Insurance Fraud

Our insurance fraud attorneys regularly team with Special Investigation Units (SIU), as well as Claims and Auditing departments, to investigate and litigate claims involving suspected insurance fraud. We partner with our clients to develop solutions to insurance fraud, working in a manner that allows clients to quantify the impact and results of their anti-fraud activities.

Our group is typically involved in all aspects of the claim process, including:

  • Investigating the claim, taking examinations under oath and providing coverage opinions
  • Defending the denial of fraudulent claims and any related bad faith actions
  • Initiating litigation to recover amounts paid out on fraudulent claims
  • Filing declaratory judgment actions to prevent payment on claims
  • Developing and implementing insurance fraud initiatives to deter the filing of additional fraudulent claims

Insurance fraud may occur across various lines of coverage and at different stages of the process. For example, there may be underwriting/rate evasion fraud at policy inception, fabricated losses and post-loss claim enhancement. Our attorneys have a wealth of experience investigating and litigating claims, including handling litigation in state and federal courts. Some of the key issues our attorneys have addressed include:

  • Application and premium fraud
  • Discovery of hidden payroll in computer business records
  • Recovery of unpaid insurance premiums
  • Policy cancellation
  • Staged motor vehicle accident rings and thefts
  • Unlicensed medical providers
  • Medical provider billing eligibility and fraud
  • Business interruption losses
  • Identity fraud
  • Fraudulent employment discrimination claims
  • Property damage
  • Surety/fidelity bonds

Our attorneys have handled commercial lines premiums (premium recovery) for nursing homes, professional employer organizations (PEOs), security companies, and the construction and trucking industries. Our experience with personal line premiums include initiatives against medical providers, staged motor-vehicle accident rings, vehicle theft rings, property and auto claims, fraudulent claims for homeowner’s insurance benefits, personal automobile insurance application/premium fraud, and personal automobile staged theft claims.

We have a wide range of experience in civil, criminal and administrative litigation and are able to analyze a variety of claims and issues. We have experience in insurance coverage and defense as well as corporate, tax and commercial issues. Our attorneys publish articles and lecture regularly, in addition to frequent training programs involving both the insurance industry and law enforcement.

We provide full case analysis, including underwriting, audits, claims, coverage, fraud and defenses and take a proactive approach for the carrier. We are bottom-line driven and create integrated, result-based action plans in order to recover lost premiums and benefits wrongfully obtained by insured/claimants. We affirmatively challenge suspicious claims (declaratory judgment actions) and counterclaims when appropriate. When necessary, we target medical providers and other licensed professionals.

Our attorneys provide customized, in-house training programs on a variety of topics, including:

  • Red flags of premium fraud for auditors
  • Auditing of suspicious employers - what to review and prepare
  • How auditor’s familiarity with insured’s loss experience can facilitate discovery of fraud
  • The claims department’s role in facilitating discovery of fraud
  • Independent contractors - what to look for in an audit
  • Auditing problematic industries - construction, trucking and PEOs
  • The role of Underwriting in detecting potential fraud
  • The role of Loss Prevention in identifying potential fraud
  • Role playing for deposition and trial
  • Focus on identity and loss history as claim defenses
  • Strategic use of recorded interview and EUOs
  • Coordination with Audit, Claims and Underwriting to present a total analysis and defense
  • Licensure and eligibility concerns for analysis and coverage defenses
  • Insurance fraud initiatives - identifying problematic industries/claims/claimants/medical providers/carriers' goals and how to measure success

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Peer Reviews

  • 4.6/5.0 (810 reviews)
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  • 5.0/5.0 Review for Louis A. Russo by a Associate on 05/19/16 in Litigation

    I have known Lou for over a decade and value him as a colleague and a friend. He is an excellent attorney.

