Monthly Archives: August 2011

Pollution Exclusion Enforced

Exclusion is Absolute The Minnesota Court of Appeals concluded that the pollution exclusion in a CGL was sufficiently open, obvious and clear to include injuries from a carbon monoxide leak from an improperly installed boiler and carbon monoxide detector.  In … Continue reading

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Claims In A Catastrophe

Presenting a Claim If your house was damaged or destroyed by fire, windstorm, hurricane, tornado, or flood as a result of state declared catastrophes and you had a fire, homeowners, flood insurance, tenant’s homeowners or condominium policy you will be … Continue reading

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The Private Limitation of Action

Ohio Enforces Private Limitation Almost every policy of first party property insurance contain a private limitation of action provision that limits the right of the insured to sue on the policy for a period shorter than the statutory limitation period.  … Continue reading

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Friday Fun

The story that follows is based on fact. It is, however, a work of fiction. The names, places and descriptions have been changed to protect the guilty. Any resemblance to real people is purely coincidental. This story was written for … Continue reading

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EXTRINSIC EVIDENCE MUST BE CONSIDERED IN UTAH TO DETERMINE DUTY TO DEFEND

Unless The Policy Requires It The “Eight Corners Rule” Is Dead In Utah The Need For a Thorough Investigation Since insurance is a contract of the utmost good faith insurers must conduct a thorough investigation of the policy and the … Continue reading

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South Carolina CGL Ruling on Time on Risk

South Carolina Adopts “Time on Risk” Apportionment of Continuing and Progressive Losses In Crossmann Communities of N.C., Inc. v. Harleysville Mutual Ins. Co., Op. No. 26909 (S.C. Sup. Ct. re-filed August 22, 2011) the Supreme Court of South Caro lina … Continue reading

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Duty To Provide Safe Place to Work is Delegable

Prudent to Delegate Duty to Independent Contractor The California Supreme Court resolved disputes between different district courts of appeal with regard to the duty raised by the California Occupational and Safety and Heath Act (CalOSHA) and whether it is delegable … Continue reading

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Insurer Wins

On June 14, 2011,  Limor Lehavi (llehavi@archernorris.com), a partner with Archer Norris PLC in Newport Beach, California, along with partner Kevin L. Place, obtained a unanimous 12-0 jury defense verdict for an insurance company in an insurance bad faith case … Continue reading

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WHO GOT CAUGHT

Recent Convictions for Insurance Fraud The following are some stories of convictions for insurance fraud across the country that will be published in the September 1, 2011 issue of Zalma’s Insurance Fraud Letter. Six Months for Creating Fake Claims Pamela … Continue reading

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Plaintiff May Only Recover for Damages Incurred

What Took So Long? Until the California Supreme Court ruled on August 18, 2011, injured plaintiffs would present into evidence medical bills they were never required to pay. Rather, the invoiced amount were reduced by contracts between the plaintiff’s health … Continue reading

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DEFECT IN ILLINOIS CAN BE AN OCCURRENCE

Fail to Defend at Your Peril Insurance companies are loathe to defend insureds who are accused of defective construction since CGL policies are only intended to protect the insured from liability for injury or damage to the persons or property … Continue reading

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Insurer Avoids Liability for Agent’s Fraud

Contract Between Agent And Insurer The relationship between insurance agents and brokers with insurers is based upon the contract between the insurer and the agent or broker. When the agent or broker breaches the contract with an insurer by defrauding … Continue reading

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Ninth Circuit Punts — No Standing to Sue on Obamacare

Standing Requires an Actual Injury About the same time the Eleventh Circuit decided that the individual mandate provision of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010)., also known as “Obamacare,” was unconstitutional the … Continue reading

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Individual Mandate Unconstitutional

Doing Nothing Is Not Commerce The decision of Eleventh Circuit Court of Appeal in State of Florida v. U.S. Dep’t of Health & Human Services, No. 11-11021 (11th Cir. 08/12/2011) finding unconstitutional the  individual mandate of the Patient Protection and … Continue reading

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No Good Representation Goes Unpunished

Insurance Appraiser/Arbitrator & Lawyer At Risk People get seriously upset when an insurance dispute does not provide them that to which they believe they are entitled. Some get angry and yell. Some threaten physical harm. Some sue the insurer. Others … Continue reading

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Taking the Profit Out of Arson

Continuing with the sixthteenth issue of the 15th Year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma reports on the results of presenting a claim supported by lies, a trip to jail; grants by the California Department of … Continue reading

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Health Insurance Fraud Convictions

Health Insurance Fraud Is Profitable I have written a regular newsletter on insurance fraud for the last fifteen years reporting on, among other things, those who are convicted of insurance fraud. Some estimates indicate that insurance fraud takes from the … Continue reading

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An Effective Assault & Battery Exclusion

Artful Pleading Fails Insurers who insure bars and other places where alcoholic beverages are sold are loathe to insure the bar against liability for bar room fights, acts of security personnel (bouncers) or any form of assault or battery. Plaintiffs’ … Continue reading

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Nevada Adopts Notice Prejudice Rule

Insurer Must Prove Prejudice to Avoid Coverage Every third party liability insurance policy requires that the insured report a claim to the insurer promptly. They use different words in different policies, most of which require reports immediately, as soon as … Continue reading

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What Is Insurance?

I Know It When I See It As U. S. Supreme Court Justice Stewart said in  Jacobellis v. Ohio, 378 U. S. 184, 197 (1964) when dealing with pornography “I know it when I see it,” most members of the … Continue reading

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Heads I Win, Tails You Lose – 2011

Heads I Win, Tails You Lose – 2011 This E-Book book started as a collection of columns I wrote and published in the magazines “Insurance Journal,” “Insurance Week,” and “The John Cooke Insurance Fraud Report” insurance trade publications serving the insurance … Continue reading

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Is There a Right To Contract?

Insurance and Construction Contracts In the United States the right to enter into any contract that does not violate law or public policy has been inviolate. The right to contract is a liberty which falls within the protection of the … Continue reading

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Insurance fraud

An E-Book by Barry Zalma Insurance fraud continually takes more money each year than it did the last from the insurance buying public. Estimates of the extent of insurance fraud in the United States range from $87 billion to $300 … Continue reading

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WORKERS’ COMPENSATION DECEPTION FAILS

Never Lie to Your Insurer In Connecticut, a construction company obtained a workers’ compensation policy through an assigned risk plan that placed him with CNA Insurance Company (CNA) who determined premium based upon the contractors representation that he had only … Continue reading

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PRIMARY vs. EXCESS

Risk Shifting Construction contracts are often used to shift risks of loss by contract terms and requirement that subcontractors insure general contractors and the owner. By doing so the risks of loss faced by the owner and general contractor are … Continue reading

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Zalma on California Claims Regulations — 2010

      Barry Zalma has updated and refined his seminal work on California Claims Regulations, available as an e-book from http://www.zalma.com/zalmabooks.htm, to be available for all insurers who must prove to the California Department of Insurance that all personnel … Continue reading

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Fail to Read A Policy and Suffer the Consequences

It Is Necessary to Read the Insurance Policy Many, if not most, insurance consumers, according to several studies and my experience, buy insurance based on price rather than on the terms or conditions of the policy. Doing so may save … Continue reading

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Zalma on California Claims Regulations — 2010

Barry Zalma has updated and refined his seminal work on California Claims Regulations to be available for all insurers who must prove to the California Department of Insurance that all personnel have been trained and understand their obligations under California … Continue reading

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