Possible Insurance Fraud

[vicclark0710]

What is the name of your state? Ohio
Hi, a really good friend of mine got a letter in the mail today and found out she is being sued by the insurance company of her former employer. I'm trying to get some information and help calm her down and I'm starting to think her former employer may have committed insurance fraud.
The whole incident happened years ago, she is a really good person, a single mother and honestly does not deserve to be in this situation. She was going through a custody battle at the time and took a plea deal because she couldn't afford to fight the charges. Both parties, her and her former employer, agreed on an amount for alleged losses and she was only deemed to be responsible for half of the alleged losses with another party being found responsible for the other half. The total amount of losses was paid back in restitution so her former employer was paid back in full. We're not sure when her former employer made the insurance claim but now the insurance company is trying to sue her for three times the amount that was alleged in the plea deal?
This has to be fraud right? Her former employer made an insurance claim for three times the amount of the alleged losses when he agreed to the amount in the plea deal, and he was paid back in full with restitution. How is this even possible? I also believe part of the plea deal was if she was going to pay restitution the insurance company wasn't supposed to come after her, I believe her former employer agreed to that as well. It sounds to me like he double dipped, not only did he double dip but he made an insurance claim for alot more than the alleged loss.
It's also interesting that the other person who was deemed responsible for half of the alleged losses isn't named in the lawsuit. Why is the insurance company only going after my friend and not the other party?
Let's say they're suing the other party separately, then that means her former employer claimed way more than they're suing her for, that would take it from three times the amount to six times the amount.
I don't know but this sounds like insurance fraud to me and now my friend is being screwed when she already paid her employer for the alleged losses. She is looking for an attorney and trying to get help through legal aid but I'd still like to know what she's looking at here. It just doesn't seem right that she can be sued for losses she already paid back years after the fact and for way more than what was allegdly lost in the first place.
It seems like they're only going after her for it when she was only found responsible for half. The other party isn't mentioned in any of the papers she got and when she asked the other party they haven't gotten any letter about it but said they're expecting to get one after hearing about her situation.

 

[cbg]

I've read your post three times and I can't make heads or tails of what is going on. What kind of charges? What kind of insurance? How is her employer involved? What does a custody battle have to do with anything?

 

[vicclark0710]

It was a theft charge, it couldn't really be proven and she could have fought it. The only reason the custody battle was mentioned is because that was the deciding factor in why she took the plea deal instead of fighting the theft charge. I believe it's business insurance.
Her former employer alleged that her and another party were stealing, the plea deal was that her and the other party pay back the alleged amount that was missing, on top of probation and fines. All sides agreed on the amount and she and the other person paid her former employer back in restitution. This was roughly 4-5 years ago.
Today she gets a certified letter from the insurance companies attorney and apparently her former employer made an insurance claim for three times the amount of the alleged losses and the insurance company is suing her for that amount.
So not only was her former employer paid back in full, he took out an insurance claim for three times the amount he alleged was missing which couldn't be proven in the first place.
I haven't read a copy of the plea deal but she said her lawyer told them during plea negotiations if she accepted the deal and paid restitution he didn't want the insurance company to come after her, wether this was written into the plea deal or not I don't know but I do know that it was supposed to be.
It's just strange that her former employer was able to take out an insurance claim for the alleged losses when he was paid back in full and claim a loss of three times the amount he alleged in the first place.
Also, it seems that the insurance company is only suing her when she was only deemed responsible for half.

