Insurer Awarded Damages For Fraud: Insured's Suit for Fire Insurance Benefits Defeated by Qui Tarn Claim by Insurer.

AuthorZalma, Barry

* In Lisa A. McCullough v. Metlife Auto & Home, No. 4:20-CV-01807, United States District Court, M.D. Pennsylvania (September 30, 2022) McCullough sued seeking to force MetLife to pay Plaintiff for an insurance policy on the McCullough's home, which was destroyed in a fire in 2019.


MetLife moved the case to the USDC and filed an answer to complaint, along with a counterclaim against Plaintiff for insurance fraud. MetLife served the counterclaim on Plaintiff's attorney that same month, alleging insurance fraud under Pennsylvania law. Plaintiff failed to respond to the counterclaim. In March 2021, MetLife moved for entry of default against Plaintiff, and default was subsequently entered by the Clerk of Court.

MetLife moved for a default judgment. In January 2022, this Court granted MetLife's motion and requested briefing and evidence of any damages sought by MetLife. MetLife has submitted a brief and evidence listing its damages. MetLife has additionally moved for judgment on the pleadings pursuant to Federal Rule of Civil Procedure 12(c). For the following reasons, MetLife's Rule 12(c) motion will be granted and its motion for a default judgment will be granted in part and denied in part.


When considering a motion for judgment on the pleadings a court assumes the truth of all factual allegations in the plaintiff's complaint and draws all inferences in favor of that party. It does not, however, assume the truth of any of the complaint's legal conclusions

Pennsylvania law provides that an individual commits the offense of insurance fraud if she "[k]nowingly and with the intent to defraud any insurer or self-insured, presents or causes to be presented to any insurer or self-insured any statement forming a part of, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim."

Although these elements are set forth in a criminal statute, the statute further allows aggrieved insurers to file a civil action against violators of the statute "to recover compensatory damages, which may include reasonable investigation expenses, costs of suit and attorney fees."

Additional facts indicated that Plaintiff set the fire, such as her relocation of important documents before the fire and the discovery of newly purchased gas cans with residual gasoline in them at her home, after the fire. Plaintiff "submitted a claim to Defendant for the alleged loss as a...

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