Monthly Archives: March 2012

Zalma’s Insurance Fraud Letter

Attempt to Sue Fraud Perpetrators Fails In this, the seventh issue of the 16th year of publication Zalma’s Insurance Fraud Letter (ZIFL), ZIFL reports on: 1.    An insurer that sues its insureds or vendors for insurance fraud must do so … Continue reading

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Assault & Battery Not In Scope of Employment

When an Insured is Not an Insured The Maine Supreme Judicial Court was asked to resolve an insurance coverage issue raised by an assault and battery in The Travelers Indemnity Company v. Michael A. Bryant et al., No. Docket: Cum-11-380 … Continue reading

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Go Directly to Jail

Insurance Agent Should Not Steal From an Old Lady Aaron Pittman (defendant) appealed from judgments entered upon jury convictions for 1) insurance fraud, 2) obtaining property by false pretenses, and 3) exploitation of an elder adult. He unsuccessfully asked the … Continue reading

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Insurance Only Adds to Security of Mortgagee

Contract Controls Who Gets Insurance Proceeds in a Foreclosure The Connecticut Court of Appeal was asked to resolve a dispute over who was entitled to recover from an excess insurance policy for damage to property in James M. Jancewicz et … Continue reading

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Medicaid’s Right Of Subrogation Limited

Medicaid Must Assert Lien on Personal Injury Recovery Under federal law, states participating in the Medicaid program are obligated (with some exceptions) to seek reimbursement from third-party tortfeasors for health care expenditures made on behalf of Medicaid beneficiaries who are … Continue reading

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AUTO LESSOR MUST COMPLY WITH STATE MINIMUM LIABILITY STATUTE

Breach of Lease by Lessee Expensive to Lessor When a person is uninsured and injures someone the injured parties who are also uninsured must be creative to obtain damages for their injuries. Without primary insurance or uninsured motorist coverage the … Continue reading

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First Circuit On Insurance for Loss of Use

Loss of Use The First Circuit Court of Appeal was called upon to resolve an insurance coverage dispute concerning the scope of a “loss of use” provision in Vicor Corporation v. Vigilant Insurance Company; Federal Insurance, No. Nos. 09-1470, (1st … Continue reading

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Convictions for Health Insurance Fraud

The following are reports from Zalma’s Insurance Fraud Letter (ZIFL), March 15, 2012, on health insurance fraud convictions. You can read the last two issues of ZIFL at:  http://www.zalma.com/ZIFL-CURRENT.htm. Indiana Doctor Guilty of Health Care Fraud Dr. Kamal Tiwari, a … Continue reading

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It is Still Time to Put A Stake Through the Heart of the Tort of Bad Faith

In 2008 I wrote an article about the so-called tort of bad faith called “It’s Time to Put a State Through the Heart of the Tort of Bad Faith.” It is time to review its conclusions, and repeat and add … Continue reading

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Damage to “Work” Not “Property Damage”

A ROOF TILE IS PART OF A ROOF The Eleventh Circuit Court of Appeal was asked to resolve an insurance coverage dispute that required it to determine, under Florida law, what constitutes “property damage” under a post-1986 standard form commercial … Continue reading

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An “Insured Location” is As Defined By the Policy

Serious Injury Requires Clarification of Policy Terms The Connecticut Supreme Court was asked by the United States Court of Appeals for the Second Circuit, to explain the proper construction of terms in a homeowners insurance contract under Connecticut law in … Continue reading

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POLLUTION EXCLUSION EXPLAINED

Pollution Exclusion Applies The Seventh Circuit was called upon to resolve, using the law of Illinois, the proper interpretation of the pollution exclusion in a general liability insurance policy. The most common policy is the “commercial general liability policy” drafted … Continue reading

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The Attempts to Limit Insurance Fraud Continue

Zalma’s Insurance Fraud Letter March 15, 2012 In the sixth issue of the 16th year of publication Zalma’s Insurance Fraud Letter (ZIFL), reports on: 1.    How the incompetence of those in control of the Medicaid system make insurance fraud against … Continue reading

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Recovery for Medical Bills Not Owed

Fair or Fraud? The Wisconsin Supreme Court was asked to determine the proper measure of damages in an action to recover under an injured party’s underinsured motorist (UIM) coverage in Lindy Orlowski v. State Farm Mutual Automobile Insurance Company, 2012 … Continue reading

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Victim of Katrina Can’t Sue Twice

When You A Vacate Settlement Agreement You Must Give Back The Money Usually a settlement agreement between an insured and insurer resolves the entire dispute and both sides go on to live the rest of their life. Insurance claims, even … Continue reading

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Appraisal Only Determines Loss

The Need For Competent and Experienced Claims People The Ohio Court of Appeal was required to resolve a dispute between Westfield Insurance Co. (hereinafter “Westfield”) and its insureds over the entry of judgment after an appraisal award was entered. Westfield … Continue reading

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IN, ON, OR UPON AN AUTOMOBILE

Clear and Unambiguous Policy Language In Michigan the Court of Appeal was asked to determine whether a person close to or touching a vehicle is “occupying” it or is “in, on or upon” the vehicle for the purpose of determining … Continue reading

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PRIVATE LIMITATION OF ACTION PROVISION ENFORCED

INSURANCE IS ONLY A CONTRACT The Tennessee Court of Appeal was asked to resolve whether a private limitation of action provision of an insurance policy trumps a longer breach of contract statute of limitations enacted by the state legislature in … Continue reading

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AN EXCEPTION TO THE EIGHT CORNERS RULE

The Eight Corners Rule Fails To Provide Justice The eight corners rule of contract interpretation applied in Texas and other states limits the court’s analysis of an insurance coverage dispute to the words of the policy and the allegations of … Continue reading

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Holy Bat Trap, Batman! – Guano & Insurance

Bat Guano — Pollutant or Not The plaintiffs filed suit against their insurer, Auto-Owners, for breach of contract and bad faith, claiming that Auto-Owners was liable for the total loss of their vacation home that was uninhabitable and unsaleable as … Continue reading

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Insurance Policy Means What it Says in Virginia

Courts Must Apply Clear and Unambiguous Policy Exclusion The Supreme Court of Virginia was asked to overturn a trial court decision that an exclusion in an automobile insurance policy regarding coverage for medical expenses barred the policyholder from receiving any … Continue reading

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BROKER’S DUTY TO ADVISE OF INSOLVENCY OF INSURER

Limitations on a Broker’s Duty The California Court of Appeal was presented with an issue it described as an issue of first impression in California in Pacific Rim Mechanical Contractors, Inc v. Aon Risk Insurance Services West, Inc., et al, … Continue reading

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Zalma’s Insurance Fraud Letter — March 1, 2012

INSURANCE FRAUD  DEEP WATER CRIME In this, the fifth issue of the 16th year of publication Zalma’s Insurance Fraud Letter (ZIFL) reports on the crime of insurance fraud reminding its readers that insurance fraud continues, without any cognizable abatement. Insurers … Continue reading

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