Monthly Archives: December 2011

Happy New Year

May the new year bring each of you a very happy, prosperous and successful time with all of the hard times the last few years have brought a fading bad memory. I also want to again thank each of you … Continue reading

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When an Intentional Tort Isn’t Intentional

The Four Corners Rule Strikes Again The Maine Supreme Judicial Court was asked to determine whether an insurer had a duty to defend a policyholder against a complaint alleging, among other things, that the policyholder converted another person’s lobster traps … Continue reading

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No Coverage for Child Molestation

Child Molestation Not Within Course and Scope of Employment The Texas Court of Appeal was asked to resolve a dispute between an employee of a child care center and the child care center’s insurer, seeking defense of an allegation that … Continue reading

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Claims Made Policy Means What it Says

A LOSS BEFORE RETROACTIVE DATE IS NOT COVERED Creative Litigation is Expensive Lawyers and litigants, when a great deal of money is involved and facts are egregious will try multiple creative arguments to cause a court to interpret a policy … Continue reading

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AN APPLICATION FOR INSURANCE IS ONLY AN OFFER

Before Insurance Exists There Must Be an Offer, Acceptance and Payment of Premium Insurance is nothing more than a contract. To form a contract there must first be an offer from a potential insured to be insured, acceptance of that … Continue reading

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HOIST ON THEIR OWN PETARD

$56 Million Stipulated Judgment Down the Tubes Failure to read, understand, and properly word an agreement can be exceptionally expensive to all involved. When a tortfeasor, with insurance, files bankruptcy it is not unusual for the parties to enter into … Continue reading

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Insurance Fraud & Poetry

In Every Case Some Verse Must Exist In Commonwealth of Pennsylvania v. Daniel Goodson, III, No. 28 WAP 2010, the Supreme Court of Pennsylvania, Western District, Mr. Justice Eakin for the court issued the opinion in verse that is repeated, … Continue reading

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Pain and Suffering Damages Need Not Always Be Awarded

UIM Claimant Only Gets Meds After a trial on Ruth Streetie’s Uninsured Motorist claim against her insurer, Progressive Classic Insurance Company, a jury awarded Streetie a judgment in an amount exactly equal to the medical expenses she incurred during a … Continue reading

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CALIFORNIA INSURANCE COMMISSIONER DAVE JONES ANNOUNCES APPROVAL OF “PRINCIPALLY AT-FAULT” REGULATIONS

Press Release The following is a Press Release from the California Department of Insurance and is presented for information of my readers only with a short commentary. When the Department publishes the Regulation I recommend that it be carefully reviewed. … Continue reading

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Go Directly to Jail

68 MONTHS IN PRISON FOR FAKE INSURANCE SCAM UPHELD BY SIXTH CIRCUIT David E. Groppi (“Groppi”) pleaded guilty to one count of mail fraud in connection with an insurance-fraud scheme. The United States Probation Office recommended a sentence of seventy … Continue reading

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Exclusion Applies to UIM Claim

Failure of Public Policy Argument An uninsured motorist and underinsured motorist policy (“UM” & “UIM”) policy specifically excluded coverage to an insured who is injured by a UM or UIM if the injury occurs when the insured is operating a … Continue reading

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Jury Duty

Only A Citizen May Serve on a Jury I have been a lawyer for 40 years. In that time I have spoken to juries as a lawyer and expert witness. I have never served on a jury. I am a … Continue reading

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Katrina – The Creator of Full Employment for Insurance Lawyers

Hurricane Katrina:  It Is Expensive to Refuse Coverage An insured living on the Gulf Coast of Mississippi had the good sense to buy homeowners insurance, flood insurance and a hurricane rider only to find what they purchased was insufficient to … Continue reading

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“Zalma On Insurance” — The E-Book

A Resource for Every Insurance Professional Zalma on Insurance is an e-book published in Adobe Acrobat .pdf format available for download from http://www.zalma.com/INSURANCE.htm and is updated almost daily by this blog, Zalma on Insurance. Every lawyer retained to prosecute or … Continue reading

