Zalma on Insurance
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Zalma on Insurance
- Report Promptly or Lose June 19, 2013
- Confession Is Good For Conviction June 18, 2013
- Excess – Primary – Joint June 17, 2013
- First Amendment Protects Legal Research June 17, 2013
- Must Read Entire Policy June 14, 2013
- Defend or Else June 13, 2013
- The Tipsy Coachman June 12, 2013
- A Bird in the Hand June 11, 2013
- State Statute Invalid June 10, 2013
- Carbon Monoxide Flow Not Property Damage June 7, 2013
- Obligations are Not Payments June 6, 2013
- Threat Isn’t Enough June 5, 2013
- Contract of Personal Indemnity June 4, 2013
- Drug Intoxication Not Accidental Death June 3, 2013
- New E-Book by Barry Zalma May 31, 2013
- Promises – Promises May 31, 2013
- NFL Suits Stayed May 30, 2013
- Coinsurance Avoided May 29, 2013
- Policy Defines Who Is An Insured May 28, 2013
- Accident or Intentional Act May 27, 2013
More E-Books by Barry Zalma
Available at http://www.zalma.com/zalmabooks.htm including: "Zalma on Diminution in Value Damages 2012" "Heads I Win, Tails You Lose -- 2011" "The Truth, The Whole Truth and Nothing But the Truth" "Zalma on California Claims Regulations - 2011" "Zalma on Rescission in California" "Arson for Profit" a novel "Insurance Fraud" "Murder and Insurance Fraud Don't Mix" a novella All are published in Adobe Acrobat .pdf format and can be read on any I-Pad, I-Phone, Kindle, book reader, smart phone or computer.New E-Books
"Zalma on Diminution of Value Damages -- 2013"
This is the 2013 edition of Zalma On Diminution In Value Damages. It has been totally rewritten with more 910 pages of material. It is the most extensive and detailed coverage of the issue and how to apply diminution in value damages to losses to property. The E-book Zalma on Diminution In Value Damages – 2013 was written to provide sufficient information to those who became interested in the issue since the Georgia Supreme Court decided State Farm Mutual Automobile Insurance Co. v. Mabry, 274 Ga. 498, 556 S.E.2d 114 (Ga. 11/28/2001).
Available at http://www.zalma.com/diminution.htm,
"Zalma on California SIU Regulations"
"Zalma On California SIU Regulations" is designed to assist California insurance claims personnel, claims professionals, independent insurance adjusters, special fraud investigators, private investigators who work for the insurance industry, the management in the industry, the attorneys who serve the industry, and all integral anti-fraud personnel working with California admitted insurers to comply with the requirements of California SIU Claims Regulations.
The state of California, by statute, requires all admitted insurers to maintain a Special Investigative Unit (an "SIU") that complies with the requirements set forth in the Special Investigative Unit Regulations (the "SIU Regulations") and train all integral anti-fraud personnel to recognize indicators of insurance fraud.
It is necessary, therefore, that insurance personnel who are engaged in any way in the presentation, processing, or negotiation of insurance claims in California be familiar with the SIU Regulations imposed by the state on all insurers doing business in the state.
Available at http://www.zalma.com/zalmabooks.htm.
"Zalma on California Claims Regulations - 2013"
The 2013 issue adds information on a September 2012 ruling by an administrative law judge that prohibits the enforcement of many of the Regulations because they violate, by unlawfully expanding, the meaning of California Insurance Code Section 790.03(h). The new edition was rewritten and includes detailed analysis of the ruling by California Administrative Law Judge Stephen J. Smith who issued a 51-page ruling finding the CDI’s Fair Claims Practices Regulations (FCPR) might not be brought as unfair claims acts. The ruling affects how the CDI has imposed, and will impose in the future, penalties against insurers for claims since the inception of the FCPR in 1992.
In the court’s extensive ruling, which contained 150 separate findings, the court ruled that:
None of the standards prescribed in the FCPR appear anywhere in California Insurance Code § 790.03 (pursuant to which statute the CDI adopted the FCPR); these are additional standards added exclusively by regulatory action of the CDI.
The FCPR as applied are unenforceable pursuant to California Government Code §§ 11152 and 11342.2, which establish the test for determining the validity of regulations. Specifically, the court held that § 2695.1 of the FCPR improperly creates new unfair standards and duties within the meaning of Insurance Code § 790.03(h), which subjects insurers to the penalty provisions of Insurance Code § 790.035 for failure to meet those standards.
