Law Alerts

FRAUD

New Jersey
By Douglas Alba, Esq. (dmalba@mdwcg.com or 856-779-6119)

This case involved Liberty Mutual Fire Insurance Company paying the plaintiffs over $200,000 toward fire damages to their home, and related expenses, but refusing to pay for additional mold remediation in the basement, which was caused by the flooding of the basement during efforts by the firefighters. As a result, the plaintiffs sued Liberty Mutual and a number of other defendants.

In this opinion, the appellate court affirms the trial court's: (1) denial of plaintiffs' motion seeking to extend discovery (consequently barring plaintiffs from producing expert testimony) due to the plaintiffs' continued discovery defalcations and failure to show due diligence or exceptional circumstances; and (2) dismissal of the plaintiffs' claims against all parties except the general contractor, which order is reversed. Moreover, as to Liberty Mutual, evidence showed that the plaintiffs submitted fraudulent bills to the carrier for payment of their living expenses, and the judge aptly found that their fraud precluded their claim for coverage.

Because the Appellate Division has no jurisdiction under the Alternative Procedure for Dispute Resolution Act to review the merits of a Law Division judgment affirming, modifying or vacating an APDRA award, it dismissed the appeal of the defendant health care provider from such a judgment vacating an arbitration award in its favor, which required the plaintiff to pay PIP benefits to which the plaintiff's insured was entitled for emergency medical services. In reversing the award, the Law Division judge concluded that the defendant's lack of an assignment from the insured was fatal and that it had no authority to present a claim on her behalf.