    I have known Lou for over a decade and value him as a colleague and a friend. He is an excellent attorney. Read less

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  • 5.0/5.0 Review for John M. Allen by a Associate on 05/04/16 in General Liability

    John is an excellent civil defense attorney. Most importantly, he seeks resolutions that are fair to the parties. This is a trait not often found in litigation matters. Given that John and I were on opposite sides of the fence in a recent case, my... Read more

    Read more

    John is an excellent civil defense attorney. Most importantly, he seeks resolutions that are fair to the parties. This is a trait not often found in litigation matters. Given that John and I were on opposite sides of the fence in a recent case, my comments stem from personal knowledge of this gentleman. Read less

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Client Reviews

  • 5.0/5.0 (7 reviews)
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Leadership and Action

To put our philosophy and commitment into practice, we have a Diversity Task Force, which includes our Managing Partner, in place to conceptualize and implement diversity-focused programs as well as give diversity a voice in our decision-making at the highest level. The individuals on this task force share the firm’s strong commitment to increasing the diversity, and they use their unique experiences and backgrounds to support and advance that goal. The team meets regularly to create programs, schedule events, establish diversity initiatives both inside and outside of the firm, set long-term goals, and develop the strategy to recruit and retain people from diverse backgrounds.

The Chair of our Diversity Task Force, Joseph M. Hanna, has spearheaded numerous diversity initiatives in various organizations and outreach programs, serves on several diversity-related committees, and is a frequent author and speaker on diversity. Among other positions, he is Chair of the American Bar Association (ABA) Minority Trial Lawyer Committee and its Special Committee on Human Rights, Editor-in-Chief of the ABA’sMinority Trial Lawyer, a 2014 Fellow of the Leadership Council on Legal Diversity (LCLD), a past President of the Minority Bar Association of Western New York (MBAWNY), current President of the MBAWNY Foundation, and the Diversity Liaison for several committees at the 22,000-member Defense Research Institute (DRI).

Each summer, Goldberg Segalla proudly welcomes interns through a formal Diversity Clerkship Program that was conceived by Joe while he served as President of the MBAWNY. The program was developed in collaboration with the MBAWNY and the SUNY Buffalo Law School to provide opportunities for minority UB Law students to gain firsthand experience in the legal system. Since it was launched in 2011, the program has placed more than 80 students in clerkships in area courts as well as in several area law firms, with more judges and law firms asking to participate every day. It provides participants with an in-depth look at the legal process and the interaction between the bench and the bar that they would not otherwise get. At our firm, a dedicated team of partners monitors the work of these law clerks and ensures they obtain valuable experience to help develop important legal research, writing, case management, and client service skills critical to their long-term success. Our program earned the firm the Minority Corporate Counsel Association’s 2012 George B. Vashon Innovator Award.

We also have sponsored Success in the City, an annual diversity networking and mentoring event developed by Joe that brought together students, legal and business professionals, educators, nonprofits, and political leaders to make lasting partnerships. Many employment, business, and mentoring relationships resulted from this event. Past events have drawn more than 500 political and business leaders, legal professionals, and students. Success in the City has influenced the development of similar programs in Baltimore, Cleveland, Birmingham, Dallas, and elsewhere.

Goldberg Segalla also demonstrates leadership inside our firm and throughout the legal community specifically focused on the advancement of women. As a complement to our Diversity Task Force, we have developed a formal Women’s Initiative — a firm-wide movement designed to spark opportunities, develop mentoring relationships, promote leadership, plan events, and support the advancement of women in legal, management, and administrative contexts.

Our firm is committed to spreading the message throughout the broad legal and business communities that embracing diversity contributes to greater overall success. We conduct training sessions for in-house counsel at Fortune 500 corporations on increasing and promoting diversity.  Our attorneys have authored articles and delivered presentations on diversity for various legal organizations, including the Defense Research Institute and the American Bar Association, and our efforts and accomplishments in this area have been profiled in publications such as Law360, the New York State Bar Association’s State Bar NewsBusiness First of Buffalo, the Buffalo Law Journal, and others.

