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Insurance fraud adds $900 to average policy – here’s how to avoid it

By Robert Brown

Experts share strategies to spot and stop fraud before it hits clients

Insurance News

By Kenneth Araullo

Nov 20, 2025Share

Travelers is marking International Fraud Awareness Week by outlining strategies to help businesses and consumers guard against insurance fraud.

The company cites data from the Coalition Against Insurance Fraud, which estimates that insurance fraud costs Americans $308.6 billion each year.

A recent Travelers survey found that businesses are most concerned about medical provider schemes involving coordinated networks of health care professionals, digital scams targeting business systems and data, and employee fraud within organizations.

Are you an insurance innovator? Tell us — we want to hear your story

Consumers, on the other hand, reported concerns about contractor fraud and staged car accidents that target individuals.

Pranay Mittal (pictured above), vice president of Travelers Investigative Services, said, “Insurance fraud drives up the overall cost for everyone and undermines consumer trust and the integrity of the insurance process.”

Raising awareness about the various forms of fraud and providing tools to recognize and prevent it can help create a more secure marketplace, Mittal said.

Read more:NICB urges consumers to take action against rising insurance fraud losses

The National Insurance Crime Bureau (NICB) has echoed these concerns, launching a national campaign in partnership with the Anti-Fraud Alliance to encourage consumers to learn about insurance fraud and share prevention tips.

The NICB estimates that insurance fraud adds about $900 to the average policyholder’s annual insurance costs. The campaign highlights that fraud can range from exaggerated claims by individuals to complex operations involving staged accidents, false billing, and property damage scams.

Strategies against insurance fraud

Travelers advises the public to remain vigilant about new fraud schemes and to report any suspicious activity to their insurer and law enforcement. The company recommends that businesses provide ongoing employee training to recognize and report suspicious behavior, enhance security monitoring in key areas, and share intelligence with insurance carriers to identify patterns and prevent repeat offenses.

For consumers, Travelers suggests verifying the credentials of contractors, medical providers, and repair shops before engaging in transactions and urges policyholders to maintain honesty and transparency in their claims.

According to the NICB, fraudsters often target policyholders during periods of confusion or vulnerability, such as after storms or accidents. These individuals may pose as legitimate contractors, medical professionals, or tow operators to exploit insurance benefits.

This tactic is designed to pressure people into quick decisions, which can result in fraudulent claims and increased costs for all insured parties.

In light of these developments, the NICB and Anti-Fraud Alliance have expanded public education efforts, focusing on helping consumers recognize warning signs and encouraging the reporting of suspicious activity to insurers or law enforcement. These initiatives are intended to reduce fraudulent activity and its financial impact by increasing public awareness and cooperation.

Travelers Lloyds challenges insured's improper appraisal tactics in $354k dispute

