Zalma on Insurance

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Barry Zalma, CFE, is an insurance coverage attorney. He is the founder of Barry Zalma, Inc., a California law firm whose practice emphasizes the representation of insurers and those in the business of insurance.

Mr. Zalma is the author of Insurance Claims: A Comprehensive Guide, published by Specialty Technical Publishers, Vancouver, BC at http://www.stpub.com  The Truth, The Whole Truth & Nothing But The Truth, Property Claims 2nd Edition and Liability Claims and all course books used by ClaimSchool, Inc. in its training programs.  He is also the author of  three books published by Thomas Investigative Publishing, and numerous articles for insurance trade publications and law journals.

Mr. Zalma writes the monthly Zalma's Insurance Fraud Letter which is available, FREE, from ClaimSchool, Inc. and over the internet at http://www.zalma.com

Specialty Technical Publishers has published "Mold: A Comprehensive Claims Guide" by Culver City lawyer Barry Zalma. The book is the only comprehensive guide to cover all issues relating to claims of damage by mold or fungal infestations. It is an essential tool for every person who owns real property, manages real property, for all risk managers, realtors, property inspection companies, insurance agents and brokers, insurance claims people, and lawyers who represent property owners or insurers. It is available at http://www.stpub.com or by calling 1800-251-0381

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I Don't Need Your Stinkin' License!
A Heads I Win, Tails You Lose Story
by Barry Zalma, Esq., CFE

The story that follows is based on fact but is fiction. The names, places and descriptions have been changed to protect the guilty. This story was written for the purpose of providing insurers, those in the insurance business and the insurance buying public sufficient information to recognize and join in the fight against insurance fraud.


Yuri Gasparov was 19-years-old when he entered the United States from the old Soviet Republic of Georgia. Although still a teenager he was strong of will and body. In the old Soviet Georgia he had made his mark as a thief, extortionist and enforcer. He was 13-years-old when he first killed a man who refused to pay half his earnings to the group Gasparov joined at when he was 11. When the Soviet Union fell, he emigrated to the U.S. He saw the U.S., unlike the new Georgian Republic, as a place of opportunity for his criminal skills.
Gasparov arrived at Los Angeles International Airport on an immigrant's Visa claiming to be a persecuted Russian Jew. He was unusual as an immigrant. There were gold bars weighing ten Kilograms and 30 carats of "D" to "H" color diamonds in his luggage. Yuri stepped off an Al Italia jet from the First Class Cabin wearing an English suit cut by a Saville Row tailor, a Gold Rolex President watch and Italian alligator leather shoes.
As he waited in the "Nothing to Declare" line at the Bradley International Terminal women in the line openly stared. They saw a handsome young man with long black hair, green eyes, an aquiline nose and a neatly trimmed Van Dyke beard. They assumed he was an Italian Actor come to try his hand at Hollywood. As a refugee Yuri was ushered through Customs with alacrity. The Customs Officer, unaware of the damage he was setting loose on the American Public passed him through saying: "Welcome to the United States Mr. Gasparov."
A limousine was waiting to pick him up at the curb. The chauffeur held the door for him as he entered the long, white, stretched Lincoln Town Car welcoming him to the U.S. in Russian. Gasparov was driven to a brick, three story house near Fairfax Boulevard and Highland (the old "Jewish" neighborhood of Los Angeles) now occupied mostly by Russian and Armenian immigrants. The house was the headquarters of his group of Georgian criminals who had established themselves in Los Angeles and preyed, mostly, on the immigrant community.
Gasparov had plans to improve on the extortion, strong-arm tactics and violent crimes to increase the profits of the group. He expected to live like a movie star or middle-eastern prince. He had studied the United States, its system of government, its police agencies and its attitude toward violent crime. Members of his group had been arrested, and incarcerated, for violent crimes committed in the U.S. with regularity.
Although they enjoyed their stays in American jails (compared to a Gulag they felt American jail time was like a paid vacation in a nice hotel) the profits of the group were diminishing.
Yuri Gasparov had convinced the boss in Georgia that it was necessary to use the American system to make profit and leave the violent tried and true methods of making a criminal profit perfected in the old Republic of Georgia. The American system of civil justice was open to the devious, the criminal and the unethical for instant wealth.
Within a week of his arrival in Los Angeles Yuri had converted his gold and diamonds into the cash needed to capitalize the business he intended to run for his own profit and that of his group. He was introduced to two Russian and one Armenian medical doctors who received licenses after taking an examination. They agreed readily to write reports that they had treated accident victims and kick back half of all billings. Gasparov found a lawyer who had grown up in Yerevan, Soviet Armenia, and had passed the California Bar Examination six months before. The lawyer, Hratch Casparian, was working as a waiter at Cantor's Delicatessen because his language skills were weak and his degree from the Thomas Jefferson College of Law in Burbank, California was less than impressive. Gasparov made Casparian an offer he could not refuse. He would set him up in a nice law office on Wilshire Boulevard and help him operate a successful personal injury law practice. Casparian agreed. Only a fool would have turned down the offer.
Gasparov would bring clients to the new office and would pay Casparian 10 per cent of all the money earned by the law office. Yuri would act as the office administrator and handle all the details of the operation of the business.
Within two weeks of the meeting of Casparian and Gasparov over a corned beef sandwich in Cantor's Deli, the Law Offices of Hratch Casparian was opened at 3600 Wilshire Boulevard, Suite 1313, Los Angeles, California. It was a 3,000 square foot suite paneled in honey oak. Casparian's office was 20 feet by 20 feet, his desk was an antique partner's desk with a green leather top. The remainder of the office was occupied by five secretaries, and in small 10 foot by 12 foot offices, six insurance adjusters who would negotiate with the insurance companies. Casparian showed his new office to his mother, father, three brothers and two sisters. They admired his immediate success. He knew nothing about the practice of law, had never drafted a complaint, had never appeared in court, had never argued a motion or in any way practiced law. He had studied hard at Thomas Jefferson and passed the California Bar Examination on the first try. Casparian was a licensed attorney. He had no idea what was needed to practice law. What he did not know, basking in all the accouterments of immediate success, that knowledge of the law or how to practice law, was irrelevant to his success. All that was required of Casparian was to hang his license on the wall and wait for the profits to roll in.
While the office was being set up Gasparov did more than cause to be built a professional looking law office. Yuri recruited a staff of cappers, Russian and Armenian immigrants with auto insurance and who became accident facilitators for a fee. These people would become the source of the client base of the Casparian law office.
On the day the office opened 32 personal injury plaintiffs signed retainer agreements with the Casparian law office. None of them saw Casparian. The secretaries and insurance adjusters obtained the signed retainer agreements and insurance information. Form letters were immediately sent to insurers for the "victims" of the accidents who were making claims under uninsured motorist insurance coverages. Insurers for the persons who were claimed to cause an injury were contacted by telephone and mail with demands for indemnity. Each of the "victims" immediately went to the two doctors who had agreed to work with Gasparov.
By the third week of operation the Casparian law office was one of the busiest law offices in Los Angeles. Three hundred claims had been presented to insurers, medical bills attesting to treatment for soft-tissue injuries to the neck and back were settled within the first month of operation. The settlements averaged $6,000. For each settlement Casparian was paid 10 percent, the capper who brought in the business was paid $500 and the doctors were paid $500. The remainder was kept by Gasparov.
Suits were never filed. Insurance companies, faced with cases of clear liability, and an opportunity to settle for only two to three times the medical bills presented jumped at the chance. Investigation, when the insurers suspected fraud, were cursory and seldom established the fraud.
The "victims" and "insureds" were all from the now defunct Soviet Union.
They had scripts to follow when contacted by the insurance investigator and stuck to their prepared story with conviction.
In the first year of operation the Casparian law office took in gross revenues of $3,250,000. The first year Casparian received a salary of $325,000 ($300,000 more than he was making at his last job) in cash. No deductions for income taxes or Social Security were paid to the state or federal authorities. He thought, since he was called in only when the adjuster insisted on interviewing the "clients" that he was a brilliant lawyer and businessman for protecting his clients and obtaining excellent settlements for them. He did not know - or refused to learn - that his "clients" were not injured, that they never received medical treatment and that most had never been involved in an accident. Casparian convinced himself that he had achieved the American dream and was the most successful new lawyer in the state of California.
Gasparov, as office manager, earned in that first year more than $1,500,000. He was pleased but felt that the business could do better and needed more clients for his law firm. He needed better injuries to increase the average settlement from $6,000 to $15,000. He did not want it to get higher because none of his cases were ever large enough to make it cost-effective for the insurance companies to fight the claim he presented.
His largest source of business was Miguel Coyote, an immigrant from El Salvador who provided twenty or thirty El Salvadorian, Guatemalan and Argentine immigrants (mostly illegal) to the Casparian law firm. For a $500 fee per body Coyote trained the immigrants in the answers to give to investigators and doctors. He had complete control over the "victims" and threatened each with deportation for criminal conduct if they turned on him. The "victims" who claimed injury were paid by Coyote $50 each allowing him a net, $450 profit.
Yuri met with Coyote in the Wilshire Boulevard office:
"Miguel, my friend." Gasparov said in a conspiratorial whisper. "We need to increase our flow of clients."
"But Yuri, I am already bringing to you every legitimate accident involving a Central or South American."
"That's the problem. You only bring me people who have been in accidents." "I thought that was what you wanted, Yuri. How else can you make a claim?"
"You, my El Salvadorian friend, have no imagination." Yuri responded with a smile curling on his thin lips as he brushed his mustache with his forefinger. "I have available hundreds of Russian and Armenian immigrants with auto insurance who are willing to say they were in accidents with your clients for a fee of $25.00. I need four times the number of your people to be the 'victims' and clients of the Casparian law firm. Can you provide me with four hundred or more 'victims?'" " Yes, but it may cost more."
"How much more?"
"$750 each."
"You are a thief, Coyote."
"Of course."
"I will pay $600 for each body."
"$650."
"$625."
"We have an agreement. But, it is necessary that there be evidence of the accident happening."
"I thought of that. Mikaelian's Body Shop in Glendale will give us estimates, and photographs of broken cars, as if they were the cars of our Russians and Armenians who will claim they were at fault. Your South and Central Americans must find some way to damage the rear of their cars since all the reports to the insurance companies will be that they rear-ended the law firm client's cars." "That's easy, we'll just back them into buildings or posts." "Wonderful, get to work."
Within weeks new clients' cases were flowing into the Casparian law firm at three times the rate as the first year of business. The three doctors were, by their billing, treating over sixty patients a day. Medical bills were forwarded to the Casparian law firm on behalf of its clients of more than $100,000 a day. Profits increased exponentially. Casparian, sitting in his office spent most of his time watching daytime soap operas on the office television. The secretarial staff and the staff of adjusters worked 10 hours a day negotiating hundreds of claims a day. Everyone in the Casparian law firm was happy and Gasparov had purchased, for cash, a four-bedroom house in Brentwood.
Gasparov became greedy. He started to have his cappers, like Coyote, stage accidents. People not involved with Gasparov or the Russian community were forced into accidents by cars full of El Salvadorans when the driver slammed on his breaks on the freeway.
An insurance investigator for Hercules Insurance Company began to notice that the all of the clients of the Casparian law office went to one of the same two doctors. He arranged a meeting with other members of the International Association of Special Investigation Units. Each pulled records relating to claims where one of the three doctors treated the claimant. The hunch developed into a deep conviction.
The SIU staff created a database. It found that the doctors, by their billing records, were billing for more than 80 hours of work a day. Auto accident victims, although never making claim to the same insurer twice, were involved in more than fifteen accidents a month.
The information was taken to the Major Fraud Division of the Los Angeles District Attorney's office. In a task-force with the Fraud Division, California Department of Insurance and the Los Angeles Police Department, search warrants were issued for the files of the law office and the offices of the two doctors. Records were gathered and collated. Four months later arrest warrants were issued for Casparian, the two doctors and each "adjuster" in the law firm. Gasparov, the instigator and receiver of the profits, sold his house in Brentwood when the search warrants were issued, moved to Fresno, and started an office with a lawyer who had immigrated from Kazakstan. Casparian was convicted of sixty-two counts of insurance fraud and sentenced to five years in jail, suspended and actually served sixty days in the Los Angeles County jail. His license to practice law was revoked. The doctors were convicted of paying illegal kickbacks and money laundering. They had their medical licenses suspended for six months and were publicly reproved.
Gasparov's new law office in Fresno is a great success. His position in the criminal organization has improved and he is now only third to the boss in Georgia. Without the benefit of education, training or a license, Yuri Gasparov made more money from the practice of law in California than 99 percent of the lawyers in the state.

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