 

[quincy]

What is the name of your state? Ohio
Hi, a really good friend of mine got a letter in the mail today and found out she is being sued by the insurance company of her former employer. I'm trying to get some information and help calm her down and I'm starting to think her former employer may have committed insurance fraud.
The whole incident happened years ago, she is a really good person, a single mother and honestly does not deserve to be in this situation. She was going through a custody battle at the time and took a plea deal because she couldn't afford to fight the charges. Both parties, her and her former employer, agreed on an amount for alleged losses and she was only deemed to be responsible for half of the alleged losses with another party being found responsible for the other half. The total amount of losses was paid back in restitution so her former employer was paid back in full. We're not sure when her former employer made the insurance claim but now the insurance company is trying to sue her for three times the amount that was alleged in the plea deal?
This has to be fraud right? Her former employer made an insurance claim for three times the amount of the alleged losses when he agreed to the amount in the plea deal, and he was paid back in full with restitution. How is this even possible? I also believe part of the plea deal was if she was going to pay restitution the insurance company wasn't supposed to come after her, I believe her former employer agreed to that as well. It sounds to me like he double dipped, not only did he double dip but he made an insurance claim for alot more than the alleged loss.
It's also interesting that the other person who was deemed responsible for half of the alleged losses isn't named in the lawsuit. Why is the insurance company only going after my friend and not the other party?
Let's say they're suing the other party separately, then that means her former employer claimed way more than they're suing her for, that would take it from three times the amount to six times the amount.
I don't know but this sounds like insurance fraud to me and now my friend is being screwed when she already paid her employer for the alleged losses. She is looking for an attorney and trying to get help through legal aid but I'd still like to know what she's looking at here. It just doesn't seem right that she can be sued for losses she already paid back years after the fact and for way more than what was allegdly lost in the first place.
It seems like they're only going after her for it when she was only found responsible for half. The other party isn't mentioned in any of the papers she got and when she asked the other party they haven't gotten any letter about it but said they're expecting to get one after hearing about her situation.

It was a theft charge, it couldn't really be proven and she could have fought it. The only reason the custody battle was mentioned is because that was the deciding factor in why she took the plea deal instead of fighting the theft charge. I believe it's business insurance.
Her former employer alleged that her and another party were stealing, the plea deal was that her and the other party pay back the alleged amount that was missing, on top of probation and fines. All sides agreed on the amount and she and the other person paid her former employer back in restitution. This was roughly 4-5 years ago.
Today she gets a certified letter from the insurance companies attorney and apparently her former employer made an insurance claim for three times the amount of the alleged losses and the insurance company is suing her for that amount.
So not only was her former employer paid back in full, he took out an insurance claim for three times the amount he alleged was missing which couldn't be proven in the first place.
I haven't read a copy of the plea deal but she said her lawyer told them during plea negotiations if she accepted the deal and paid restitution he didn't want the insurance company to come after her, wether this was written into the plea deal or not I don't know but I do know that it was supposed to be.
It's just strange that her former employer was able to take out an insurance claim for the alleged losses when he was paid back in full and claim a loss of three times the amount he alleged in the first place.
Also, it seems that the insurance company is only suing her when she was only deemed responsible for half.

It does sound puzzling. It is good that your friend is seeking out advice from an attorney in her area.

The attorney will be able to personally review the facts of the original theft, the plea agreement, the restitution paid, the insurance claim, and all other facts that led to your friend’s receipt of the letter from the insurance company (a review we are unable to do on this forum), and the attorney will then be able to advise your friend accordingly.

You are nice to be concerned about your friend.

 

[commentator]

Yes indeed, she needs an attorney. Soon. And based on the details of what you're telling us, or trying to express here, I would caution you against taking up offenses for others. It can lead to much frustration for you. On this site, we hear much of this, and the advice is the same. Let this person take this up with their attorney. You are outside and probably do not know nearly enough details to get any reasonable answers from anyone, especially on an internet forum.

It sounds as though you are very much trying to help. There are lots of telling little details, such as "she's a wonderful person" and "a single mother" and "there was a custody battle going on, so she was under stress" so she just pled to a little old theft charge that causes a supicious mind to think there may be a world of things that went on behind the scenes that you are not hearing. Though it may seem only she is being sued, there's no way she can know for sure if the other person is being sued as well, or how they may have been dealt with. You can best help by encouraging her to obtain an attorney and talk only to them.

 

[quincy]

If a character reference is ever needed, vicclark0710 will be one that his good friend will want to call.