Documentation evasion allegations ignite appraisal battle in federal courtLegal InsightsBy Tez RomeroNov 24, 2025ShareTravelers Lloyds has challenged a hail storm claim appraisal, alleging the insured dodged documentation demands and pursued improper procedures. When a hail storm damaged a Texas commercial property in late September 2024, the claim seemed straightforward enough. Then months of friction over documentation, valuation disputes, and procedural maneuvering landed the case in federal court this month. Travelers Lloyds Insurance Company filed a declaratory judgment action on November 18 against VSS Carriers, Inc., seeking to invalidate an appraisal demand and umpire appointment it contends violated core policy requirements. At the heart of the dispute: a $354,000 gap between what Travelers paid and what the insured claims the damage is worth. Are you an insurance innovator? Tell us — we want to hear your storyThe timeline matters here. VSS Carriers reported the alleged hail damage on March 3, 2025, more than five months after the September 25, 2024 loss. Travelers issued an initial payment of $257,773.68, followed by a supplemental $285,116.59, totaling $542,890.27. VSS Carriers rejected this and claimed the damage should be valued at $896,812.40, insisting on an additional $148,082.27 for general contractor overhead and profit. The valuation dispute centers on how the policy reads. Travelers points to language stating the insurer will pay replacement cost but not more than "the amount you actually spend that is necessary to repair or replace the lost or damaged property." The insured wanted overhead and profit included despite lacking those actual expenditures at the time of demanding appraisal. But the real tension emerged over documentation. Starting in May, Travelers repeatedly asked VSS Carriers for proof of what was actually spent on repairs, including invoices and payment records. Requests continued through summer with no response. This matters because the policy requires insureds to cooperate in claims investigation and settlement, and to permit inspection of records proving the loss. When VSS Carriers invoked the appraisal clause in August, Travelers agreed conditionally, but only if the insured produced documentation and limited the appraisal to covered damages. Tensions escalated when Travelers formally withdrew from the appraisal process in early October, citing missing documentation. What happened next raised questions. VSS Carriers unilaterally petitioned the state court for umpire appointment that same day, which was granted immediately. The insured's designated appraiser then submitted a position statement and proposed award directly to the appointed umpire without Travelers' participation. The incident highlights a growing tension in claims handling. Travelers argues that cooperation and documentation requirements are conditions precedent to appraisal, meaning an insured cannot invoke appraisal without first satisfying these contractual duties. Without them, the insurer contends, there is no legitimate dispute to appraise. According to the filing, all three key documents supporting the claim contain identical figures of $896,812.40, raising questions about the documentation itself. A federal court will ultimately decide whether VSS Carriers complied with policy requirements and whether the appraisal process can proceed as initiated. For now, the case represents a flashpoint in how insurers and insureds navigate valuation disputes and enforce policy conditions. Related StoriesFrankenmuth blocks appraisal its own policy explicitly allows, policyholders sueAllstate rejects $332k appraisal award after accepting hail damage claim process

Insurance News

AM Best maintains stable outlook for US personal lines

Pricing gains and persistent loss pressures continue to challenge the marketInsurance NewsBy Josh RecamaraDec 01, 2025ShareAM Best has held its market segment outlook on the US personal lines sector at stable, noting that aggressive rate increases and portfolio management actions have significantly improved overall underwriting performance. According to the Best's Market Segment Report,"Market Segment Outlook: US Personal Lines Insurance,"carriers continue to focus on maintaining strong risk-adjusted capitalization, achieving consistent profitability and ensuring sufficient liquidity.These strengths are being tempered by persistently high loss cost severity driven by inflation and rising medical costs. Other challenges include ongoing severe weather events, economic uncertainty, including potential tariff impacts, as well as heightened market competition.AM Best’s director, Chris Draghi, explained that inflation had created a new norm to which rates needed to be aligned, with the elevated loss severity negatively impacting performance as rates caught up. He added that economic inflation, social inflation, and rising medical and casualty costs have significantly affected insurers’ loss reserve positions.Rate increasesThe outlook also highlighted regulators’ recognition of the need for rate increases amid macroeconomic trends. While regulators have been more accommodating than in previous cycles, implementation takes time, and insurers must allow higher rates to fully earn through to see financial benefits.Pricing has been central to carrier strategies, particularly as the operating environment shifts post-pandemic. Insurers moved from gradual rate adjustments to more aggressive pricing, resulting in the largest annual increases in direct premiums written, on a percentage basis, in 2023 and 2024 over the last decade.Draghi noted that premiums began to increase meaningfully in 2022 and have continued to climb since, but the pace appears to have slowed in 2025, particularly on the personal auto side, with negative rate filings appearing in some regions.AM Best emphasized that the stable segment outlook reflects expectations for market trends over the next 12 months. While the overall environment is considered neutral, this does not imply that all companies within the personal lines segment will maintain stable financial performance, the report said.Related StoriesUS life and annuity insurers hold firm as capital strengthens – AM BestAM Best revises US E&S lines outlook

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AIG risk chief and insurance industry veteran Tom Bolt dies

