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Kelley Kronenberg’s Fraud Fighters is a specialized team of seasoned attorneys, many of whom are former prosecutors, law enforcement professionals, and in-house investigators. Together, they bring decades of industry knowledge and litigation experience to the fight against insurance fraud. Our Fraud Fighters team collaborates directly with Special Investigative Units (SIUs) to identify, investigate, and defend against fraudulent claims across our core insurance defense practice areas: First-Party Property, Personal Injury Protection/No-Fault, General Liability, and Workers’ Compensation.

With 20 offices across 9 states, we provide comprehensive geographic coverage for our clients. Our approach is strategic and data-driven, tailored specifically to each client’s unique needs.

First-Party Property Insurance Fraud Defense

Kelley Kronenberg’s First-Party Property Insurance Defense team handles fraudulent cases including arson, material misrepresentation involving insurance applications or specific damage claims, staged accidents, intentional losses, and fraudulent property claims. Through Examinations Under Oath (EUOs), Coverage Opinions, Declaratory Actions, and pursuing fraud defenses in litigation, our team understands the importance of proactive investigation to expose fraudsters.

We work directly with our clients’ SIUs to pursue fraudulent claims. Our strategic approach to these complex cases, handled by select experienced attorneys, has resulted in numerous dismissals, judgments, claim withdrawals, fraud referrals, and fee recoveries for our clients.

Personal Injury Protection/No-Fault

Fraud in automobile cases often emerges through patterns of exaggerated or entirely fabricated injuries, staged accidents, and collusion between claimants and medical providers. In PIP claims, where benefits are paid quickly and without regard to fault, fraudsters exploit the system by submitting inflated medical bills, billing for services not rendered, or orchestrating treatment through complicit clinics.

In Bodily Injury claims, fraud appears when claimants exaggerate their injuries, continue unnecessary treatment to inflate damages, or seek pain and suffering compensation based on false information. Staged accidents are common in both PIP and BI claims, often involving multiple participants who coordinate their accounts to appear legitimate. These schemes may include fake witnesses, falsified accident reports, and attorneys or providers who facilitate the fraud for a share of the settlement or judgment.

We uncover these schemes through surveillance, data analytics, EUOs, and cooperation with law enforcement and fraud investigators.

General Liability Fraud Defense

Fraud manifests differently in Third-Party claims than in First-Party Property and PIP/No-Fault claims. Investigation may reveal staged accidents, falsified accident reports, or significantly exaggerated damages from legitimate accidents involving treatment from suspicious medical providers. Red flags include drivers who knew each other prior to the incident, or multiple plaintiffs receiving identical treatment plans from the same physician—typically one with an established referral relationship with the plaintiffs’ attorney who consistently recommends high-cost treatments.

While fraud is prevalent throughout all states where we defend tort claims, New York has become a particular hotbed for fraudulent claims under Labor Law Sections 240, 241(6), and 200. Because comparative negligence and assumption of risk defenses cannot be used against Labor Law Section 240 claims, these cases present attractive targets for fraudulent schemes.

Workers’ Compensation Fraud Defense

Don Allen Team Lead

Jose Zalduondo Team Lead

Workers’ Compensation fraud typically involves employees exaggerating injury severity, claiming non-work-related injuries occurred on the job, or continuing to collect benefits while working elsewhere. Fraudulent schemes may also include staged workplace accidents, collusion between employees and medical providers to inflate treatment costs, or claimants who misrepresent their ability to work while receiving disability benefits.

We combat these fraudulent activities through comprehensive surveillance, independent medical evaluations, and thorough depositions to verify claim legitimacy. Our team works closely with clients’ Special Investigation Units and utilizes data analytics to identify suspicious patterns across multiple claims. This strategic approach has resulted in successful claim denials, benefit terminations, fraud referrals to law enforcement, and significant cost savings for our clients.

Comprehensive Fraud Defense Strategy: 

From early detection to trial, our team is equipped to navigate the evolving landscape of fraud schemes and regulatory challenges. We provide clients with a strategic, data-driven approach that combines proactive investigation techniques with aggressive litigation tactics. Our experienced attorneys work collaboratively across all practice areas to identify emerging fraud patterns, adapt to new regulatory requirements, and deliver cost-effective solutions that protect our clients’ interests while deterring future fraudulent activity.