People v. Merz

125 Misc. 2d 821, 480 N.Y.S.2d 697, 1984 N.Y. Misc. LEXIS 3487
New York County Courts·Decided September 7, 1984·Published·Cited by 1 cases

Opinion

OPINION OF THE COURT

Raymond E. Cornelius, J.

Pursuant to the provisions of CPL 210.30, a motion has been made to inspect the Grand Jury minutes, and for dismissal of the indictment. The first three counts of the indictment accuse the defendant of the crime of insurance fraud in the first degree, in violation of section 176.20 of the Penal Law of the State of New York, in connection with three separate insurance policies issued by different insurance companies, for personal property owned by the defendant. The court’s inspection of the Grand Jury minutes discloses that these criminal charges were based, in significant part, upon a standard clause, contained in each of the three insurance policies, limiting liability in the event of other insurance coverage, together with the fact that the defendant represented that he did not have such concurrent insurance in submitting claims of loss for the same [822] personal property. The fourth and final count of the indictment charges the crime of perjury in the first degree, in violation of section 210.15 of .the Penal Law of the State of New York, based upon claimed false testimony given in law offices of attorneys representing two of the insurance companies, and, specifically, statements made by the defendant to the effect that he did not have other insurance coverage.

The defendant, by his counsel, relies upon the definition of insurance fraud, as contained in section 176.05 of the Penal Law, which requires materiality to be established as an essential element of the crime. This section, in relevant part, reads as follows: “A fraudulent insurance act is committed by any person who, knowingly and with intent to defraud presents * * * to * * * an insurer or purported insurer, or any agent thereof * * * a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which he knows to: (i) contain materially false information concerning any fact material thereto; or (ii) conceal, for the purpose of misleading, information concerning any fact material thereto.” (Emphasis added.) In essence, the defendant contends that the failure to disclose other insurance coverage, in connection with submitting each of his proofs of loss of his personal property, could not be material because his total loss exceeded the combined liability coverage of the three policies, and, therefore, each of the insurance companies would not be relieved from payment of the respective policy limits. At the time of the loss, which resulted from an alleged burglary at the defendant’s residence on September 5, 1983, the total liability coverage for the three insurance policies maintained in effect was $68,000 (Travelers Ins. Co. — $28,000, General Acc. Ins. Co. — $25,000, Royal Ind. Co. — $15,000).

The clause in question, which applies in cases where an insured maintains concurrent insurance on the same property, provides, in effect, that an insurance carrier is not necessarily liable for the policy limits but only the percentage which such amount bears to the total amount of insurance covering the loss. As aforesaid, this is a standard clause contained in various types of insurance policies, and [823] has been sanctioned by the Legislature. (See, e.g., Insurance Law, § 168, subd 3, par [a].) Thus, for example, if the total loss sustained as a result of the burglary had been the same as the limit of liability, as contained in the Travelers policy, to wit, $28,000, the Travelers Insurance Co. would only be responsible for paying approximately $11,500. If this insurance carrier, in such an instance, were unaware of the other insurance coverage and paid the defendant the full amount of such a loss, to wit, $28,000, they would have been defrauded by an amount in excess of $16,000. Article 176 of the Penal Law, which contains the definition of insurance fraud as well as the different degrees thereof, was part of the Insurance Frauds Prevention Act, which was enacted by chapter 720 of the Laws of 1981. The Governor’s memorandum, upon approving the legislation, states as follows: “The amendments to the Penal Law, particularly the classification of insurance fraud involving pecuniary values in excess of fifteen hundred dollars as class D felonies, track the classifications for larcenies and will be an indication by the Legislature that the State will no longer tolerate crime in the insurance field, and should encourage the prosecution of such crimes by prosecutors.” (McKinney’s Session Laws of NY, 1981, p 2618.) The felony crime of insurance fraud in the first degree, as well as second degree, require a defendant, by his conduct, to attempt or actually take, obtain, or withhold property in excess of a specified value. This, of course, is analogous to the degrees of larceny. Although the misdemeanor crime of insurance fraud in the third degree does not include the theft of property as a necessary element, materiality must nevertheless be established.

This court would hold that the attempted or actual taking, obtaining or withholding of insurance proceeds, to which an insured is not entitled under the terms of the contract, would establish the element of materiality, or as a minimum, the insurance company must have been adversely affected in some manner. Thus, in the hypothetical example, posed by the court, any representation by the defendant, which resulted in a monetary loss in excess of $16,000, would certainly be material. The same would be true in any case where a misrepresentation, concerning [824] other insurance coverage, would result in a difference in the amount paid by the insurance company to the insured.

Nevertheless, as a matter of simple mathematics, in the pending case or any case where the total loss is either equal to or exceeds the total amount of insurance coverage, the insurance carrier would be responsible for payment of the full liability limit, as contained in the policy, regardless of the existence of other insurance policies. Assuming the defendant’s total claim to be otherwise valid, Travelers Insurance Co., for example, would be required to pay him $28,000, whether based upon the liability limit set forth in the policy, itself, or based upon the percentage of the loss which such amount bears to the total amount of insurance coverage. It is apparent to the court that a primary reason for a clause of the types involved in this case, whereby liability is limited to a percentage of the total insurance coverage, is to prevent an insured from collecting more proceeds than his actual loss. However, this would not occur where the actual loss is equal to or exceeds the total amount of insurance coverage. In such a situation, an insured’s misrepresentation concerning the existence of other insurance coverage would not be material because it would not affect the amount of payment by the insurance company, again assuming that the total claim is otherwise valid. There was no evidence to indicate that the defendant’s misrepresentations were, in any other way, material.

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People v. Merz, 125 Misc. 2d 821, 480 N.Y.S.2d 697, 1984 N.Y. Misc. LEXIS 3487 (N.Y. Super. Ct. 1984).

125 Misc. 2d 821 (People v. Merz) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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