He spent more than four decades at some of the industry's most prominent carriersInsurance NewsBy Kenneth AraulloNov 25, 2025ShareTom Bolt, a veteran insurance executive who held senior leadership roles at AIG, Berkshire Hathaway Specialty Insurance and Lloyd's of London, has died, as confirmed by AIG in a LinkedIn post.Bolt spent more than four decades in the insurance industry. He joined AIG in January 2018 as global chief underwriting officer of general insurance before later serving as executive vice president and chief risk officer, a position he held until his retirement in 2024.During his tenure at AIG's General Insurance division, Bolt worked to establish underwriting standards across the company. His role focused on developing underwriting practices during a period of operational restructuring for AIG.Are you an insurance innovator? Tell us — we want to hear your storyPrior to joining AIG, Bolt held the position of president and chief executive officer of Berkshire Hathaway Specialty Insurance's operations in the United Kingdom and Southern Europe. He also served as a board member of Berkshire Hathaway International Insurance Ltd.Earlier in his career, Bolt worked at Lloyd's of London, where he served as director of performance management. He also held the position of managing director of Marlborough Managing Agency at Lloyd's.Read more:AIG Q3 2025 net income surges as latest deals boost outlookBolt's departure from AIG occurred during a period of significant leadership transitions at the company. Earlier in the year, AIG announced a broader reshaping of its North America commercial insurance leadership, which included the retirement of long-serving executive Don Bailey.AIG's board and executive leadership issued a statement regarding Bolt's career at the company. According to the statement, Bolt's work contributed to establishing what the company described as general insurance's position as an industry leader for underwriting excellence.Survivors include his wife, Patti, and his children and grandchildren.Related StoriesAIG's incoming president John Neal withdrawsAIG Q3 2025 net income surges as latest deals boost outlook

Insurance News

Surge in distressed companies pushing more risks into the wholesale FL market

Insurers are ramping up wholesale underwriting capabilities to meet brokers’ demandWholesaleBy Gia SnapeDec 04, 2025ShareThe financial lines market is undergoing a pronounced shift as a growing wave of distressed US companies drive more complex risks into the wholesale channel, prompting carriers to stand up dedicated wholesale underwriting units.According to Vincent Cisternino (pictured), VP of wholesale financial lines at Westfield Specialty, this evolution is reshaping competition, service expectations, and the underwriting playbook heading into the new year. As distress increases, more insureds require the speed, flexibility, and specialty underwriting expertise that wholesale markets are designed to deliver.“On the wholesale side, you often get more complex deals that require a solution quickly,” Cisternino explained. “Brokers recognize this need for different skill sets from underwriters in wholesale versus retail, driving the demand for dedicated wholesale financial lines underwriting."Macro trends reshape corporate balance sheetsThis shift is rooted in a macroeconomic backdrop marked by rising bankruptcies, tightening liquidity, and elevated borrowing costs.US bankruptcy petitions reached 504,112 in 2024, an increase of more than 70,000 year over year, according to the Administrative Office of the US Courts.The acceleration has been particularly acute among corporates: S&P Global Market Intelligence recorded 694 US corporate bankruptcies in 2024, followed by 655 filings through October 2025, putting this year on track for the highest total since 2010.At the same time, persistently high interest rates have stifled cash flow for firms. After more than a decade of near-zero interest rates, the Federal Reserve’s rapid tightening cycle lifted the federal funds rate to 5.25%-5.5% by mid-2023, the highest in over 20 years, and kept rates elevated into 2024.For financial lines carriers, those macro trends don’t necessarily change the nature of claims, but they do change who is showing up at their door.“Most of the distress we’re seeing comes down to debt,” Cisternino noted. “Either companies took on too much when money was cheap, or their variable-rate debt has become too expensive.”As distress intensifies, the need for specialized underwriting, bespoke coverage structures, and rapid turnaround has pushed more risks into the wholesale segment, he said.“Wholesale brokers, many of whom specialize in distressed risks, know the playbook,” Cisternino said. “They understand restructuring scenarios and how to ensure the directors and officers have the protection they need.”Wholesale FL underwriting rises to meet the momentThe influx of distressed risks has simultaneously increased competition and reshaped how insurers operate in the wholesale space. Many carriers, including Westfield Specialty, have responded by building standalone wholesale financial lines units equipped to handle complex, fast-moving submissions.“There’s a greater sense of urgency,” Cisternino said. “We want to help the broker win the deal, assuming the terms make sense for everyone. That means responding quickly and eliminating bottlenecks wherever possible.”At Westfield Specialty, that has meant redesigning clearance processes, enhancing internal coordination, and staffing the wholesale unit with underwriters explicitly skilled in handling intricate and distressed financial profiles.“We were intentional about bringing on people who could dig into the details of challenging risks,” he noted. “Instead of saying, ‘this class isn’t for us,’ we ask how we can write it and whether the broker would support that approach.”The shift is also driving a more flexible underwriting mindset. Wholesale units are increasingly adopting E&S-inspired practices, pushing beyond rigid class-based underwriting toward more customized solutions, according to Cisternino.Product innovation to match broader wholesale expectationsAs wholesale brokers absorb a wider range of financial and professional lines placements, the Westfield Specialty VP sees growing demand for multi-line product solutions.“Wholesale brokers are often placing everything from EPLI to property manager E&O to publicly traded D&O,” Cisternino said. “We’re working on products designed to span multiple lines so brokers don’t have to get six different quotes. That’s where innovation is headed.”Amid this transition, he emphasized that durable broker-underwriter relationships have become even more important.“Once we write a deal, we view it as a long-term relationship, not a one-and-done,” he said. “Claims come in, issues arise, but when both sides work through them collaboratively, it builds trust.”Related StoriesD&O claims rebound as boards face converging geopolitical, cyber and AI risks – Allianz"Collectively we are moving past the height of the hard market" – Westfield Specialty president

