Tag Archives: insurance

Couple Denied Coverage After Water Heater Leak Under Policy’s Earth Movement Exclusion

Barbara and Charles Hatch had a water heater leak about 4,000 gallons of water flooding their home. Their insurance company, GeoVera Specialty Insurance Co., inspected the claim and issued payment to mitigate the damage. However, after then work had begun the Hatch’s discovered damage to the foundation and structure of the home.

Upon further inspection, GeoVera denied coverage based on the Hatch’s policy that excludes under the earth movement, which caused the foundation and structural damage. The district court ruled the structural damage to the Hatches’ home was excluded as the company claimed and GeoVera was entitled to summary judgment on that portion of the Hatches’ claim. In its decision, the district court explained that, under the policy, any damage caused by the accidental discharge of water from the water heater, including the structural damage to the Hatches’ home, was covered “unless otherwise excluded.”

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Filed under Coverage

Brothers Sentenced in $20 Million Insurance Fraud Scheme

Former insurance agent Stuart Alan Starr of One Stop Insurance Agency pled guilty to conspiracy to commit wire fraud and wire fraud in April 2019. Starr’s brother, Glen Wayne Starr pled guilty to the conspiracy to commit wire fraud in August 2018. The brothers received the same sentence of 101 months in prison, followed by three years of supervised release. They are both been ordered to pay over $20 million in restitution to the financial institutions they defrauded.

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Filed under Insurance Fraud

South Florida Pain Clinic Owner Sentenced in Health Care Fraud Case

Scott Novick, owner of pain clinics in Palm Beach, Broward and Miami, was sentenced to six and a half years in prison and forfeit almost $1.4 to Medicare. Novick pled guilty to conspiracy to commit health-care fraud resulting in Medicare losses in the amount of $2.2 million. He was sentenced to six and a half years in prison and ordered to forfeit $1.4 million to Medicare.

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Filed under Insurance Fraud

Kissimmee School Teacher Arrested for Staged Accident Scheme

Kissimmee elementary school teacher, Lanfranco Palman, is facing three felony charges for allegedly faking being hit by a car to defraud his insurance company. The staged accident occurred at a grocery store in 2016 where Palman claimed he was hit by a vehicle, but witnesses say he fell onto the hood after the car had stopped.

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Filed under Insurance Fraud

Former Gubernatorial Candidate Charged with Insurance Fraud

Michael Williams, former candidate for governor has taken a plea deal on charges of insurance fraud and falsely reporting a crime. Williams was sentenced to four years of probation for making false statements claiming computers were stolen from his Gainesville office.

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Filed under Insurance Fraud

Roig Lawyers Partners Selected to Present at the 2019 Florida Liability Claims Conference

Roig Lawyers is proud to announce that three of its partners have been chosen to speak at the 2019 Florida Liability Claims Conference from June 5-7 at the Disney’s Boardwalk Inn and Conference Center in Orlando, FL.

Ricardo M. Luces & Patricia G. Preciado

  • Evidence: The Building Blocks to a Successful Jury Trial

Miguel R. Roura & John Miller (Stockholder – Henderson, Franklin, Starnes & Holt, P.A.)

  • Annual Case Law Update

Click here for more information.

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Filed under Liability Claims, Uncategorized

Roig Lawyers Partners Selected as Speakers for the 2019 Florida Insurance Fraud Education Committee Conference

FIFEC

Roig Lawyers is proud to announce that four of its partners have been chosen to speak at the 2019 Florida Insurance Fraud Education Committee Conference from June 5-7 at the Caribe Royale Orlando.

John S. LeinickePartner

  • Up in Smoke? Cannabis and the Insurance Industry in 2019

Ricardo M. LucesPartner Patricia G. Preciado, Partner

  • EVIDENCE: The Building Blocks To A Successful Jury Trial

Patricia G. PreciadoPartner Ricardo M. Luces, Partner

  • The Best Interest of the Insured: When Public Adjusters Goes Too Far

Scharome R. WolfeManaging Partner of Orlando Office

  • Injections Don’t Need to Be Painful
  • Let’s Make a Deal! Factoring and Pre-Surgical Funding

Click here for more information.

 

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Filed under Insurance Fraud, Uncategorized

Geico Seeks To Recover $20M in Racketeering Suit

As reported by Law360, Geico is seeking to recover at least $20 million in compensatory damages, in addition to costs, fees and punitive damages from a Florida chiropractor and his network of clinics.

On Thursday, May 30th, the insurer filed suit in Florida federal court against Mark A. Cereceda claiming civil racketeering violations and unjust enrichment as well as common law fraud and other claims.

According to the complaint, Geico says Mark A. Cereceda and his various Ceda Orthopedics clinics in Miami billed for services that were unnecessary, never provided and performed by people who were not properly licensed. Geico paid for physical therapy services performed by unsupervised massage therapists who are unqualified to perform physical therapy and who, under Florida law, cannot be reimbursed under PIP insurance. The insurer is also requesting a declaration from the court that it is not legally obligated to pay reimbursement of more than $75,000 in pending fraudulent PIP claims submitted by Cereceda’s clinics.

Cereceda has been sued by insurers at least three times over fraudulent medical billing and coding, delivering medically unnecessary chiropractic care and engaging in an unlawful referral scheme.

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Filed under Insurance Fraud, Lawsuits, Miami-Dade County, Miami-Dade Fraud, PIP, Uncategorized, Unlicensed Clinics

Update: Florida Governor Signs AOB Reform Bill

In recent years, lawmakers deliberated changes to the AOB process but could not reach an agreement, amidst heavy lobbying by groups on both sides of the issue. This year, however, the House and Senate came to an agreement and sent the bill to Florida Governor Ron DeSantis. DeSantis signed House Bill 7065 on Thursday, marking the end to a seven-year battle by the industry and reform advocates. This law takes effect on July 1, 2019.

Click here to view our earlier post on what the bill entails or contact us to discuss the implications of this significant change in Florida law.

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Filed under AOB, Assignment of Benefits, Property Insurance

Contractor and Suspected Fraudster Prohibited from Betting While Case is Ongoing

The News4Jax I-TEAM spotted Wyatt Green, a Jacksonville contractor suspected of insurance fraud, betting thousands in a Best Bet poker room while out on bond. Green was just arrested and charged with felony forgery, fraud, and grand theft a month ago.

Green and his team are accused of taking insurance money meant to pay for customers’ repairs, but not completing the work. The State Attorney’s Office changed his bond conditions as a result of the I-TEAM investigation, keeping him from betting or gambling while his case is ongoing.

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Filed under Insurance Fraud, Uncategorized