The FCPR through CCR § 2695.1(a) dramatically and impermissibly expands the scope, nature and reach of the 16 unfair claims settlement practices set forth in Insurance Code § 790.03(h)(1)-(16). The court held that new unfair acts may only be promulgated by the legislature or through the process set forth in Insurance Code § 790.06.
The CDI’s language in CCR § 2695.1 impermissibly amends Insurance Code § 790.03(h) such that a violation can be proved by means of a single knowing act or by proof of a general business practice, which amendment lowers the burden of proof and quality of evidence necessary for the CDI to prove a violation of § 790.03(h). In order to assert a violation of § 790.03(h), proof must be shown that the violation was both knowingly committed and performed with such frequency as to reflect a general business practice.
An OSC drawn from the conclusions or statements in a Market Conduct Examination is improper to support a valid pleading. Such examinations lack specificity about each act. OSC pleadings must assert violations under Insurance Code § 790.03(h)(1)-(16) and pleadings must set forth the charges and allegations in ordinary and concise language, such that the acts or omissions of which the respondent is charged may be reasonably ascertained.
"Zalma on Rescission of Insurance in California - 2013"Insurers in California have the right to rescind a policy of insurance if the insured misrepresents or conceals a material fact when seeking insurance. California, more than a century ago, adopted, and codified, the ancient Marine Rule with regard to the interpretation of insurance contracts created as a result of misrepresentation or concealment of a material fact allowing rescission even if the concealment or misrepresentation was innocent or unintentional.
Available at http://www.zalma.com/rescission.htm
"Random Thoughts on Insurance"
Since 2010 I have been writing a blog post at least five days a week. This e-book is a collection of those posts that reveal my interest in insurance case law. Some of the cases reviewed were important. Some were of first impression. Others will be totally unimportant. All were interesting to me and I hope are interesting to the reader.
The book is available at http://www.zalma.com/RANDOMTHOUGHTS.htm
====="Zalma on Insurance Fraud - 2012"
Barry Zalma has totally rewritten his seminal E-Book on insurance fraud and has added over 600 pages to the original book.
It is the purpose of the E-book to provide information to those who are engaged in the effort to reduce insurance fraud. It will provide information for the lawyers representing insurers so that they can adequately advise their clients who are victims of the crime of insurance fraud.
This E-book will provide information for insurance claims investigators, special insurance fraud investigators working at insurance company Special Investigation Units (SIU), Fraud Bureau Investigators, and Prosecutors will have the information needed to allow prosecution of insurance criminals to proceed. Prosecutors will also have sufficient information to understand the importance of the crime and the need to reduce the crime by effective prosecution and punishment of the insurance fraud perpetrators.
====="Zalma On Diminution In Value Damages - 2012"
The 2012 edition of Zalma On Diminution In Value Damages. It has been totally rewritten with more than 240 pages of new cases and statutes. It is the most extensive and detailed coverage of the issue and how to apply diminution in value damages to losses to property. The E-book Zalma on Diminution In Value Damages – 2012 was written to provide sufficient information to those who became interested in the issue since the Georgia Supreme Court decided State Farm Mutual Automobile Insurance Co. v. Mabry, 274 Ga. 498, 556 S.E.2d 114 (Ga. 11/28/2001).
Because of the differences in the various jurisdiction and apparent confusion concerning diminution of value damages this E-Book was created to more thoroughly review how each jurisdiction in the United States deals with the issue. The E-book covers each of the fifty states of the United States, the District of Columbia, Guam, Puerto Rico, the 12 Federal Circuit Courts of Appeal and the U.S. Supreme Court.
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"Zalma on Insurance" at http://www.zalma.com/zalmabooks.htm.Every lawyer retained to prosecute or defend a civil suit should begin the representation with efforts to find insurance coverage for the benefit of the client. Indeed, a lawyer that does not know the law of insurance is litigating with duct tape firmly placed across his or her mouth.
====="Murder and Insurance Fraud Don't Mix" -- A Novella Only $5.00
A new Novella from Barry Zalma involving an insurance fraud that goes terribly wrong when the perpetrator finds it necessary to murder the only possible witness to the crime. Follow the actions of MOM, the insurance company investigator who discovers the fraud and helps the police bring the killer to justice.