Insurance News

Data-driven seas: Behind the strategic pivot towards data-driven underwriting in marine insurance

Insurers turning to real-time visibility and aggregation modeling to navigate unprecedented volatilityMarineBy Gia SnapeDec 01, 2025ShareGlobal marine insurance premiums hit a record $39.92 billion in 2024, representing a 1.5% rate of growth compared to 5.9% recorded in 2023, and 8.3% the year prior, according to the International Union of Marine Insurance (IUMI).Amid slowing growth, competition is intensifying. Insurers are sharpening their focus on one advantage that is proving decisive: data.From real-time cargo tracking to sustainability-linked vessel retrofits, the industry is undergoing a structural shift toward analytics-driven risk management, according to Sam Hellebush (pictured), president, US Marine at Intact Insurance Specialty Solutions.“Everybody is moving toward more data-driven models,” Hellebush told Insurance Business America. “It’s not parametrics, but it aligns with that trend. The industry is trying to use data to get away from reactive remedies and be proactive to avoid the claim in the first place.”Real-time visibility reshapes marine riskIn marine insurance, few challenges loom as large as understanding cargo aggregation: the concentration of insured values across ships, ports, and key waterways. Real-time tracking technologies, once cost-prohibitive, are quickly maturing to respond to mounting losses at sea, according to Hellebush.“The technology exists to track individual shipments; it’s quite expensive,” Hellebush said. “As the cost decreases, you’ll see more take-up on the insurance or insured side. That’s important for many reasons, one of which is sustainability and the environment.”Climate change intensifies the need for such visibility. With the vast majority of global commerce moving through coastal, climate-exposed locations, insurers face heightened vulnerability to storms, sea-level rise, wildfire smoke disruptions, and extreme weather–induced port congestion.“Marine insurers specifically have an outsized interest in managing aggregations and addressing climate change,” he emphasized.Intact Insurance has reportedly invested roughly $500 million into elevating data quality. That investment, Hellebush said, is already reshaping underwriting confidence.“As we collect more and more of that data, the level of uncertainty surrounding a risk decreases,” he said. “When we can make a quality decision more frequently, we can pass cost savings on to the consumer.”Geopolitical tension accelerates the data raceApart from climate risk, supply chain disrurption stemming from geopolitical tensions have underscored the limitations of traditional, retrospective underwriting.The wave of attacks by Houthis on commercial shipping in the Red Sea since late 2023, for example, has radically altered how insurers view maritime risk. According to market sources, war-risk premiums for transits through the Red Sea have surged from around 0.3% of a vessel’s insured value to as high as 0.7%.In early July 2025, two vessels were struck by Houthi drones, missiles and explosive boats. One vessel was sunk; several crew members were killed or went missing, prompting fresh waves of underwriters to pause cover for certain transits. In response, many global carriers have rerouted around Africa’s Cape of Good Hope, but this detour adds thousands of miles to voyages, increases fuel consumption and voyage time, and further complicates logistics.Sustainability mandates are reshaping insurer-client relationshipsCompounding the security-driven volatility is the growing pressure of climate change and decarbonization. More shipping firms are exploring hybrid-electric propulsion, alternative fuels like hydrogen or ammonia, and other sustainability retrofits, especially as regulatory pressure mounts globally, driven by the International Maritime Organization (IMO)’s 2050 net-zero goals.Hellebush said insurers like Intact are already incentivizing such proactive adaptation: when retrofits are done properly, insurers can “digest the risk” and offer more competitive pricing. This aligns insurer and insured interests over fewer toxic emissions, reduced long-term risk, and a lower probability of costly claims.“Part of supporting retrofits requires us to educate ourselves,” Hellebush said. “When retrofits are done properly, and in a best-in-class manner, we can digest the risk and offer more competitive pricing.”A softening market meets an analytics revolutionIUMI has warned that, despite record premium volume, growth in the marine insurance sector is slowing amid overcapacity, especially in the cargo and hull & machinery markets. In this environment, differentiation increasingly comes from risk prevention rather than price.“We’re going to continue incentivizing proactive behavior,” Hellebush said. “Ultimately, if we’re paying fewer claims, we can pass those savings on to the customer.”Heading into the 2026 renewal season, Hellebush stressed that disruption means opportunity. For brokers, he said, the winners will be those who understand how data, sustainability, and emerging technology are reshaping both risk profiles and pricing models.“The industry has always been dynamic,” Hellebush reflected, going back to the Lloyd’s coffee house days.“The pace of change is accelerating, but it’s not something we should shy away from. Brokers should view this ongoing change as an opportunity.”Related StoriesGlobal marine insurance premiums hit record levels, but momentum ebbsConflict is reshaping global shipping routes and increasing marine insurance risks