In one recent example of our work to provide inspiration and raise awareness of diversity and women’s issues in the legal community, Caroline Berdzik, a partner in our Princeton office and a member of our Women’s Initiative Leadership Committee, spoke to Law360 for the publication’s “Female Powerbrokers” series. In the interview, Caroline discussed her career, the challenges of being a woman at a senior level at a law firm, the work-family life balance, and the importance of taking risks. She also offered guidance to female attorneys on moving their careers forward and advice to law firms on both increasing the number of women partners and retaining top female talent. Her longtime advocacy for women (at her previous firm, she served on the Women’s Business Development Committee and was a member of what became the national Women’s Presidents Organization) helped earn her a spot on the 2015 NJBIZ list of New Jersey’s Best 50 Women in Business.

Joe Hanna also was featured by Law360 in its “Minority Powerbrokers” series, in which he shared his perspective on breaking the glass ceiling in the legal industry, the challenges of being a lawyer of color at a senior level, how law firms can increase diversity in their partner ranks, and Goldberg Segalla’s core commitment to diversity.


Goldberg Segalla is proud to be a member of the Minority Corporate Counsel Association Firm Affiliate Network, which was created by the MCCA to assist and acknowledge law firms that are committed to advancing diversity and inclusion in the legal profession.

We are also a member of the Leadership Council on Legal Diversity (LCLD), a national organization of leaders in law firms and corporate legal departments dedicated to creating a truly diverse legal profession. As noted earlier, Joe Hanna was a Fellow of the LCLD in 2014. In this position, he played a critical role in organizing the first-ever New York City LCLD Fellows Roundtable event, and he was instrumental in establishing a mentorship program in Hartford for local diverse first-year law students.

We support the diversity efforts of numerous organizations, including:

  • American Bar Association
  • Asian American Bar Association of New York
  • Columbian Lawyers Association
  • Defense Research Institute
  • Federal Bar Association
  • Korean American Association of Greater New York
  • League of First Nations
  • Minority Bar Association of Western New York
  • National Bar Association
  • Native American Rights Fund
  • National Association of Asian American Professionals
  • National Congress of American Indians
  • New York State Bar Association
  • Seneca Free Trade Association
  • SUNY Buffalo Law School
  • Women’s Bar Association of the State of New York

Our outreach efforts led to the creation of a comprehensive database of more than 500 minority law organizations throughout the United States. Contact between these organizations takes place in anticipation of bringing CLE and legal programs together. This group of minority bar associations includes both local and national organizations, such as:

  • National Association of Women Lawyers
  • National Association of Muslim Lawyers
  • Hispanic National Bar Association
  • National Asian Pacific American Bar
  • Black Women Lawyers Association of Los Angeles
  • South Asian Bar Association of Philadelphia
  • Vietnamese American Bar Association of North Carolina
A Talented and Diverse Team

Diversity is further evident within our firm through the many languages and dialects our team speaks, including Arabic, Croatian, French, German, Greek, Hebrew, Hindi, Italian, Korean, Malayalam, Mandarin, Marathi, Norwegian, Portuguese, Punjabi, Russian, Spanish, Swedish, Tagalog, Tamil, Thai, and Urdu.

Goldberg Segalla’s culture is one that values team-spiritedness, collegiality, and interpersonal harmony within our working community. We are a firm that believes in diversity in the workplace, and we are proud to offer a professional and positive work environment for each and every member of our team.

On these values, and on our commitment to diversity, we will never waver. We are proud of what we have accomplished thus far, but we also realize that this is a long-term mission. We will continue to innovate and to improve diversity in law and business — both within Goldberg Segalla and across the communities in which we live and work.

Diversity Matters — Join the Conversation

If you have questions regarding any of the firm’s diversity initiatives or would like to discuss ideas regarding increasing diversity in the legal profession, please contact Joe Hanna (716.566.5447;[email protected]) or another member of our Diversity Task Force: