Staged Accident is One Where Claimed Collision Was Intentional
Post 5025
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In State Farm Fire And Casualty Company v. Felix A. Quinones, et al, INDEX No. 152505/2021, 2025 NY Slip Op 30754(U), MOTION SEQ. No. 002, Supreme Court, New York County (March 7, 2025) State Farm, sought to disclaim coverage for medical treatment provided to the defendants, who were involved in an automobile collision on February 26, 2020.
The court granted the plaintiff’s motion for summary judgment in part, declaring that State Farm has no obligation to pay claims submitted by Grand Medical Supply Corp. due to Quinones’s failure to appear for examinations under oath (EUOs). However, the court denied the plaintiff’s motion for summary judgment on the basis that the collision was staged, citing insufficient evidence.
FACTUAL BACKGROUND
In this declaratory judgment action, plaintiff seeks to disclaim coverage for medical treatment provided to defendants Felix A. Quinones, Miguel Burgos and Kevin Gonzalez by the other defendants, all medical providers, for injuries Quinones, Burgos, and Gonzalez allegedly sustained in an automobile collision on February 26, 2020, involving a car owned and operated by Quinones in which Burgos and Gonzalez were passengers.
Burgos and Gonzalez appeared at examinations under oath (“EUOs”) and testified, in pertinent part, that they were traveling to a Sonic restaurant for dinner and that the subject collision occurred on a highway-the name of which they did not know-when Quinones’s car was hit “hard” from behind, leaving a big dent in the bumper of Quinones’s car.
Plaintiff moved for summary judgment on the grounds that:
it has established that the subject automobile collision was staged; and
Quinones failed to appear for examinations under oath (“EUO”) on July 2, 2020, August 18, 2020, and October 27, 2020, thereby breaching a condition precedent to coverage under his policy with plaintiff.
In support of its motion, plaintiff submited an affidavit by Claim Specialist Dominique Wafer, transcripts from the EUOs of Burgos and Gonzalez, the certified police report and amended police report from the subject collision, and the declarations page of Quinones’s insurance policy with plaintiff.
In her affidavit, Wafer states that plaintiffs investigation of the subject claim uncovered evidence that the alleged accident involving Felix Quinones and his 2015 Hyundai Veloster occurred on February 26, 2020, just two days after Mr. Quinones insured the vehicle with State Farm.
THE DECISION
The court granted the plaintiff’s motion for summary judgment in part, declaring that State Farm has no obligation to pay claims submitted by Grand Medical Supply Corp. due to Felix A. Quinones’s failure to appear for examinations under oath (EUOs).
The court denied the plaintiff’s motion for summary judgment on the basis that the collision was staged. The court concluded there was insufficient evidence to establish the accident was staged.
The court noted that while an intentional and staged collision caused in the furtherance of an insurance fraud scheme is not a covered accident under a policy of insurance, the plaintiff had not established that the subject collision was staged. Specifically, the court found that the evidence relied upon by Wafer, such as Accurint reports, Carfax reports, and information from the other vehicle’s Event Data Recorder, were inadmissible hearsay.
Additionally, although the EUO transcripts referenced by Wafer were admissible, the purported inconsistencies and inaccuracies in these transcripts raised serious credibility issues but ultimately did not pertain to the nature of the collision itself so as to meet the heavy burden required to obtain summary judgment.
Insurers are faced with insurance fraud and claims from staged accidents on a regular basis. The insurers and their investigators are compelled by law to conduct a full and thorough investigation by its claims or special fraud investigative unit. In this case there were many elements of a staged accident produced in the motion for summary judgment but the court was not convinced – on a motion – that the insurer proved the accident was staged. Every insurer faced with this type of attempted fraud must do a thorough investigation and produce convincing evidence that the accident was staged recognizing that all of the available red flags exist that is not evidence of fraud or of a staged accident.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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About Barry Zalma
An insurance coverage and claims handling author, consultant and expert witness with more than 48 years of practical and court room experience.