Insurance News

Florida lawmakers propose mandatory human review for claim denials

The robots aren’t taking over – the humans areClaimsBy Matthew SellersNov 28, 2025ShareFlorida lawmakers aim to restrict automated claims decisions, with a bill requiring human professionals to make all claim denials.House Bill 527, sponsored by Rep. Hillary Cassel and filed on November 24, 2025, would require that every claim denial in the state be made by a qualified human professional, not a computer system acting alone. The legislation is proposed to take effect on July 1, 2026.The bill imposes a clear requirement: automated tools can assist in the claims process, but they cannot be the sole basis for denying a claim.For insurance professionals operating in Florida, one of the nation's largest insurance markets, the implications are significant. The bill would require carriers to maintain human involvement in their claims operations whenever a denial decision is made.The legislation establishes specific definitions for the tools it restricts. An algorithm is a mathematical process designed to produce specific results. An artificial intelligence system is a machine-based tool that can generate outputs like predictions or recommendations that influence decisions. A machine learning system is an AI tool that learns from data without being explicitly programmed. Under the bill, none of these could serve as the sole reason for denying a claim.Before making any decision to deny a claim or part of a claim, a qualified human professional must first analyze the facts and policy terms independently of any automated system. They must then review whatever the algorithm or AI tool produced to check for accuracy. If another person already reviewed the claim, that human professional must conduct their own review as well.This requirement means companies cannot rely on an algorithm to filter claims and then have a human approve the decision without independent analysis. The human reviewer must conduct substantive work.Insurers will also face new documentation obligations. Companies must maintain detailed records showing who made each denial decision and who reviewed it, along with the date and time. They must document the basis for every denial, including any information provided by automated systems, creating an audit trail that regulators can examine.When notifying a claimant about a denial, the company must clearly identify the qualified human professional who made the decision. The insurer must also explicitly state that an algorithm or AI system did not serve as the sole basis for the denial.For insurers that use automated systems in their claims process, the bill requires them to explain in their claims-handling manuals how those tools work and how the company ensures compliance with the new requirements.The Office of Insurance Regulation will have authority to examine carriers and investigate compliance with the rules. The Financial Services Commission can adopt additional rules to implement the statute.From a practical standpoint, carriers that have automated significant portions of their claims operations will need to adjust their workflows to ensure that human professionals conduct independent analysis before any claim denial is finalized.The bill has not yet been enacted, but its introduction indicates that the conversation about automation in insurance claims is shifting from operational efficiency to accountability and human oversight.Related StoriesFlorida ruling allows Citizens arbitration system to move aheadState Farm cuts Florida auto rates

