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Most car collisions that cause injuries happen unintentionally. Insurance policies provide people with buffer from incidental economic costs that may arise from these car collisions and injuries. Insurance providers require that car collisions be accidental. Any deliberate incident that caused cervical spinal injuries to other people is not considered covered under insurance policies.
Sometimes, though, other people may use these incidents as excuses to benefit from insurance claims. Having said that, when people stage incidents and make them look like they happened intentionally, then these deliberate incidents fall outside the “no-fault” policy of insurance companies and these people who staged the incident will not be entitled to insurance claims. Not surprisingly, as noted by our , accidents or car collisions that are not covered by insurance are mostly staged to obtain insurance claims fraudulently.
This case is about a staged incident that happened on May 2001; the Plaintiffs were involved in a car collision in a 1985 Nissan, owned and insured by Victor Herasme. He claimed that he always lent his car to acquaintances and friends. Moreover, he also stated that he has been involved in an accident using the car in January 2001 and just prior to the accident on May 2001. According to Herasme, Carlos Gaviria borrowed the car and when he returned the vehicle, there was a small scratch. When he asked Gaviria about the scratch, he quickly dismissed it and said that a car had scraped it but no additional details were given. Herasme also stated that they were casual acquaintances and knows Gaviria as “Carlos” and Gaviria knows him as “Victor”. When the Defendant questioned Gaviria under oath, he denied ever knowing Victor Herasme and stated that he borrowed the car from “Jose”.
The Plaintiffs motioned for a summary judgment and sought to recover claims from Allstate Insurance Company, the Defendant, for spinal injuries sustained in a car collision. The Defendant subsequently moved to dismiss the Plaintiffs’ claims for no-fault benefits on the account that the claimed car collision was deliberate and that it was not covered within the scope of the no-fault policy. The Defendant substantiated this counterclaim by bringing in three witnesses: Victor Herasme; the owner of the insured car, Robert Sasso; a private investigator who went to locate witnesses, wherein out of all those he has found, only Mr. Herasme was served subpoena to make a statement, and Sandra Pryce; a claims investigator under the employ of the Defendant and who concluded that the incident was staged out of several bases deduced from her interviews with the Plaintiffs, Gaviria and another passenger involved in the alleged accident.
Our source revealed that Ms. Pryce recommended that the insurance claims made by the Plaintiffs should be denied because of several reasons. First, in an examination under oath made by the Defendant to Mr. Gaviria, he denied knowing Mr. Herasme who owned the insured Nissan that he borrowed. Next, the purported accident happened on May 2001 and a month later, the insurance plan was applied for and was ended after only a month for non-payment. Similarly, another incident was investigated when Mr. Herasme used up the insurance plan on the Nissan in January 2001 for an alleged accident in December 2000. And after the insurance policy was taken out, it was defaulted for non-payment. Ms. Pryce detected patterns from both accidents that included minimal damages to the car, the number of passengers involved and absence of recorded emergency room expenses but with medical treatments for alleged injuries, also, both accidents happened in the same area in Manhattan but on different streets.
There were also discrepancies noted in the results of the examination under oath of Mr. Gaviria and Mr. Torres, one of the passengers. Mr. Gaviria stated under oath that there were three other people in the car when it happened and that they were all male, whereas Mr. Torres mentioned that there were four of them including one female. Moreover, Mr. Gaviria stated that the police witnessed the accident contrary to what Mr. Torres said that the police arrived later in the scene. Furthermore, Mr. Gaviria stated that they were going to pick up one of the passenger’s mother in the area as opposed to Mr. Torres who said that they were only driving around the area for nothing. All of these inaccuracies were noted by Ms. Pryce and concluded that they were signs of a pre-conceived accident. Therefore, since the incident was deliberate, the incident does not fall under the no-fault policy and not a covered accident that is why she recommended that the claims of the Plaintiffs be denied. In addition, she notified authorized agencies to report the insurance fraud scheme staged by the plaintiffs. According to our NY Car Crash Attorney, reporting cases like these is paramount to record the incident and apprehend dishonest policy holders.
To know if a person is entitled to an insurance claim, the insurance providers will have to determine whether an accident is truly unintentional. Sometimes, people get confused about the manner that accidents are classified as unintentional or deliberate because even if a person was just an injured party and was not involved in any pre-planning or staging of an incident, coverage will be denied because one of the parties to the incident had a purposeful motive. An accident must be unintentional. This is absolute. It may also be true that some intentional car incidents may not involve insurance fraud schemes, the fact that a party to the incident performed a deliberate act means that it is not an accident and therefore, may not be covered by an insurance policy.
Our source further explains that in a fraud scheme involving policies, the insurance company has the burden to come forward and demands to have an allegedly injured party’s claim. An injured party, however, doesn’t need to prove that he or she is entitled for an insurance claim. A personal injury case whether it’s in Brooklyn or Manhattan is enough to presume that the allegedly injured party is entitled to a claim only if the accident was found to be unintentional. In this case, the Defendant came forward in order to dismiss the motion for summary judgment of the Plaintiffs for insurance claims on the basis of lack of coverage. Ms. Pryce’s investigation established beliefs that the Plaintiffs’ alleged injuries arose from an incident that was not covered by the insurance policy. The Defendant provided concrete and valid evidences to prove their point or establish that the Plaintiffs’ coverage is non-existent and that the collision was intentional. On the other hand, the Plaintiffs were not able to persuade the Court that their injuries came out of an accident and not from a pre-planned car collision using valid evidences. They were not able to produce witnesses and proofs of medical records to substantiate their insurance claims. Therefore, the motion filed by the Defendant, Allstate Insurance Company was sustained and no claims were awarded to the Plaintiffs.
If you are involved in a car accident or know anyone who is experiencing the same situation, we at Stephen Bilkis and Associates can help you. Our team of highly motivated New York Car Accident Lawyers will also assist you in properly claiming insurance policies and compensation for injuries that you may have sustained. We also assist insurance providers to run after some policyholders from getting away with claiming for injuries that were sustained from non-covered incidents. Protect your rights and businesses; call one of our New York offices now.