Monitoring Implements Fraud Protection

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The plaintiff appealed the trial court’s order granting summary judgment against defendants Home-Owners Insurance Company (“Home-Owners”), American Country Insurance Company (ACIC), and Hartford Accident and Indemnity Company (“Hartford”), alleging about the prosecutor. Claims for uninsured or underinsured motorist benefits and PIP benefits under the no-fault law, MCL 500.3101 and seq. Although the defendants argued that they were required to pay PIP, the trial court did not decide the substantive issue, but instead dismissed all claims pursuant to the anti-fraud provisions of the defendants’ statutes.

In Jonathan Jones v. Home-Owners Insurance Company, American Country Insurance Company, And Hartford Accident & Indemnity Company, and Sharneta HendersonNo. 355118, Michigan Court of Appeals (August 18, 2022) The Court of Appeals issued a decision similar to Solomon.


The lawsuit stems from a car accident on October 28, 2017, where the plaintiff’s car was hit by a car driven by defendant Sharneta Henderson in Detroit. The plaintiff is said to be driving a 2009 Ford Crown Victoria and was stopped at a red light when Henderson’s car, which was speeding, ran through the red light and hit his car.

Plaintiff sued all three insurers to recover no-fault PIP benefits and uninsured or underinsured motorist benefits. All three insurers moved for summary judgment, arguing that the plaintiff’s claims were barred by the statute’s anti-fraud provisions.

In support of their claims of fraud, the defendants relied on forensic evidence from February, June, and July of 2018, which contradicted the plaintiff’s claims regarding the extent of his injuries and pain, his physical limitations, and his inability to work. The trial court found that there was no genuine issue of fact that the plaintiff committed fraud by making false statements and held that all three insurers were entitled to briefs on the contents of the anti-fraud policies, and as such, they were dismissed. all claims to insurers.



First, the Court of Appeals held that the trial court erred in failing to address which insurance was more important to pay PIP benefits under MCL 500.3114.

The general rule is that one looks to one’s own insurance for benefits without a problem unless one of the statutory provisions applies. A person may be entitled to PIP benefits under a no-fault condition even if the person has it no A named insured “under a no-fault policy, and such person may not be subject to this policy against fraud.” Because the plaintiff’s right to a fair benefit was mandated by law, the special provision in the defendant’s policy did not apply and cannot operate to bar the defendant’s claims.

Therefore, the Court of Appeals reversed the trial court’s order granting summary judgment and remanded the case to examine first the claims of the insurers, whether the plaintiff is entitled to benefits under the policy, and whether the benefits arise by law or contract.


Although the trial court found that summary judgment was appropriate because of the insurance policies provided by the insurer, it failed to determine whether the plaintiff was treated as an insured for the purposes of the policies and whether any alleged fraud occurred to create the policy as distinct from post-purchase fraud and as a legal defense or the common law existed in consideration of the fraud committed. You see Meemic Ins Co v Fortson,506 me. 287, 305; 954 NW2d 115 (2020); Williams v Farm Bureau Mut Ins Co of Mich, 335 Mich.App. 574, 578, 580; 967 NW2d 869 (2021) (holding that if the alleged fraud did not affect or induce the purchase of the policy, and fraud claims are invalid when they allege that they apply to false or fraudulent practices occurring after issuance.


The plaintiff’s complaint also included complaints about the safety of unsecured and unsecured vehicles. The insurer itself will control the interpretation of the provisions regarding the benefits of uninsured motorists, which are not required by law. In cases where the benefits of uninsured motorists are difficult, the policy definitions are in control. Therefore, because uninsured and underinsured car Learning is not a responsibility and a no-fault practice, there is no prohibition against the enforcement of anti-fraud laws in the insurance policy’ as a practice Learning this.

The evidence shows that the plaintiff spoke repeatedly during his December 2018 walkthrough about his pain and weakness after the accident, which he said affected his walking and ability to lift things, and his ability to work. This statement was directly challenged and established as wrong by the observational evidence, which shows that the plaintiff is walking freely without pain and suffering, and repeatedly lifting heavy objects in the car. Therefore, the trial court concluded that the evidence, especially the testimony of the plaintiff and the evidence of the examiner, proves that there is no real issue of fact as to whether the plaintiff made false and material misrepresentations, knowing that his statements are false.

False statements made in discovery do not preclude the process. To be clear, when an insurance company fails to pay its debt on time and a suit is filed, the parties’ duty to disclose is governed by state law, not insurance. The defendant-insured only commences a lawsuit after the defendant-insured denies the defendant’s claims and that denial cannot be sustained because of an event that did not occur. This does not mean that a defendant cannot rely on fraudulent evidence obtained after trial. It simply means that the evidence must relate to fraud that occurred before the trial.

Defendant’s statement in due course put, which occurred after the litigation began, cannot be used to insert an anti-fraud clause into insurance policies. However, the word fraud created already Lawsuits initiated properly can be considered and may include preventing insurance fraud.

In this case, the plaintiff participated in a recorded interview with the Landlord’s representative on February 16, 2018, before the trial began. The defendant made all the false statements he made later.

During her written statement, the plaintiff lied about the extent of her injuries and her condition which was proven false by forensic evidence.

Looking at the evidence in the most favorable light to the plaintiff, there is no real issue of fact that the plaintiff presented physical defects in terms of his physical limitations, including his ability to perform his daily activities of life, which was proven by the evidence to be true. wrong and false. The audit evidence was clear, undisputed, and disproved plaintiff’s claim that her injuries prevented her from caring for herself.

The evidence was also such that a reasonable mind could not deny that the plaintiff made the statement during the interview which was recorded knowing that it was false, and for the purpose of the innocent insurance to make them know that they have the right to receive treatment. Accordingly, the Court of Appeals held that the trial court did not err in dismissing the plaintiff’s claim for uninsured and underinsured motorist benefits on the plaintiff’s fraudulent misrepresentation.

In summary, the Court of Appeals affirmed the trial court’s grant of summary judgment to the defendants regarding the plaintiff’s claims against uninsured or underinsured motorists but reversed the order to deny the plaintiff’s claim for PIP benefits and remand.

Michigan’s no-fault law needs to be changed so that it does not benefit a person if they make a fraudulent claim. This case allows the plaintiff to collect harmless benefits even though the claims are false and fraudulent. Trying to figure out how many benefits – due to fraud – will be interesting and limited. Of course, since this fraud is obvious, defendant Jones should be arrested, tried and convicted for insurance fraud under state law. Michigan Insurance Code Section 500.4503, and Section 500.4511 make it a felony to knowingly make a false statement, or to conceal a material fact related to an insurance policy or a payment made under an insurance policy. It deals with false insurance claims and price fixing. It also includes a scheme to do any of the above. The court would refer Jones to the district attorney.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, now limits his practice to working as an insurance consultant specializing in insurance coverage, insurance litigation, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He has practiced law in California for over 44 years as an insurance and claims attorney and over 54 years in the insurance business. He can be reached at

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