 

[Ohiogal]

I am in Ohio and won't comment except to say your friend needs to take EVERYTHING to an attorney. Because what you are stating doesn't make sense. 0

 

[Zigner]

I am in Ohio and won't comment except to say your friend needs to take EVERYTHING to an attorney. Because what you are stating doesn't make sense. 0

We're getting the story from a third party who got the story from the involved person who was dealing with the matter in a system that they didn't understand. Add to that the fact that this occurred "years ago," and the reason for the non-sensical nature of the story becomes quite clear.
Veering into the hypothetical, I can see that the "restitution" did not relieve the defendant from civil claims made by the insurer. The amount being claimed is confusing, but I suspect there's a reason for it that doesn't require any fraud.
Yes, the convicted person should speak to an attorney. The OP's best way of helping is to offer to assist with the cost of the attorney.

 

[quincy]

... The OP's best way of helping is to offer to assist with the cost of the attorney.

Agree. That would be a nice, and no doubt very appreciated, way for vicclark to help his friend.

 

[Litigator22]

What is the name of your state? Ohio
Hi, a really good friend of mine got a letter in the mail today and found out she is being sued by the insurance company of her former employer. I'm trying to get some information and help calm her down and I'm starting to think her former employer may have committed insurance fraud.
The whole incident happened years ago, she is a really good person, a single mother and honestly does not deserve to be in this situation. She was going through a custody battle at the time and took a plea deal because she couldn't afford to fight the charges. Both parties, her and her former employer, agreed on an amount for alleged losses and she was only deemed to be responsible for half of the alleged losses with another party being found responsible for the other half. The total amount of losses was paid back in restitution so her former employer was paid back in full. We're not sure when her former employer made the insurance claim but now the insurance company is trying to sue her for three times the amount that was alleged in the plea deal?
This has to be fraud right? Her former employer made an insurance claim for three times the amount of the alleged losses when he agreed to the amount in the plea deal, and he was paid back in full with restitution. How is this even possible? I also believe part of the plea deal was if she was going to pay restitution the insurance company wasn't supposed to come after her, I believe her former employer agreed to that as well. It sounds to me like he double dipped, not only did he double dip but he made an insurance claim for alot more than the alleged loss.
It's also interesting that the other person who was deemed responsible for half of the alleged losses isn't named in the lawsuit. Why is the insurance company only going after my friend and not the other party?
Let's say they're suing the other party separately, then that means her former employer claimed way more than they're suing her for, that would take it from three times the amount to six times the amount.
I don't know but this sounds like insurance fraud to me and now my friend is being screwed when she already paid her employer for the alleged losses. She is looking for an attorney and trying to get help through legal aid but I'd still like to know what she's looking at here. It just doesn't seem right that she can be sued for losses she already paid back years after the fact and for way more than what was allegdly lost in the first place.
It seems like they're only going after her for it when she was only found responsible for half. The other party isn't mentioned in any of the papers she got and when she asked the other party they haven't gotten any letter about it but said they're expecting to get one after hearing about her situation.

Your professed vexation results not only from a distinctly biased point of view, a very limited factual background, but also largely due to your futile effort in attempting correlate the two separate lawsuits. Like apples and oranges, they are not fully comparable!

The first was clearly a criminal case seemingly based on breaches of criminal law (theft, embezzlement, etc.). Whereas the pending case is grounded on civil laws applying to the principles of subrogation; (being "a term describing a legal right held by most insurance carriers to legally pursue a third party that caused an insurance loss to the insured.")

There may be some incidental overlapping aspects of the two. For instance, crediting restitution paid to the complainant employer as per the terms of the criminal judgment. However, not being a party to the criminal proceedings little of the results affect the rights of the carrier. INCLUDING, please note, any orders allocating restitution between the criminal co-defendants!

Your role must be limited to assisting your friend in obtaining professional representation.

 

[Zigner]

I thought I said that...

 

[Just Blue]

I thought I said that...

lol...you did. And in a non-bloviating way.

 

[Litigator22]

I thought I said that...

Had I read your discerning response beforehand mine might be taken as a form of flattery, except that I didn't.