Insurance News

Wisconsin bill proposes long-term care guaranty fund

Assessments on life and disability insurers would back the proposed solvency protection measureLife & HealthBy Insurance BusinessDec 02, 2025ShareA new bill introduced in the Wisconsin Assembly seeks to bolster protections for long-term care (LTC) policyholders through the creation of a dedicated guaranty mechanism.Assembly Bill 699 proposes adding a specific LTC insurance guaranty account to the state's existing insurance security fund.The fund is designed to protect policyholders in the event of insurer liquidations.The proposed account would be financially backed by assessments levied on life and disability insurers operating within the state.Under current Wisconsin law, the security fund is already segmented into separate accounts for life and annuities, health maintenance organizations, and disability insurance.The new legislation mandates that the funding for the specific LTC account be split evenly between life and disability insurance carriers.Assessments would be based on premiums written in the preceding year, with rates calculated according to each carrier's market share.The bill defines a life insurer as an organization deriving more than 50% of its premiums from life and annuity products.Conversely, carriers receiving more than 50% of premiums from disability policies would be categorized under the disability line.To offset the financial burden, the bill extends tax credit provisions to carriers paying into the new LTC account.These credits would equal 20% of the total LTC-related assessment and could be applied to state income taxes, franchise taxes, or license fees.The credits are valid for application for up to five years after the assessment is paid.Notably, the bill specifies that these tax credits would be refundable specifically for disability insurers, though not for other carrier types.State Senator and bill co-sponsor Jamie Wall emphasized the growing necessity of such protections given current demographic shifts. "Solvency of long-term care is important, as more people continue to use these services,” he said.Wall argued that the legislation is a necessary safety net for consumers. "This bill will shore up the system and not leave policyholders in the lurch."The bill was officially introduced and referred to the Assembly Committee on Insurance on November 26.This legislative move comes as Wisconsin lawmakers also consider changes to workers' compensation regulations, including updates to permanent partial disability compensation.The LTC market in the state is currently concentrated among a few major providers.According to Best Wire data for 2024, CNA Insurance Cos. held the majority market share at 56.72%. Other top writers included State Farm Group with 29.95% and American Family Insurance Group with 12.46%.Related StoriesWisconsin lawmakers weigh workers' comp overhaulRising long-term care costs pose global financial challenge – Gallagher Re

Insurance News

Miller appoints Paul Lineham to lead data strategy

Data tools drive faster responses for brokersInsurance NewsBy Rod BolivarDec 01, 2025ShareMiller has appointed Paul Lineham head of data, placing additional attention on data-led services as competitive pressures continue across the re/insurance sector.Lineham will lead the broker’s approach to how data is collected, structured, and used in internal functions and client delivery. His role includes advancing technological solutions, supporting operational efficiency and encouraging data usage across decision-making processes.Lineham said he focuses on aligning data strategies with business needs and seeing data used for measurable results.“I have always been passionate about aligning data strategies to business need and seeing data used to deliver tangible outcomes,” he said. “Miller’s entrepreneurial culture and client-first approach made it an obvious fit, and I greatly look forward to working with the full team to maximise value and deliver meaningful, innovative solutions.”Lineham has more than 30 years of experience across data and architecture roles in insurance, manufacturing and consulting sectors. He most recently served as head of data architecture at Beazley and previously held group head of data – platforms at Howden. His earlier roles involved delivery of end-to-end data environments at Hitachi Consulting and HSO.Steve Jolley, group chief information officer at Miller, said the broker intends to place more focus on insight-supported solutions for clients and employees. “I am delighted to welcome Paul to Miller as we continue to strengthen our ability to deliver more insight-led, bespoke solutions for our clients,” said Jolley. “With his breadth of experience across data and data architecture, he will be a real asset to the team as we enhance our capabilities and support better outcomes for our clients and our people.”Miller said the hire is part of its ongoing investment in digital capability. Over recent years, the broker has developed tools such as MillerBoost, a smart follow facility to improve the speed and efficiency of property placements in the London Market. MillerBoost is powered by InsurX’s trading infrastructure and provides access to exclusive A+ rated Lloyd’s capacity.Read more:Miller introduces digital follow facility with InsurX to fast-track quotesMiller continues to put time into areas linked to analytics and technological delivery across broking functions. Lineham will work with leadership groups to continue those efforts and support the company’s business strategy.Related StoriesPowering the next wave of delegated authority innovationMiller introduces digital follow facility with InsurX to fast-track quotes

