Allstate New Jersey Ins. Co. v. Legome, No. A-1886-20, 2022 WL 2920996 (N.J. Super. Ct. App. Div. Jul. 26, 2022)

To bring an action under the Insurance Fraud Prevention Act, it must be determined whether the alleged fraudulent act amounts to a prerequisite for a violation under the Act.

The New Jersey Appellate Division confirmed a motion for summary judgment, finding that even if the defendant had submitted fraudulent fee certifications to the insurance carrier and arbitrators, attorney’s fees were authorized under N.J.A.C. 11:3-5.6(e), not a provision or claim under the insurance policy. Therefore, the prerequisite for a violation under the Insurance Fraud Prevention Act, a payment relating to an insurance policy, had not been met. Accordingly, in determining whether to bring an action under the Insurance Fraud Prevention Act, it must be determined whether the alleged fraudulent act amounts to a prerequisite for a violation under the Act.

 

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