPF Medical Services, P.C., Jules Francois Parisien, Kings Rehab Acupuncture, P.C., and Maria Shiela Masigla.

The judgment granting that branch of the plaintiffs' motion which was for summary judgment on the complaint insofar as asserted against those defendants declared that the plaintiffs have no duty to provide coverage for the subject no-fault claims.

FACTS

In April 2017 and June 2017, within days of the defendants Jerry Noland and Franklin Blasco procuring automobile insurance policies, the vehicles for which the policies were issued were involved in two separate automobile collisions when they each came into contact with two separate taxicabs. The insurer was suspicious, investigated and established that the accidents were staged.

In or around April 2018, the plaintiffs, National General Insurance Online, Inc., and National General Insurance Company, sued Noland, Blasco and other individuals involved in the collisions, as well as, among others, the defendant medical providers alleging that the collisions were intentional and the insurers owed nothing.

After the Supreme Court (trial court) granted the plaintiffs' motion for leave to enter a default judgment against the individuals involved in the two collisions, the plaintiffs moved for summary judgment on the complaint insofar as asserted against the medical provider defendants, arguing that they are not obligated to pay no-fault claims submitted to them by the medical provider defendants in connection with the collisions.

The Supreme Court granted that branch of the motion. A judgment was entered November 13, 2019. The medical provider defendants appealed.

ANALYSIS

The medical provider defendants failed to sustain their burden of demonstrating that the branch of the plaintiffs' motion which was for summary judgment on the complaint insofar as asserted against them was premature.

Further, in what should be obvious, an intentional and staged collision caused in furtherance of an insurance fraud scheme is not a covered accident under a policy of insurance under New York law. Here, the plaintiffs established their prima facie entitlement to judgment as a matter of law by demonstrating, through admissible evidence, that the subject collisions were intentionally caused or staged.

The medical provider defendants failed to raise a triable issue of fact. Accordingly, the Supreme Court properly granted that branch of the plaintiffs' motion which was for summary judgment on the complaint insofar as asserted against the medical provider defendants.

ZALMA OPINION

National General has adopted a most effective method of deterring or defeating insurance fraud: they took the profit out of the crime. By suing both the fraud perpetrators and the so-called medical providers who allegedly provided medical services to the fraudsters, they avoided paying anyone who participated in the fraud and made it known to the community of fraudsters that National General is not an insurer worthy of the effort to defraud.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

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].

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