Monthly Archives: May 2011

Is The Covenant of Good Faith Mutual?

The Need For Underwriters Insurance companies, when making a decision to insure or not insure, a risk rely on the information provided to them by the insured. The insured must provide the information requested honestly and in good faith. After … Continue reading

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Thank You

To all who have served in the armed forces of the United States, Thank You, and may we remember what we owe you every day, not just Memorial Day.

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Herding Cats

Managing Lawyers is an Oxymoron As an insurance coverage, insurance claims handling and insurance bad faith consultant I am totally conflicted about the subject of “litigation management” since the insurance executives that attempt to manage litigation with inexperienced, untrained and … Continue reading

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The Law of Unintended Consequences

Fraud Reporting Compliance Statutes The law of unintended consequences is not statutory. It is, rather, a law of the nature of people. It is an adage or idiomatic warning that an intervention in a complex system always creates unanticipated and … Continue reading

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Valuation Methodology Subject to Declaratory Relief

Insurance Appraisal Subject to Judicial Declaration of The Proper Valuation Method Before Submitting to the Statutory Appraisal Process First party property insurers have been reluctant to define the term “actual cash value” in a consistent manner where those insured and … Continue reading

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Don’t Pay Restitution – 11 Years After Conviction – More Probation

Courts, trying to do justice rather than punish insurance criminals, will often grant the criminal probation and order him or her to make restitution to the insurer victim. The restitution is seldom paid and the criminal continues living a good … Continue reading

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The Birth of a Private Investigator

HOW A WATCHMAKER BECAME AN INVESTIGATOR My name is Morpheus Orwell Mobley. My friends, and some enemies, call me “MOM”. It is not a designation of my ability to nuture my clients. I have never been, nor will I ever … Continue reading

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Don’t Lie To Your Insurance Company

An Insured Must Honestly Complete an Application for Insurance Since insurance is, by definition, a business of utmost good faith, those who would be insured are obligated to honestly explain to the proposed insured the facts requested by the insurer … Continue reading

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E-Books from Barry Zalma

E-Books from Barry Zalma Do you have a book reader like the Kindle, the Nook from Barnes and Noble, the Sony Reader, an IPAD or any computer that can read Adobe pdf files?  If you do, you can read any … Continue reading

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If Vehicle Not Identified on Policy — No Coverage

The estate of the victim of an auto accident attempted to force an insurer to add benefits that were not contemplated by a personal automobile insurance policy issued to the wife of the driver of the vehicle causing the accident … Continue reading

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Government Fails to Collect from Fraud

When The Government Catches a Fraud It Should Not Rely on a Judgment The US attempted to collect on a $60 million judgment against a person who defrauded the Medicare and Medicaid programs in United States of America v. Peter … Continue reading

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Lawyer — Never Represent Yourself

Lawyers Representing Themselves Not Entitled to Fees From Insurer When advised that their insureds had been sued, Sequoia Insurance Company (Sequoia) was concerned about the applicability of coverage. They advised the insured that they were seeking the advice of coverage … Continue reading

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14 Years For Multiple Fraudulent Small Claims

Jail for Fake Shaving Injury Insurance fraud by presenting the same claim to more than one insurer has been a crime in California for almost 100 years. However, in The People v. Larry Wade Butler, B218946. Second Dist., Div. One. … Continue reading

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Zalma to be on Varney & Company

I have been asked to appear on the Fox Business Show “Varney & Company” on May 16, 2011 at approximately 7:30 A.M PDT or 10:30 EDT to discuss insurance issues. If you have time and access please watch. You can … Continue reading

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Restricting Assignments of Claims Possible But Dangerous

Policy and Claim May Be Assigned After Loss If Contract Allows Traditionally, an insurer that pays its insured’s claim is entitled to recover the payment from the third party who caused the insured’s covered loss. This concept is called subrogation, … Continue reading

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Sexual Molestation in Maine Not an Insurable Risk

