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Last Post 03/24/2007 1:02 PM by  Ray Hall
Presumption Of Fraud
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JimWil
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03/24/2007 9:47 AM

    An interesting bit of reading as the spring court cases come about...

    3/15/07 Latha Restaurant Corp. v. Tower Insurance Company
    Appellate Division, First Department 
    Dramatic Overstatement of Property Claim Raises Presumption of Fraud; Here, Presumption became Conclusive Since No Explanation Offered for Gross Disparities
     

    Property claim with plaintiff’s proof of loss statement including duplicative items, and property in which insured had no insurable interest. It also sought to recover for debris removal although no expense was ever incurred. Plaintiff’s losses as proven totaled $275,000 and almost $400,000 in proof of loss is unsustainable and inexplicable. Overvaluation of insured property raises a presumption of fraud in proportion as to the excess, and such presumption becomes conclusive where, as here, the insurer demonstrates that the difference between the amounts claimed in the proof of loss and the losses actually shown to have been sustained are grossly disparate and without reasonable explanation. Fact that public adjuster may have been one at fault is of no avail since public adjuster was agent of insured.

    http://www.courts.state.ny.us/reporter/3dseries/2007/2007_02034.htm

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    sbeau4014
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    03/24/2007 11:24 AM
    That is good stuff, but I don't know if i've ever seen a claim where the insured or their PA tried to inflate the loss.........Jurys in most areas will pop the insured big time if it can be proven that the there was blatant exaggeration of the claimed damages. I actually tired a case in the valley in TX in the early 90'swhere our insured 9trucking company) pulled into an intersection, stopped, realized he needed to turn, and backed up to make the turn. There was a completely innocent driver behind him and we backed up into the car. We were 150% at fault in the accident.about 4300 damages to the front of the car, but the other driver went right from the accident to the lawyer, and then to the lawyers quack doctor for about $5,000 in medical bills. Long and short of it, the attorney's lowest demand was $50,000, and after talks broke down the demand went back to $100,000. A no brainer to try the case. Keep in mind this was in thevalley in TX at a time that it was the most dangerous place to try a case in the country. Jury came back and found no fault on the part of our driver! Found out that excessive greed on the part of the plaintiff was the deciding factor on the negligence issue, not the facts of the case. Pltf atty was incredibly pissed and threatened appeal. We just reminded him that he better have good E & O insurance and that every offer we gave to him was told to his client, because these issues would come out. Never heard from the clown again.
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    Ray Hall
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    03/24/2007 1:02 PM

    I was a temp in a very large auto insuror in Houston several years back. They tried ever case of excessive treatment for low impact collisions if they could not be settled in the range of $250 to $2500. range. Yes thats the range. A law firm would try these cases with all discovery etc from 5 to 10 K and WIN rear end accidents . Most the special damages came up to the exhaust the PIP limits and was chiropractic and physical therapy, and ended when the PIP was burned up.

    The plaintiffs do not have it so good anymore in Texas

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