Insurance News

Crossfire in insurtech: Comulate strikes back at Applied System’s trade secrets suit

“Sham lawsuit” was allegedly deployed to scare off shared customersTransformationBy Kenneth AraulloDec 04, 2025ShareApplied Systems and Comulate are now locked in cross litigation in Delaware, with Comulate filing a verified complaint in the Court of Chancery seeking immediate relief to halt what it describes as Applied’s campaign to eliminate competition in the insurance technology market.The move follows Applied’s November lawsuit accusing Comulate of misusing trade secrets and intellectual property tied to the Applied Epic agency management system.Comulate’s complaint frames the new action as a direct response to Applied’s suit, which the startup contends is “frivolous litigation” and part of a broader scheme to remove a rival from the market. The company says it is asking the court for relief to protect its customers, its own operations, its employees and what it calls the broader insurance technology ecosystem.The San Francisco-based firm says it was founded to build “visionary and transformative software,” not to focus on courtroom disputes. Comulate maintains that it sought other ways to resolve the conflict but that those efforts were unsuccessful, prompting its decision to pursue relief in Chancery Court.Read more:Applied Systems sues Comulate for alleged IP theft via fake agency frontAccording to the complaint, Comulate alleges that Applied and its representatives engaged in a series of anticompetitive acts as Comulate expanded its technology for insurance brokers.Those alleged acts include spreading false statements that Comulate was “going out of business”, fabricating months-long software development kit delays, pressing for contracts with intellectual property clauses that Comulate says were designed to seize its technology, asserting improper control of a nonprofit trade group, and filing a “frivolous” lawsuit that was then used to pressure customers into cancelling.From the complaint, Comulate asserts: “Applied does not compete - it destroys. When a startup builds technology that Applied cannot match, Applied’s playbook is simple: acquire or annihilate.”The filing states that Comulate refused an acquisition and now alleges that Applied “is trying to annihilate it.”Comulate also claims that Applied has “weaponized a sham lawsuit,” told customers Comulate is about to “go out of business,” and threatened to cut off clients that continue working with Comulate, describing these steps as efforts “to eliminate the competitor that Applied and its private equity owner, Hellman & Friedman LLC, are ‘very scared of’ and track as ‘#1 on their list of competition.’”Battle over “trade secrets” and “open platform”In Applied’s earlier complaint, the company alleged that Comulate “leveraged its trade secrets” and reverse engineered critical components within Applied Epic to accelerate its own product development and support new offerings not otherwise available without access to Applied intellectual property.Applied is seeking injunctive relief, monetary damages and other remedies in that case.In a previous statement toInsurance Business, Comulate had already disputed those allegations, calling them false and saying the action was intended to undermine a competitor rather than resolve a legitimate legal issue.The company also contends that Applied is using the litigation “to pressure shared customers, deter new deployments and restrict competition,” and says it is open to de-escalation if Applied withdraws what Comulate characterizes as customer threats.Comulate’s new filing further claims that Applied has cemented its position in the market through conduct that, in Comulate’s view, violates the letter and spirit of antitrust law. The complaint cites Applied’s Epic agency management system as having more than 80% market share among enterprise insurance brokers and points to Applied’s ownership of Ivans, described as essential data infrastructure for both Epic competitors and customers.According to the complaint, Applied acquired Ivans in 2013 after promising to keep it an “open platform,” but Comulate alleges that Applied “broke that promise” and now controls “who gets access to Ivans, on what terms, and for how long.”The filing asserts that competitors in the agency management and connectivity space “survive at Applied’s pleasure” due to this control.Applied confident "empty allegations will fail"Update: Applied has issued a response to Comulate's filing. In its latest emailed statement toInsurance Business, a spokesperson called the lawsuit "predictable" and "retaliatory," noting that it serves as nothing more than a strategy "intended to deflect from its own corporate theft scheme.""Applied welcomes fair competition but will not tolerate outright theft. We will hold Comulate accountable for stealing our trade secrets and are confident Comulate’s empty allegations will fail," the spokesperson said.Related StoriesAI and human-in-the-loop: Applied Systems' smarter model for insurance data accuracyApplied Systems sues Comulate for alleged IP theft via fake agency front

