Plus, an AOB claim ruling
The co-owners of a Ft. Myers roofing company have pled guilty to a $1.4 million tax evasion, DFS announces five arrests in a $1.3 million insurance fraud scheme, plus the latest legal ruling on Assignment of Benefits claims, and a federal review of a hurricane damage claim. It’s all in our roundup this week of fraud and legal cases of note.
Tax Evasion: The co-owners of Marlin Construction Group, a Fort Myers-based residential and commercial roofing company, have pled guilty to evading taxes on more than $3 million in business receipts. David Aaron and Russell Ultes diverted the money from customer checks made payable to Marlin, by cashing them at check-cashing businesses in nearby counties and using the cash to pay personal expenses. According to a U.S. Justice Department release, the pair each face five years in prison upon sentencing later this year.
Insurance Fraud: The Florida Department of Financial Services (DFS) reports that five people were arrested in Miami last week and charged with using a former dentist’s professional credentials to defraud insurance companies out of more than $1.3 million. The dentist had worked at One Care Pediatric Dental where the five suspects were managers. They allegedly used the former dentist’s provider data to submit more than 101,000 fraudulent claims to five insurance companies and then pocketed the $1.3 million in reimbursed payments.
AOB Execution: Florida’s Third District Court of Appeal has adopted the reasoning of the Fourth District Court of Appeal that the date of an Assignment of Benefits (AOB) contract is the controlling date in litigation resulting from the legislature’s 2019 AOB Reform. The Court in February affirmed a Miami-Dade Country Court ruling in The Restoration Team v. Southern Oak Insurance that the AOB did not contain an estimate and violated the emergency services cap of $3,000 under 627.7152 F.S. It was undisputed that the policy pre-dated the 2019 AOB reform statute and that the AOB was executed after the reform. You can read more about this and other case updates in Kelley Kronenberg’s First-Party Property Appellate Division’s “In The Know” latest monthly newsletter.
Hurricane Claim: The 11th U.S. Circuit Court of Appeals has ruled in favor of a Melbourne, Florida church, writing that “The cardinal principle is that a policy’s text is paramount.” Although Shiloh Christian Center had asked its insurance carrier, Aspen Specialty Insurance to discontinue coverage for named windstorm losses back in 2015, the carrier failed to list the exclusion in the church’s 2016 and 2017 policies. So when Hurricane Matthew struck in 2016 followed by Hurricane Irma in 2017 and damaged the church’s roof, the church filed a claim. The ruling reverses a federal district court decision that sided with the carrier.
Have a great week and call or email us if we can help you navigate Bill Watch or you have other questions. Of course, you are always welcome to stay with us in our home and walk the halls of the Florida Capitol with us!
See you on the trail,
Lisa
LMA Newsletter of 4-17-23
