Monthly Archives: May 2012

Claims Commandment V

Thou Shall Communicate With the Insured This is an effort to provide direction to every person involved in claims handling for insurers and the public and will continue until completed. Unlike the Old Testament I will not limit myself to … Continue reading

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Claims Commandment IV

This is an effort to provide direction to every person involved in claims handling for insurers and the public and will continue until completed. Unlike the Old Testament I will not limit myself to just ten Commandments that should be … Continue reading

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Claims Commandment III

This is an effort to provide direction to every person involved in claims handling for insurers and the public and will continue until completed. Unlike the Old Testament I will not limit myself to just ten Commandments that should be … Continue reading

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Claims Commandment II

This is an effort to provide direction to every person involved in claims handling for insurers and the public and will continue until completed. Unlike the Old Testament I will not limit myself to just ten Commandments that should be … Continue reading

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Claims Commandment I

Thou Shall Confirm Coverage This is the beginning of an effort to provide direction to every person involved in claims handling for insurers and the public and will continue until completed. Unlike the Old Testament I will not limit myself … Continue reading

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Stop Loss Insurance is Not Reinsurance

Self-Funded Employee Health Plan is Not Insurance The Supreme Court of Texas was asked to resolve whether stop-loss insurance sold to self-funded employee health-benefit plans is “direct health insurance” or “reinsurance.” The distinction was important because, in Texas, direct insurance … Continue reading

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Clear Exclusion in CGL Must Be Applied

Policies Must Be Carefully Read Before Acquisition An injured party sued defendant-appellant Perry Stolberg (“Stolberg”), a developer, in a Massachusetts state court for injuries allegedly sustained in the course of construction work. The appellant tendered the defense of the suit … Continue reading

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Insurance Policy Interpretation

Physician Heal Thyself — No Coverage When a professional is disciplined by a professional organization like a medical board or a state bar association the professional seeks defense from a professional errors and omissions insurer claiming that the disciplinary proceeding … Continue reading

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Intentional Harm to an Infant is Abuse

No Cover For Intentional Harm to Infant Kurt Schmoldt, Stacy Schmoldt, and Jane Doe, by her guardian ad litem (collectively, the “Schmoldt Plaintiffs”), appealed the trial court order that ruled that American Family Mutual Insurance Company (“American Family”) had no … Continue reading

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Clear & Unambiguous Policy Enforced

Not Disabled from “Own Occupation” Disability insurers are often chastised for not accepting an insured’s claim of disability. At the same time, people who are not disabled from their own occupation attempt to recover from their disability insurer when they … Continue reading

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Statute Rewrites Policy

The Unquestioned Right Is Questioned Some states do not like insurance companies and have been known to eliminate the right of the insurer and insured to agree on a restrictive provision in a statute. Although most state courts, including that … Continue reading

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18 Years in Prison for Arson for Profit

Obvious Arson For Profit Deserves Jail Amateur arsonists do everything necessary to convince fire cause and origin investigators that a fire was not accidental. They use petroleum based accellerants to speed and spread the fire. They set more than one … Continue reading

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Insurance Fraud Is A Crime

Zalma’s Insurance Fraud Letter May 15, 2012 Continuing with the tenth issue of 16th  Year of publication of Zalma’s Insurance Fraud Letter (ZIFL) reports on May 15, 2012 Barry Zalma comments on why faking the theft of a vehicle to … Continue reading

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Appraisal

Complex Claims Should Be Resolved by Insurance Policy Appraisal “Appraisal” is a form of arbitration required by insurance policies that allows the amount of loss to be determined by a panel of three appraisers whose duty is limited to determining … Continue reading

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Just For Fun

The Mortgagee The story that follows is based on fact. The names, places and descriptions have been changed to protect the guilty. This story was written for the purpose of providing insurers, those in the insurance business, and the insurance … Continue reading

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No Coverage For Illegal Act

Is Shooting a Car and Killing Its Occupant An Occurrence? The Mississippi Court of Appeal was asked to determine whether a criminal act that caused the “accidental death” of a person can be an “occurrence” or “accident” as defined in … Continue reading

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Potential of Coverage Not Unlimited

Intentional Act Never Covered Imaginative and creative lawyers, seeking to provide a defense to an insured person who intentionally and willfully caused damage to another will attempt to characterize the litigation, and the facts surrounding it, as negligent rather than … Continue reading

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Private Limitation of Actions Provision Enforced

Failure to Read Policy No Excuse In more than 40 years of legal practice I have only interviewed two people who claimed they read and understood their insurance policy — both lied. Insurance policies, especially modern easy to read policies … Continue reading

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Court Refuses to Rewrite an Insurance Policy

Evidence is Required to Prove Exclusion Applies The Indiana Court of Appeal was called upon to resolve an insurance dispute over an exclusion for causing an accident while under influence of a controlled substance. In Shawn A. Keckler, Kari Felda, Special … Continue reading

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Third Party Beneficiary Can Sue Insurer for Bad Faith

Med Pay Is For Benefit Of Injured Patricia Meleski appealed a trial court’s non-final order dismissing on summary judgment her bad-faith claims against Partners Mutual Insurance Company. In Patricia Meleski v. Schbohm LLC and Partners Mutual Insurance Company, No. 2010AP2951 … Continue reading

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You Only Get What You Ask For

Flood Insurer is Not A Fiduciary James Grissom purchased flood insurance for his home in Pascagoula, Mississippi under the Federal National Flood Insurance Program (“NFIP”). Grissom was eligible for a preferred risk insurance policy, but did not know about his … Continue reading

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Collateral Source In Colorado

Colorado Allows Doctor’s Billing Rather Than True Value of Services The Supreme Court of Colorado was asked to review an unpublished decision of the Court of Appeal in in Sunahara v. State Farm Mutual Automobile Insurance Co., No. 09CA0599, slip … Continue reading

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Happy Law Day – A New Method to Defeat Arson-For Profit

Free Zalma’s Insurance Fraud Letter May 1, 2012 In this, the ninth issue of the 16th year of publication Zalma’s Insurance Fraud Letter (ZIFL), ZIFL reports on: 1.    Barry Zalma reports on an interesting appellate decision that convicted a person … Continue reading

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