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GEICO alleges $4 million no-fault pharmacy fraud scheme in Queens

It outlines alleged high-priced scheme exploiting New York no-fault systemClaimsBy Tez RomeroDec 01, 2025ShareGEICO is accusing a Queens pharmacy of a multimillion-dollar no-fault drug billing scheme built on high-priced pain medications and collusive referrals.In a filing dated November 26, 2025, in the United States District Court for the Eastern District of New York, Government Employees Insurance Company, GEICO Indemnity Company, GEICO General Insurance Company and GEICO Casualty Company set out detailed allegations against United Pharmacy NYC Inc., its owner, Irina Alishayeva, two nurse practitioners, and a series of unnamed “John Doe” defendants.At the heart of the case is New York’s no-fault auto insurance system. GEICO alleges the defendants exploited individuals involved in motor vehicle accidents who were eligible for Personal Injury Protection benefits by systematically dispensing certain prescription drugs without regard to genuine patient care.According to the filing, the defendants submitted more than $4 million in pharmaceutical claims through United Pharmacy under GEICO policies. The insurer alleges that the pharmacy, working with prescribing providers and clinic controllers, overwhelmingly focused on a limited group of products: Lidocaine 5% Ointment, Diclofenac Sodium 2% Solution, Diclofenac Sodium Gel 3%, and Naproxen-Esomeprazole tablets.Those drugs, GEICO says, accounted for approximately 84 percent of the billing submitted through United Pharmacy to the company. The filing describes charges typically ranging from $1,887.13 to $2,358.92 per prescription of Diclofenac Sodium Gel 3%; $2,686.36 or $2,636.38 for Diclofenac Sodium 2% Solution; $1,218.97 to $1,904.65 for Lidocaine 5% Ointment; and $2,680.78 for Naproxen-Esomeprazole.The insurer alleges these pharmaceuticals were prescribed and dispensed pursuant to predetermined fraudulent protocols and unlawful, collusive referral arrangements, rather than individualized medical judgment. It also alleges the defendants intentionally targeted these high-priced products, acquired at low cost, in place of other effective but much less costly prescription and non-prescription drug products, including over-the-counter items that are not covered expenses under the no-fault laws.GEICO further describes what it characterizes as unlawful, collusive referral arrangements. The filing alleges that Alishayeva and United Pharmacy, together with unknown associates, entered into financial arrangements with nurse practitioners Gaetan Jean-Marie and Shai Bikel and with clinic controllers at multidisciplinary no-fault clinics. According to the filing, those arrangements led to large volumes of prescriptions for the same set of drugs being directed to United Pharmacy, including, in some instances, prescriptions that were illegal, invalid or unauthorized and issued using another provider’s credentials.For insurance professionals, the case also draws attention to New York’s pharmacy fee schedule. Under 12 N.Y.C.R.R. §§ 440.5(a) and (d), reimbursement is based on the Average Wholesale Price associated with a drug’s National Drug Code on the day of dispensing, minus a specified percentage, plus a single dispensing fee. GEICO alleges the defendants intentionally selected a specific set of pharmaceutical products with extremely expensive average wholesale prices that could be obtained at a fraction of that cost, enabling what the filing describes as “exorbitant charges” to insurers.GEICO states it has already paid approximately $2.3 million on United Pharmacy’s bills and that approximately $1.4 million in additional claims for the same types of products remain pending. The insurer is asking the court to declare that United Pharmacy has no right to payment for any pending bills for these pharmaceuticals, to order repayment of the amounts already paid under claims including common law fraud and unjust enrichment, and to award treble damages, costs and attorneys’ fees under the federal Racketeer Influenced and Corrupt Organizations Act.These remain allegations drawn from GEICO’s filing. The court has not made findings on the facts, and no final determination has been issued on GEICO’s claims or on the defendants’ liability.Related StoriesFarmers Insurance accuses DME firms of $274k no-fault fraud schemeGEICO sues Brooklyn pharmacy over $3.5 million No-Fault fraud claims