Monthly Archives: July 2012

No Right to Stack Auto Liability Policies in Missouri

Anti-Stacking Language Upheld Patrick McGinness, driving a vehicle owned by his adult daughter, negligently struck and injured Marie DeMeo. DeMeo obtained a $350,000 state-court judgment against McGinness. His daughter’s insurer, American Family Insurance Company, paid its $100,000 policy limit under … Continue reading

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Justice Can’t Always Be Done

Not Every Wrong Has A Remedy There is a maxim of law that “for every wrong there is a remedy.” Like all maxims of law it does not fit every circumstance. In the chambers of the Wisconsin Supreme Court two … Continue reading

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What Policy Says Controls — Not What It Should Say

No Coverage for Defense The District Court, Northern District of Illinois was called upon to resolve an issue of an insurer’s duty to defend in light of a subcontractor exclusion in James River Insurance Company v. Keyes2safety, Inc., the Mcclier … Continue reading

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Control of Vehicle is Necessary

No Control, No Lease, No Borrowing, No Coverage The Iowa Court of Appeal was asked to overturn a trial court’s grant of summary judgment in favor of defendant Heritage Mutual Insurance Company (“Heritage”) after finding the commercial insurance policy Heritage … Continue reading

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Adjusters Are Entitled to Overtime

Professionalism in Claims Handling Dealt A Serious Blow by California Courts In 1967 when I became a trainee insurance adjuster I believed I was entering a profession where my skill, intelligence and experience were required to help my employer fulfill … Continue reading

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Posted in Zalma on Insurance | 4 Comments

State May Prosecute Dr. For Stealing From Medicare

Physician Fraudster Will Serve Eight Years The Appeal Defendant, Benjamin Levine, M.D., appealed his conviction by a jury of third-degree unlicensed practice of medicine,, second-degree theft by deception, two counts of fourth-degree falsification of records, and third-degree insurance fraud. He … Continue reading

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Fight Against Insurance Fraud In New Jersey Now More Difficult

Agent Owes No More Duties Than Principal The New Jersey Supreme Court was faced with an appeal that presented a discrete, narrow legal question: “is a health care provider who has received an assignment of personal injury protection (PIP) benefits … Continue reading

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He Who Sits on His Rights Loses

PRIVATE LIMITATION OF ACTION ENFORCED In March 2010, Brian and Julie Hoover (Hoovers) filed a complaint against their home insurer, Country Mutual Insurance Company (Country Mutual), and Michael Spann (the “agent”), a Country Mutual insurance agent. According to the complaint, … Continue reading

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“A Small Step For Man…”

ZALMA OPINION The Need For Risk Takers On July 20, 1969, Neil Armstrong stepped upon the surface of the moon as the ultimate successful risk taker. When he said those words 43 years ago, the United States was vigorous and … Continue reading

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Failure to Chew Not Compensable

The Quesadilla Caper The Virginia Court of Appeal was called upon to resolve a dispute between the workers’ compensation commission and Michael Bernard, a restaurant waiter who attempted to swallow a piece of quesadilla that was too big for his … Continue reading

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The Only Certainty in Life Is Taxes

Lies, Damn Lies and Taxes Oregon Taxes a Non-Resident Insurer’s Income The Oregon Tax Court was asked to resolve issues concerning earnings and taxes imposed on the Costco Wholesale Corporation (the “Taxpayer”) who is engaged in the operation of membership … Continue reading

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Insurance, to Be Effective, Must Be Written

The Insured’s Burden  It is axiomatic that in every contract of insurance or reinsurance the insured bears the burden of demonstrating that a claim falls within a policy’s affirmative grant of coverage. The First Circuit Court of Appeal was asked … Continue reading

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The Proper Use of Interpleader

COLORABLE ADVERSE CLAIMS REQUIRE INTERPLEADER When two or more people make a colorable claim on insurance proceeds an insurer cannot safely pay one without facing litigation and the possibility of double payment to the others. The Ninth Circuit Court of … Continue reading

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Arson, Dead Cat, and Fraud

Zalma’s Insurance Fraud Letter July 15, 2012 — Now Available Continuing with the fourteenth issue of the 16th Year of publication of Zalma’s Insurance Fraud Letter (ZIFL) reports in its July 15, 2012 issue why an arson-for-profit conviction was affirmed … Continue reading

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The Four Corners Rule Strikes Again

If the Allegations are Excluded there is No Coverage for Defense CGL policies written for people in the construction business are not all inclusive and clearly exclude coverage for defective work. In Ohio, faced with allegations of defective work that … Continue reading

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Bad Faith Deserves Punishment

A Clear Example of “Bad Faith” As readers of Zalma on Insurance are aware I am not a fan of the tort of bad faith. However, the following case shows such egregious conduct on the part of an insurer that … Continue reading

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A Collapse or Not a Collapse – That is the Question

“Collapse” Is Not Necessarily a Collapse   Kings Ridge Community Association, Inc. (“the Association”), appealed a final summary judgment in favor of its insurer, Sagamore Insurance Company in Kings Ridge Community Association, Inc v. Sagamore Insurance Company, No. 5D11-1051 (Fla.App. … Continue reading

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After A Jury Finds Fraud Insurance Policy Is Void

Fraud Voids Coverage While Investigating Fraud Insurer Must Act in Good Faith Mark Kohout defaulted on a loan secured by a mortgage on his home in Litchfield. The mortgagee, Mortgage Electronic Registration Systems, Inc., purchased the home for $170,000 at … Continue reading

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You Can’t Make an Apple Into an Orange

Clear Language of Policy Enforced The Wisconsin Supreme Court reviewed a published decision of the court of appeals to determine if an excess liability policy also provided uninsured motorist (UM) coverage. The Court of Appeal reversed the decision of the … Continue reading

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No Conflict When Coverage Issue Not A Fact to Be Adjudicated

Independent Counsel Available only If There is a Real Conflict Downhole Navigator, L.L.C. (“Downhole”) appealed to the Fifth Circuit Court of Appeal from the magistrate judge’s grant of partial summary judgment for Nautilus Insurance Company (“Nautilus”). Nautilus had issued Downhole … Continue reading

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Claims Commandment XV

Thou Shall Not Be Cruel This series of claims commandments 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 … Continue reading

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Attempt to Restrain Public Adjusters in Florida Fails

The First Amendment Prevails Public Insurance Adjusters provide a service to people who wish to present a claim to a first party insurer. Because, in a catastrophe, people are suffering and vulnerable states attempt to control the solicitation by public … Continue reading

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Insurance Fraud Conviction Stands

Intent to Defraud Is Necessary for Conviction The California Court of Appeal was called upon to determine the propriety of a conviction for auto insurance fraud in People v. Ronda Lee Papa, No. D058654 (Cal.App. Dist.4 06/13/2012) after a jury … Continue reading

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Happy Birthday U.S.A.

As the son of an immigrant — a first generation American born in the U.S.A. — I wish everyone a Happy Independence Day and thank everyone for the the opportunity the U.S.A. gave my family to escape oppression at the … Continue reading

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I am on vacation

My wife and I are enjoying beautiful Vancouver BC so posts and Zalma’s Insurance Fraud Letter will be late this month.    

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