Monthly Archives: July 2011

Liability Claims Adjusting in California

The Duty to Defend Every liability insurer in California knows that the duty of a third party liability insurer to defend the policyholder is greater than the duty to indemnify. As a result it is necessary, before making a decision … Continue reading

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Liability Insurance Claims Handling

The History of Liability Insurance The essence of insurance is the spreading of risk from one person to many. As early as 300 BC the Babylonians developed a system of loans for shipments by sea where the loan was not … Continue reading

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Property Insurance

Contrary to the belief of those insured, property insurance does not insure property. As a risk spreading device property insurance only insures people, partnerships or corporations against the risk of loss of property described in the policy. Insurance against the … Continue reading

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Do Not Practice to Deceive Your Insurer

Policy Void for Misrepresentation Saeed Moslem (“Moslem”) learned the true meaning of Sir Walter Scott’s Poem “Marmion” (1808) where it stated: “Oh what a tangled web we weave when first we practice to deceive…” Moslem first attempted to get coverage … Continue reading

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Extrinsic Evidence Must Be Considered in Texas to Determine Duty to Indemnify

Eight Corners Rule Only for Duty to Defend in Texas The state of Texas is now officially confused, dyslexic or performing a wild balancing act with regard to interpretation of an insurance policy’s duty to defend and indemnify. When asked … Continue reading

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Exhaustion of Policy Limits

Failure of Attempt to Avoid Costs of Defense Every insurer and defense lawyer knows that the most expensive part of a third-party liability claim when the insured has small limits is the cost to defend. Insurers spend their wits and … Continue reading

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Certificate Of Insurance Does Not Modify Terms Of Policy To Include Additional Insured

Never Rely on a Certificate Alone Insurance agents and brokers often issue, at the request of the named insured, certificates of insurance representing the insurance in effect as a matter of course. Sometimes, they do so without the authority of … Continue reading

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An Intentional Act Can Never Be an Accident

I Didn’t Mean to Hurt Him When I Hit Him in Groin By definition insurance only provides indemnity for a contingent or unknown event. Intentional acts — whether they intend to cause harm or not — are neither contingent nor … Continue reading

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Liability Insurance Claims

Insurance was originally designed to protect individuals against the risk of loss to property in which the individual had an interest. The growth of major cities and the Industrial Revolution brought on a need for insurance against claims by third … Continue reading

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Potential for Coverage Requires Defense

  Horrible injuries often change law or emphasize the reasons for benefits. In a case where children were engulfed in flames their parents, present when the fire occurred, sued for their personal emotional distress. The insurer for the defendant did … Continue reading

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$161 Million Wasted in Attempt to Stop Medicare Fraud

Can “Good Enough for Government Work” Fight Fraud? The United States is losing anywhere from $80 billion to $300 billion a year in Medicaid and Medicare fraud. The US created what was described as a Medicare cost saving program that … Continue reading

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Guaranty Association Funds Only Benefit Insureds of an Insolvent Insurer

Sharing Insurers promise to indemnify their insureds for losses that are covered by the terms and conditions of their policy. In situations where there are losses that spread over multiple policy years with different insurers the insurers will usually share … Continue reading

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Tresspass Can Never be an Accident

Insurance Is Insurance is a contract where a person (the insurer) agrees to indemnify another (the insured) against certain defined risks of loss, damage, or liability arising from a contingent or unknown event. Intentional acts can never be “contingent” or … Continue reading

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The Ancient Equitable Right to Rescission

Rescission is an equitable remedy as ancient as the common law of Britain. When the United States was conceived in 1776 and the Constitution was written some years later, the founders were concerned with protecting their rights under British common … Continue reading

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The Failure of Punitive Damages

The Reasons for Punitive Damages Civil juries have a difficult enough time establishing appropriate numbers to indemnify a plaintiff so that he or she is back the way he or she was before the incident. To ask them to set … Continue reading

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Knowledge of Insurance is Required to Adequately Investigate Insurance Fraud

Insurance Is A Contract Before insurance fraud can be understood, it is important to understand what insurance is and how it works. Politicians continue to misunderstand insurance. Insurance is not a right awarded by the Constitution to every resident of … Continue reading

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Conviction for Workers’ Compensation Fraud Upheld

Circumstantial Evidence Sufficient to Prove Intent to Commit Crime Insurance fraud is seldom prosecuted and when prosecuted the punishment is often minimal and then subject to appeal. The expense of prosecuting insurance fraud chills the vigor of prosecutors who would … Continue reading

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I’m 69-Years-Old & Still Going Strong

When I was 20-years-old, I thought 60 was old and that I would retire by the time I was 65 – if I lived that long.  Boy was I wrong. As the author of Zalma on Insurance, the only lawyer … Continue reading

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The Need For A Thorough Investigation

Insurers Must Report Suspected Fraud Insurers across the country are required to report to state insurance fraud investigators and prosecutors when they have sufficient information that cause them to suspect that an insurance fraud is being attempted. The statutes do … Continue reading

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Independent Counsel

The History of Cumis Abuse In 1995 the Ninth Circuit Court of Appeal dealt with a criminal conspiracy by a team of lawyers who used the decision of the California Court of Appeal in San Diego Federal Credit Union v. … Continue reading

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Happy Birthday USA

Today is the official birthday of the United States of America when it declared its independence from Great Britain. I am thankful that my parents emigrated from what was then the Ottoman Empire as small children. My mother was five … Continue reading

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The Absolute “Work Product” and “Attorney Client” Privileges

Attempted Fraud Insurance fraud is a serious crime in California. When a lawyer is provided with information that a fraud has been committed must work to protect the lawyer’s client from the fraud. In doing so the lawyer will collect … Continue reading

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