True Crime of Insurance Fraud Video Number 57

I Didn’t Know the Gun Was Loaded - A Lie to Get Insurance Benefits

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Pre-Existing Condition Material to No Fault Claim

No fault insurance plans, like that in Michigan, provide benefits to an injured person regardless of fault. All the state asks from the injured party is that he or she is honest in the presentation of the claim. Misrepresenting material facts in the presentation of a no fault claim is considered fraud and deprives the person injured of the right to receive benefits.

In Mark Smith v. Michigan Automobile Insurance Placement Facility, a Michigan Court of Appeals decision, Smith lied to the Placement Facility when making his claim and tried to avoid losing benefits by claiming he forgot his previous condition and did not intentionally lie.

Smith falsely testified that he did see Dr. Ayad before the accident, but only for general health checkups. Smith’s medical records from Dr. Ayad, however, showed that Smith visited Dr. Ayad for “chronic” and “acute” back and neck pain.

One makes a knowing false statement when they have knowledge that the statement is false, or when the statement is made recklessly even without knowledge of the truth.

This case is a perfect example of the last ditch attempt by a criminal who claimed – after being charged with a crime of violence – the “I didn’t know the gun was loaded.”

He knew, he lied, and his medical records established the lie. No one, not even in a no fault auto insurance state, should be allowed to profit from a fraudulent claim. What the trial court and the court of appeal should have done at the end of their decision is refer Smith to a local prosecutor for an act of criminal insurance fraud. They did not, they were satisfied he was unable to collect.

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Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com.

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