Insurance Fraud

Goldberg Segalla’s insurance fraud team of attorneys works closely and cooperatively with Special Investigation Units (SIU) as well as claims and auditing departments to investigate cases involving insurance fraud. We work collaboratively to help hone investigations, analyze data and formulate cost-effective litigation plans that allow insurers to quantify the results of their anti-fraud activities.

Insurance fraud may occur across various lines of coverage, and it may extend from rate evasion in the underwriting of coverage, suppression of exposures on audit, fabricated losses, and post-loss claim enhancement. Our attorneys combine a broad knowledge base of our client’s insurance products with up-to-the-minute knowledge of the latest schemes fraudsters are employing to take advantage of our clients. The synergies created between that knowledge base and our experienced and savvy litigators gives Goldberg Segalla clients a competitive edge against fraud.

Our experience includes combating all types of dishonest conduct aimed at harming our clients:

  • Application and premium fraud
  • Discovery of hidden payroll in computer business records
  • Recovery of unpaid insurance premiums
  • Policy rescission
  • Staged motor vehicle accident rings and thefts
  • Unlicensed medical providers
  • Medical provider billing eligibility and fraud
  • Business interruption losses
  • Identity fraud
  • Fraudulent employment discrimination claims
  • Exaggerated property loss claims
  • Enhanced personal injury claims

Representative Matters

  • Staged Accident Rings. We have devised and implemented action plans that focused on the professional enablers (attorneys and medical providers) that staged accident rings depend upon, effectively halting the criminal enterprise and obtaining restitution.
  • Fraudulent Superstorm Sandy Property Claims. We have utilized technology to demonstrate that “photos” of devastating property losses were bogus. In a multi-million-dollar commercial property claim, we utilized records from the New Jersey Department of Environmental Protection to demonstrate that the mechanism of loss proffered by an insured’s engineering expert was unlikely, while that offered by the insured’s cause and origin expert was consistent with the records of state regulators.
  • Workers’ Compensation Premium Fraud. In a case involving a moving company, where the insured maintained all its records were destroyed in a flood, we worked with our client to forensically re-create records of the insured’s activity, largely by obtaining records from the Federal Motor Carrier Safety Administration and the insured’s accountants.
  • In another case involving multiple related trucking companies, our team reconstructed the paper trail disclosing an insured’s true payroll by sifting through 30,000 pages of bank records, revealing millions of dollars of hidden payroll.
  • $2 Million Summary Judgment. In a case of first impression, we obtained a summary judgment in federal court in which the court applied a relatively unknown workers’ compensation fraud statute. Summary judgment was awarded for more than $2 million.