Choice of Law Can Be Key When Fighting Life Insurance Fraud
March 1, 2019 | Evan H. Krinick | Appeals
A stranger-originated life insurance (STOLI) policy is a life insurance policy obtained as an investment for a stranger, rather than for the benefit of the insured’s beneficiaries. Public policy disfavors STOLI policies because, among other things, legislators consider them to be wagers on human life. See, e.g., N.Y. Ins. Law §7815(c) (“No person shall directly …
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Home Court Advantage Makes a Difference For Clients
February 12, 2019 | Evan H. Krinick | Appeals
Commentary: Those who bet the spread in football games know that the being the home team is worth three or so points. Teams fight all year to have home field advantage in the playoffs. In lawsuits, being the home team also matters. If you are going to be sued, or if you intend to bring …
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The False Claims Act: A Powerful Tool Against Federal Health Care Program Fraud
January 4, 2019 | Evan H. Krinick | Appeals
The most recent report by the U.S. Department of Justice (DOJ) on its recoveries under the federal False Claims Act (FCA) (see “Fraud Statistics—Overview, October 1, 1986 – September 30, 2018”) made it quite clear that the federal government continues to seek to combat fraud by health care providers against federal health care programs such …
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Insureds’ Materially False Statements Can Doom Insurance Coverage for Their Claims
November 2, 2018 | Evan H. Krinick | Appeals
There are many different kinds of insurance fraud, as this column regularly observes. There can be fraud contained in applications for insurance policies, fraudulently staged accidents, and fraudulent claims by health care providers treating injured policyholders, among other things. Insurance policies try to eliminate, or at least to cut down on, insurance fraud in a …
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Insurers Overcome Defendants’ Efforts to Delay or Avoid Judgment Day
September 6, 2018 | Evan H. Krinick | Appeals
As insurance companies continue to bring more and more civil suits for insurance fraud, defendants are raising a variety of arguments in an effort to delay—and sometimes to significantly delay—the insurers’ actions, or even to avoid judgment altogether. Two interesting new cases—one from the U.S. District Court for the Eastern District of New York, State …
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So Far, No Consistent Lineup of Judges for Carriers or Policyholders
August 20, 2018 | Evan H. Krinick | Appeals
After a term of transition for the New York Court of Appeals—with Associate Judge Eugene F. Pigott, Jr., retiring at the end of 2016, Associate Judge Rowan D. Wilson joining in February 2017, Associate Judge Sheila Abdus-Salaam’s death in April 2017, and Associate Judge Paul G. Feinman joining at the end of June 2017—the 2017-2018 term …
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Health Insurance Fraud: A Key Focus of State and Federal Prosecutors
July 6, 2018 | Evan H. Krinick | Appeals
Health insurance fraud continues to be a problem in New York as well as nationally. Nothing may illustrate this better than two recent reports, one issued by New York’s Department of Financial Services (DFS) and the other issued jointly by the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services …
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Credit Card Fraud Insurance Case Highlights Barriers to Suits Against Brokers
May 4, 2018 | Evan H. Krinick | Appeals
Four years ago, the New York Court of Appeals issued its decision in Voss v. Netherlands Ins. Co., 22 N.Y.3d 728 (2014), which some thought might lead to more and more insurance brokers being sued by policyholders alleging that brokers had not obtained sufficient insurance or appropriate policies for them. Several recent cases—including by the U.S. …
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Failure to Cooperate in Suspected Fraud Case Can Doom Insured’s Claim
March 1, 2018 | Evan H. Krinick | Appeals
After a policyholder submits a claim to an insurance company, the insurer investigates to determine whether to pay the claim, as the insurer is permitted to do under its insurance policy. On occasion, after an insurer has begun to investigate a claim, it may come to believe that the claim is fraudulent, or at least …
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A Warning Signal for Auto Insurers From the Second Circuit
January 4, 2018 | Evan H. Krinick | Appeals
Twenty-five years ago, in Riordan v. Nationwide Mutual Fire Ins. Co., 977 F.2d 47 (2d Cir. 1992), the U.S. Court of Appeals for the Second Circuit ruled that New York General Business Law §349—one of the most powerful consumer fraud provisions of New York law—was applicable to insurance companies’ interactions with policyholders. In Riordan, the …
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