Fraud Fighters

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Personal Injury Protection/No-Fault Fraud Defense:  

Fraud in automobiles cases often emerges through patterns of exaggerated or entirely fabricated injuries, staged accidents, and collusion between claimants and medical providers. In PIP claims, where benefits are paid quickly and without regard to fault, fraudsters may exploit the system by submitting inflated medical bills, billing for services not rendered, or orchestrating treatment through clinics that are complicit in the scheme. 

In Bodily Injury claims, fraud can appear when claimants exaggerate the extent of their injuries, continue unnecessary treatment to inflate damages, or seek pain and suffering compensation based on false or misleading information. Staged accidents are a common method of perpetrating fraud in both PIP and BI claims, often involving multiple participants who coordinate their accounts to appear legitimate. These schemes may also include the use of fake witnesses, falsified accident reports, and attorneys or providers who facilitate the fraud for a share of the settlement or judgment. 

These schemes are often uncovered through surveillance, data analytics, examinations under oath in underlying PIP cases and cooperation with law enforcement and fraud investigators. 

Core Team:  
Sam Itayim, Chair, Personal Lines Auto, PIP, and Fraud/SIU Divisions 

• Lauren Galiszewski – EUO Team Lead 

• Walid Mabrouk – NY Lead 

• Toni Ann Pearson 

• Ruth Vargyas 

• Erick Colindres 

• Nicholas Young 

First Party Property Insurance Fraud Defense:  

Kelley Kronenberg’s First-Party Property team handles a wide range of fraudulent cases, including arson, material misrepresentation involving the insurance application or specific claim for damages, staged accidents, intentional losses, and fraudulent property claims.  Through Examinations Under Oath, Coverage Opinions, Declaratory Actions and pursuing fraudulent defenses in litigation, our team of experts understands the importance of proactive investigation and litigation in order to flush out the fraudsters.  We work side by side with our client’s Special Investigation Unit to pursue fraudulent claims.  Our detailed and strategic approach to these unique cases handled by a select few experienced attorneys has resulted in numerous dismissals, judgments, claim withdrawals, fraud referrals and fee recoveries for our clients.   

Core Team:  
Jeffrey Wank, Chair, First-Party Property and Insurance Coverage Division  

• Ronald Lacayo 

• Jake Huxtable 

• Luke Sharkey 

• Emma Meyerson 

• Alan Swindoll 

• Melanie Weseman 

• Ashley Moore 

• Jeanne Arceneaux 

• Andrew Labbe 

• Katie Koener 

• Kurt Ciell  

• Daniel Montgomery 

Fraud in Third-Party Claims: 

Elements of fraud play out differently in Third-Party Claims than they typically do in First-Party (Property and PIP/No Fault) Claims.  Sometimes, through early investigation, a carrier, TPA, or client will believe that the incident arose from a staged accident, includes a falsified accident report, or significantly exaggerated damages resulting from legitimate accidents with treatment from highly suspicious medical providers. Sometimes, early investigation of a transportation accident reveals that the two drivers know one another.  In other instances, multiple plaintiffs in the same accident all have the same exact treatment from the same exact physician, to whom the same plaintiff attorney always sends for treatment.  Fraud is rampant throughout all the States in which we defend tort claims, but New York has become a special hotbed for fraudulent claims under New York Labor Law Sections 240, 241(6) and 200.   As comparative negligence and assumption of risk are not defenses to a claim under Labor Law Section 240, claimants see particular benefits in undertaking fraudulent efforts.   

Core Team:                                             
David Henry, Chair, General Liability and Transportation Division  

• Team Leads: 

• Scott Kagan and Julie Karron 

• Support Team: 

• Jessica Clark 

• Christa D’Angelica  

• Justin England 

• Michael Roos 

• Kelly Ferron 

• Joe Nagy 

• Danitza Gonzalez 

• Matt Garnett 

• Allison Pedlar 

• Elizabeth Hernandez 

• Connor Milo 

Workers’ Compensation Fraud Defense:  

Workers’ Compensation fraud may involve employees exaggerating the severity of injuries, claiming injuries that occurred outside of work, or continuing to collect benefits while working elsewhere. Surveillance, medical evaluations, and depositions are often used to verify the legitimacy of claims, ensure compliance with benefit requirements, and uncover fraudulent behavior.  

Core Team:  
Don Allen, Partner/Business Unit Leader, Workers’ Compensation Division  

• Justin Nestor 

• Jose Zalduondo