Insurer says Valhalla man falsified his health for $1M in disability benefits

BY BILL HELTZEL Bheltzel@westfairinc.com

An insurance company is asking federal court to revoke a disability policy held by a Valhalla man who its claims repeatedly falsified his application.

Berkshire Life Insurance Company of America, of Pittsfield, Massachusetts, accused the man of misrepresenting his occupation and medical history, in a complaint filed March 27 in U.S. District Court, White Plains.

“Berkshire would not have issued the policy in the form it was issued,” the complaint states, “had it known the material facts and information fraudulently misrepresented.”

The Westchester County Business Journal is withholding his name because of sensitive and personal details about his health. Online records indicated that he is employed by a general contractor in Peekskill. Efforts to contact him for his side of the story failed.

The man applied for a disability policy in September 2019 that could potentially pay $15,450 a month.

He listed his work as “executive” and “senior vice president” and said he devoted 100% of his time to “management of firm.”

He answered “no” as to whether he performed manual labor or wore protective gear for work.

He repeatedly answered “no” on the health and medical history section to receiving treatment for any diseases in the past ten years.

He answered “no” to receiving advice or surgery or diagnostic tests in the past five years or to currently receiving any medical advice or treatment.

Later he amended the application to acknowledge that he had been using a medicine to help him urinate.

In October 2019 he declared that in the month since submitting the application he had not had a physical exam or checkup of any kind or been a patient in any health care facility.

The applicant attested that his answers were complete and true, the complaint states, and acknowledged that knowingly submitting false information is fraudulent.

Last year he submitted a claim for benefits beginning in January 2022 at age 55, according to the complaint, and potentially continuing to age 65 and totaling more than $1 million.

Berkshire says it notified the man’s attorney that it would begin paying the disability benefits. But it was still investi- gating the truthfulness of the insurance application and it was concerned about his occupation.

Now Berkshire alleges that many of the answers on the application were false.

The claim for benefits stated that his occupational duties were “job site;” he wore a hard hat and other protective gear; he used ladders and heavy equipment; he lifted from 50 to 75 pounds when unloading trucks at job sites; and he had been per forming manual duties at job sites for 30 years.

Berkshire says it discovered that the man was diagnosed with arthritis in his left knee around 2011. He had incidents of coughing up blood in 2015 and 2016 but declined to undergo a test. He was diagnosed with a pituitary tumor around 2017 or 2018. A brain MRI “resulted in various abnormal findings” in 2019.

Ten days before he declared he had received no recent medical checkups he consulted with a doctor about breast swelling and was advised to undergo an ultrasound test and to see an endocrinologist and a surgeon.

“These misrepresentations were incorporated into the policy,” the complaint states, “and prevented Berkshire’s underwriters from properly evaluating and underwriting the risks in insuring defendant.”

Berkshire is asking the court to nullify the disability policy and to declare that is has no duty to make any disability payments to the policy-holder.

Berkshire is represented by Stamford attorney Patrick W. Begos.

“It is exciting because we are finally able to fill in some of the last remaining vacant parcels either in the central business district or around the perimeter,” said Michael Cacace in a recent meeting of the city’s Planning and Zoning Board (PZB) on behalf of the developer, F.D. Rich Co. Cacace, who is founding partner of the law firm Cacace, Tusch & Santagata, also noted the Urby Apartments that replaced another long-empty downtown space was nearing completion, making the former Dress Barn site the next logical step towards building up the city center.

“I would note that there are a number of benefits associated with the project,” Cacace said, noting that the project as proposed would add 18 below-market-rate units to the city’s housing stock while increasing annual property taxes from $40,000 a year to an estimated $1.3 million. In addition to fees associated with the application which the city can collect and both construction and permanent jobs, Cacace asserted that the project would support the many businesses in the immediate area while enjoying a high walkability rating.

The proposed building is to be located across the street from Landmark Square and the entrance to the theater in Stamford Center Mall and just around the corner from restaurant rich Bedford Street. However, the two open areas which the developers – TR Broad II LLC, part of the F.D. Rich Co. – hoped to use for the building are bisected by Gay Street.

The City of Stamford has an easement ensuring that Gay Street remains a primary way to access both the Broad Street Garage and the parking located behind many Bedford Street businesses. To accommodate the street, the building will rise from two separate foundations and meet in the air above the street, which will also provide access to the building’s parking garage.

Parking was among the most controversial aspects of the development.

Frank Petise, the chief of Stamford’s Transportation, Traffic & Parking Bureau, joined the PZB meeting to provide insight for the board.

“Overall, we are in support of this application,” Petise said. “They have provided a number of truck turning templates for us to show that all the loading works underneath the building not only for their building but the surrounding ones.”

“I would just note for the record that we have submitted over one hundred letters of support for this project, which includes almost all of the property owners on Broad Street and Bedford Street and many of the tenants who occupy those properties,” Cacace noted.

Truck turning plans were a key point because the project has significant, but not universal, support.

“We received a letter from Malloy Realty expressing concern about the ability for trucks to access their properties closer to the corner of Bedford and Broad – do you agree with their concerns?” Zoning Board Chairman David Stein asked. The Malloy Group, part of Douglas Elliman Real Estate, currently consists of Kerry and Allison Malloy, relatives of former Stamford Mayor and Gov. Dannel Malloy.

Petise reiterated that the plans and truck turning templates received left him satisfied with the ease of access.

There were also concerns expressed by members of the board about the for-