Maine Supreme Court Upholds Sexual Molestation Exclusion In Maine the Supreme Court refused to allow a judgment to be paid from an insurance policy that insured a person who sexually molested a child over a period of years because the … Continue reading

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18 Months in Prison for Dr. Semrau

We reported on the problem of upcoding in an article called “Sentence for Health Insurance Fraud Affirmed” at http://zalma.com/blog/wp-admin/post.php?post=337&action=edit. Since the posting the FBI announced that: Edward L. Stanton, United States Attorney for the Western District of Tennessee, announced today … Continue reading

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New Novela — Murder and Insurance Fraud Don’t Mix

An insurance fraud and murder mystery e-book by Barry Zalma now available at http://www.zalma.com/zalmabooks.htm

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Professional Insurance Adjusting

Professional Insurance Adjusting Insurers, in a search for profit, have decimated their claims professional claims staff. They laid off experienced personnel and replaced them with young, untrained and unprepared people. A virtual clerk replaced the old professional claims handler. Process … Continue reading

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Appraisal Demand May Be Made After Suit is Filed If No Prejudice

  Apprai sal Demand May Be Made After Suit is Filed If No Prejudice Appraisal clauses, a common component of insurance contracts, spell out how parties will resolve disputes concerning a property’s value or the amount of a covered loss. … Continue reading

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FAILURE TO FULLY INVESTIGATE IS DANGEROUS

Failure to Fully Investigate is Dangerous When presented with an uninsured or underinsured motorist claim it is not just prudent, it is necessary, that the insurer conduct a thorough investigation of the claim before making a decision. Even when, on … Continue reading

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Segal Loses Again

“Honest Services Fraud” Decision No Help for Segal’s Conviction Michael Segal, the convicted insurance fraud and racketeer, appealed for the third time to the Seventh Circuit, hoping that a recent U. S. Supreme Court decision on “honest services fraud” would … Continue reading

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Broker Owes No Fiduciary Duty to Insured

Broker Owes No Fiduciary Duty to Insured Insurance brokers in California are, by definition, agents of the insured, because they are “a person who, for compensation and on behalf of another person, transacts insurance other than life, disability, or health … Continue reading

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Feliz Cinco De Mayo

Not insurance but a holiday that celebrates 4,000 Mexican soldiers smashed the French and traitor Mexican army of 8,000 at Puebla, Mexico, 100 miles east of Mexico City on the morning of May 5, 1862.

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IGNORANCE CAN BE CURED – STUPID IS FOREVER

Man Bites Dog Story Insurer recovers $175,302.88 from Insured It should be a maxim of law that no insured should be allowed to profit from insurance fraud. Unfortunately, in normal practice, many profit from insurance fraud because it is not … Continue reading

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Zalma on Rescission of Insurance in California

Zalma on Rescission of Insurance in California Zalma on Rescission of Insurance in California Barry Zalma has produced the only detailed resource on the remedy of rescission of insurance in California. In 832 pages Mr. Zalma has provided the full … Continue reading

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Arson is Just A Fire

Arson is Just A fire (c) 2011, Barry Zalma Arson is just a fire. It is not an excluded peril in any first party property policy of insurance. An arson-for-profit is only a defense to an insurance claim if the … Continue reading

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>Clear Limitation of Coverage Enforced

Clear Limitation of Coverage Enforced (C) Barry Zalma, 2011 Every person insured must read and understand policies of insurance issued to them. Failure to do so, as was the case in Pekin Insurance Company v. Recurrent Training Center, Inc, No. … Continue reading

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>Conviction for Workers’ Compensation Fraud Upheld

>Circumstantial Evidence Sufficient to Prove Intent to Commit Crime (c) 2011, Barry Zalma Adapted from an article in Zalma’s Insurance Fraud Letter. Insurance fraud is seldom prosecuted and when prosecuted the punishment is minimal. In The People v. Kinya Jeanette … Continue reading

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