The Insurance Institute of Michigan (IIM) held its 14th Annual Claims Seminar on September 26th, with a faculty that included Zausmer attorneys who spoke to current insurance fraud topics and winning defense strategies.
Michael Schwartz presented on the import and implications of Bahri v. IDS Property Casualty, the 2014 Michigan Court of Appeals decision that allows insurers to use fraud exclusions to deny no-fault PIP benefits to insureds who make fraudulent statements or engage in fraudulent conduct in connection with claims made under an insurance policy. In the presentation, “Bahri – A New Dawn for Fraud Defense,” Mike showed testimony and photo evidence from various lawsuits to demonstrate how a plaintiff’s knowingly false and material misrepresentation can be fatal to a claim. Additionally, he used specific examples from cases to highlight the differences between a fraud defense and traditional forms of impeachment, such as attacking a witness’ credibility when the evidence or testimony does not necessarily rise to the level of fraud.
Also, April Moore, Bryan Padgett, and Adam Post discussed how unethical solicitation, claims for unnecessary medical treatment, and pay-for-referral schemes can undermine a plaintiff’s case. During their presentation “Using Knowledge of Attorney and Provider Rings to Get the Other Side to Walk Away,” they provided actual examples including:
- When discovery revealed that a lawyer who employed investigators to solicit unrepresented insurance claimants and arranged transportation to a medical provider when treatment wasn’t warranted, the plaintiff’s attorney voluntarily dismissed the case in response to being served with a subpoena to testify at trial.
- When a physical rehabilitation clinic sought reimbursement for medical care rendered to auto accident patients, an investigation uncovered the clinic’s practice of paying the plaintiff $400 for each visit in an apparent incentive for the patient to refer others. Ultimately, the clinic paid the insurance company a $55,000 settlement and agreed never to sue the company for payment of medical services.
- When it was discovered that a physician who coordinated claimants’ medical treatment at a rehabilitation clinic had been charged and convicted of healthcare fraud and was the subject of a criminal complaint filed by a therapist at the facility, the clinic voluntarily dismissed its lawsuit seeking payment for medical services.
Zausmer attorneys have regularly appeared at the Annual Claims Seminar, which is attended by IIM members from more than 90 property and casualty insurance companies and other industry organizations.