Brian Lee Caswell of Deltona was arrested and charged with second-degree arson, arson resulting in injury, burning to defraud an insurer, giving false information to a law enforcement officer and making a false police report.
According to Caswell’s arrest warrant, he had hatched a plan with Alex Spivey of Orlando and Melinda Philbrook of Lady Lake to destroy their truck and collect an insurance payout. Caswell initially claimed the vehicle had been stolen, but later admitted planning the scheme after co-conspirator Spivey caught fire during the arson.
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A Florida man, Yoandi Marrero, has been charged with insurance fraud, theft by deception, attempted theft by deception and identity theft after assuming a New Jersey doctor’s identity to submit more than $1 million in fraudulent medical claims. The services were never rendered and the medical center did not exist.
Marrero was found out when a woman claimed a doctor had billed her insurance for services that were never rendered.
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Corrupt public adjuster Jorge Fausto Espinosa recruited dozens of homeowners via his firm, Nationwide Adjusters, in an insurance fraud plot where he inflated insurance claims to the tune of $14 million.
Espinosa paid marketers to lure homeowners with free kitchens and remodeling jobs if they allowed him to manufacture damage to their homes. He earned around 30% of the insurance payouts he lined up for the homeowners. Espinosa earned payouts of more than $317,000 at times.
Insurers were pushed to pay overblown insurance payouts from claims resulting from rigged fires to water damaged. Espinosa hit at least 14 insurers with more than 50 inflated claims. He was sentenced to 20 years in state prison for racketeering and insurance fraud among many other charges.
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According to investigators, Roderick Clark of Indian Harbour Beach is facing charges after filing a false claim for more than $30,000 in hurricane damages last year.
Clark claimed his home had sustained electrical damage during Hurricane Irma including having to replace 11 outlets and electronic devices that did not belong to him. According to court records, Clark also submitted a forged letter from an electrical company to USAA Insurance Co. stating that they made repairs in the about of $31,350.67.
Clark was arrested and charged with grand theft and insurance fraud.
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Florida Chief Financial Officer Jimmy Patronis reminds Florida homeowners that the 2018 Hurricane Season is in full swing and the importance of reviewing their insurance policies to understand the type of coverage it provides.
According to CFO Jimmy Patronis, “Last year, Hurricane Irma alone resulted in more than $8 billion in insured losses. If you haven’t already, now is the time to financially prepare for the 2018 Hurricane Season.” He advises that a vital part of hurricane preparedness is making sure that you understand what is and is not covered under your homeowner’s insurance policy so that you can have adequate coverage.
There are eight insurance coverages homeowners may want to consider for hurricane season:
- Windstorm Coverage
- Flood Insurance
- Food Spoilage
- Sinkhole Coverage
- Additional Living Expenses/Loss of Use
- Inflation Guard Endorsement
- Replacement Cost Endorsement
- Law and Ordinance
Once a storm develops, insurance companies may be under binding restrictions and may be unable to obtain a separate policy or add these essential coverages to the current policy. It is imperative that homeowners speak to their insurer to confirm these coverages as soon as possible.
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On Monday, July 10th, 14 people were charged in “Investigation Vehicle Roulette” conducted by Florida’s Bureau of Insurance Fraud and the State Attorney’s Office. Two GEICO insurance adjusters, Juan Carlos Diaz and Cesar Santiago Tapanes, prosecutors say got cash kickbacks for helping defraud their own company were among those arrested.
In September 2016, a Lexus GS350 was involved in a fender bender with a Chrysler 320 in North Miami-Dade. The rogue insurance adjusters reported inspecting the Lexus and authorized a series of payments totaling over $16,000. However, investigators say the accident never actually happened.
In fact, the same Lexus had been the subjection of 10 previous claims involving crashes that never occurred, all signed off by Diaz and Tapanes. The scam ended up costing GEICO more than a million dollars.
According to an arrest warrant by detectives, at least 45 bogus claims were made. The group faces charges including grand theft, insurance fraud, and racketeering.
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Since Hurricane Season is underway, here’s a Daily Business Review article published by Roig Lawyers Partner Patricia Preciado that still holds true today.
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Aerial image of Florida Keys after Hurricane Irma
Filed under AOB, Assignment of Benefits, Claims Handling, Florida, Hurricane Andrew, Hurricane Irma, Hurricane Matthew, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, Lawsuits, Property Insurance
The 11th U.S. Circuit Court of Appeals backed air-ambulance firm Air Methods Corp. in a dispute stemming from a traffic accident that resulted in the death of accident victim Lemar Bailey about whether the amount paid for helicopter services should be limited by Florida’s no-fault auto insurance law. The federal appeals court ruled that the air-ambulance firm is considered an air carrier under federal law and should be able to bill the child’s father, Lenworth Bailey, for costs that exceeded the limits in the state’s no-fault system.
Following the March 2013 accident, Air Methods Corp. billed $27,975 for its services. Bailey’s auto insurer, State Farm Mutual Automobile Insurance Co., paid $6,911 under the fee schedule. His health insurer, Aetna Life Insurance Co. paid another $3,681. However, Bailey did not pay the remaining balance of nearly $17,400. He filed a potential class-action lawsuit alleging that the air ambulance company was trying to improperly collect amounts in excess of the fee schedule. However, the judge ruled in favor of the Air Method, which led Bailey to the appeals court that also rejected such arguments.
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Andrew Rubinstein of Miami and the self-confessed ringleader, Felix Filenger of Sunny Isles pleaded guilty to a racketeering conspiracy charge last year. Rubinstein and Filenger were paying kickbacks to tow truck drivers and body shop workers who illegally steered accident victims to chiropractic clinics they owned at a rate of $1,500 to $2,000 per “patient.” Clinic workers would then have patients attend multiple visits, document exaggerated pain levels, and bill insurance providers for treatment in the amount of $10,000, the maximum allowed under Florida law.
According to Prosecutors, the clinics were located throughout south and central Florida, including Sunrise, Hollywood, Hallandale Beach, Pompano Beach, Delray Beach, West Palm Beach, Miami, Orlando and Kissimmee.
Under the terms of his plea agreement, both sides had agreed to recommend the six-year sentence for Rubinstein. Filenger’s sentencing has been postponed. Several other people who also admitted their roles in the fraud are scheduled for sentencing later this year.
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According to the Ocala StarBanner, Kevin M. Day, 46, used forged documents to open an Allstate branch in Dunnellon. Day pleaded guilty to the fraudulent use of personal identification information of a former client.
Day used the personal information and forged documents signed in the name of a client of his former employer, saying the client would give Day $100,000 to start his own business. At least $100,000 in liquid assets is required by Allstate to open a business.
Day’s former boss investigated the situation and contacted Dunnellon police after Day first tried to buy her business, then opened his own Allstate branch. Day was sentenced to 24 months of probation, his insurance license is suspended indefinitely and he must complete 200 hours of community service.
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