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44 Years And Still In Love

  The most important insurance any man can buy is to marry a good woman and keep her as a friend, a companion, a lover and a supporter.  Forty four years ago today I convinced a beautiful woman who I … Continue reading

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FRAUD – THE HOLIDAY ISSUE

ZIFL’s Last Issue of 2011 Regardless of which holiday you celebrate at the end of the year I, and Zalma’s Insurance Fraud Letter (ZIFL), wish each reader or ZIFL the best of the season and a fruitful, successful and happy … Continue reading

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The Moral Hazard of Valued Policies

Why A Valued Policy Is Rare It is impossible to determine whether a policy is open or valued by reading only one part of the policy and ignoring the remainder. A policy cannot be properly interpreted by only reading the … Continue reading

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When An Occurrence is Not an Occurrence

Faulty Construction is Not an “Occurrence” Kentucky law holds that faulty construction does not fit within the definition of “occurrence” in a Commercial General Liability (CGL) insurance policy. When a contractor was sued by the owner of a home he … Continue reading

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No IME — No Payment

The Appellate Term of the Supreme Court of New York often rules with brevity that could be emulated by many courts of appeal. In Socrates Medical Health, P.C. A/A/O Juan Acevedo v. Praetorian Insurance Company, No. 570272/11. (N.Y.App.Term 12/06/2011) the … Continue reading

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Zalma on Rescission of Insurance in California

An E-Book By Barry Zalma 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 text of almost every decision of the California courts … Continue reading

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No Coverage for Fraudulent Dating Service

INSURANCE IS Insurance, by definition, is a contract where one undertakes to indemnify another against loss, damage, or liability arising from a contingent or unknown event. If the event has already happened, if it is certain, if it is known, … Continue reading

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Changing A Policy Is Not Bad Faith

Insurer Breached Contract But Did Not Act In Bad Faith Supporting Punitive Damages When an insurer unilaterally changed a policy of insurance to limit coverage for loss of earnings the policy was reformed and the insurer was required to pay … Continue reading

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Who Got Caught?

The following are reports on a few convictions for insurance, Medicare and Medicaid fraud, that will be published again in the December 15, 2011 issue of Zalma’s Insurance Fraud Letter: Five Years Ten Months for Medicare/Medicaid Fraud Matthew Paul Brown, … Continue reading

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Pearl Harbor Attack and Insurance

When An Act of War Is Not War World War II and Insurance Tomorrow, December 7, 2011 is the 70th anniversary of the attack by the Empire of Japan upon the islands of Hawaii and the entry of the United … Continue reading

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Iowa Refuses to Enforce Insurance Policy Limitation Period

Contract Doesn’t Mean What It Says Almost every first party insurance policy including uninsured motorist and underinsured motorist coverages contain a private limitation of action provision that deprives an insured of the benefits of the policy if suit is not … Continue reading

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Two Lawyers Disbarred For Using Runners

Georgia Supreme Court Acts After 10 Years of Litigation Use of “runners” or “cappers” by a lawyer who pays non-lawyers to bring clients is criminal in most states and is always wrong and a violation of the duty owed by … Continue reading

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ALWAYS READ THE ENTIRE POLICY

Pigs Die — Coverage Denied Insurance policies are contracts. They cannot be interpreted clause by clause but must be interpreted as a whole contract. When an insurer relies on one exclusion in an insurance contract and denies coverage although there … Continue reading

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WHAT IS AN INSURANCE BROKER

See the video linked below What is a Broker  

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IT IS OFTEN BEST TO ACCEPT A LOSS GRACIOUSLY

 A Frivolous Appeal Is Expensive Lawyers and their clients do not like to lose. It is for that reason that appellate courts exist, to give the losing party and its lawyers, a second chance to reverse a loss. However, when … Continue reading

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FRAUD — THE EQUAL OPPORTUNITY CRIME

Zalma’s Insurance Fraud Letter  December 1, 2011 Continuing with the twenty third issue of the 15th Year of publication of Zalma’s Insurance Fraud Letter (ZIFL) notes that Insurance Fraud continues unabated as an equal opportunity crime. The current issue of … Continue reading

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