To buy go to http://www.zalma.com/zalmabooks.htm.
Zalma on Insurance Is a LexisNexis Top Blogs for Insurance Law – 2011!
Zalma on Insurance has been selected as a LexisNexis Top Blogs for Insurance Law – 2011! Selections were made by the LexisNexis Insurance Law Community staff in consultation with the Insurance Law Community Advisory Board members. The Top Blogs contain some of the best writing out there on insurance law. They contain a wealth of information for the insurance law community with timely news items, practical information, expert analysis, practice tips, frequent postings, and helpful links to other sites. These blogsites demonstrate how bloggers can impact the world of insurance law. You can read the full announcement and list of honorees at http://www.lexisnexis.com/community/insurancelaw/blogs/topblogs/archive/2011/11/11/the-winners-the-insurance-law-community-top-blogs-for-2011.aspx.Zalma On Insurance — The Blog
After more than 40 years acting as a claims person and insurance coverage lawyer I enjoy reading court decisions concerning insurance. The idea of this blog is to find new cases that are interesting to me and then write a summary. Some of the cases reviewed will be important. Some may be of first impression. Others will be totally unimportant. All will be interesting. The blog is also intended to act as an almost daily update of the E-Book "Zalma on Insurance" available at http://www.zalma.com/zalmabooks.htm.Insurance Claims: A Comprehensive Guide
by Barry Zalma, J.D., C.F.E Now available on CD and electronically so that you can take it with you on your I-Pad, book reader or laptop. This one-of-a-kind Guide covers the fields of property insurance claims, liability, and fraud. It is ideal both as a detailed reference for the insurance professional and as a plain language guide for those—such as attorneys and business owners—who frequently interact with the industry. In addition to examining the nature of property and liability policies and the processing of claims under these policies, the Guide discusses the complexities of such topics as underwriting, bad faith, subrogation and salvage, duties of the insured and insurer, and declaring a policy void. Details at http://www.stpub.com To Purchase: Call 1-800-251-0381 or email orders@stpub.comConstruction Defects
Construction Defects : Litigation and Claims Barry Zalma, J.D., C.F.E. Construction Defects: Litigation and Claims explains how to investigate, prosecute, or defend cases that address construction defects-one of the most active areas of litigation in the United States. To Purchase: Call 1-800-251-0381 or email orders@stpub.comMold: A Comprehensive Claims Guide
Barry Zalma Esq., C.F.E. Mold: A Comprehensive Claims Guide is designed to assist anyone faced with claims for property damage or bodily injury to third parties, or damage to property owned by the insured as a result of claimed exposure to mold, fungi, or bacterial infestations. It moves through the claim process, from the initial report of the claim to the final resolution, proof of loss, and payment. It provides guidance to anyone confronting losses caused by mold, and addresses the obligations imposed on insurers, including underwriting against mold claims and investigating potential fraud claims. Property owners and insurance companies alike will find Mold: A Comprehensive Claims Guide a valuable resource for presenting cases and preparing mold claims. To Purchase: Call 1-800-251-0381 or email orders@stpub.comArchives
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DISCLAIMER
This Blog is made available by the lawyer or law firm publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the publisher. The blog should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Monthly Archives: August 2012
Exclusion Applies to Accidental Death Policy
Death by Medical Malpractice The New Jersey Superior Court, Appellate Division, was called upon to resolve a dispute between Jeffrey Paul, decedent Richard Paul’s (“Paul”) son and New York Life Insurance Company (“NYLIC”) in Estate of Richard Paul, Deceased, By … Continue reading
Tolling of a Statute of Limitations
Whenever Payment Made to Claimant Advise When Statute of Limitations Will Run The California Court of Appeal was called upon to resolve a dispute over whether a statute of limitations had been tolled because an insurer that paid for a … Continue reading
INDISPUTABLE EVIDENCE NEEDED FOR “FAIRLY DEBATABLE DEFENSE
Get Evidence Before Denying a Claim The Supreme Court of Utah was asked to resolve whether a “fairly debatable” defense to a bad faith claim must be resolved by summary judgment in Chad Jones v. Farmers Insurance Exchange, 2012 UT … Continue reading
“PERSONAL INJURY” COVERAGE IS BROAD
Invasion of Right of Private Occupancy of Land is Covered The Indiana Court of Appeals was called upon to resolve an insurance coverage for claims arising from the abandonment of foundry sand from the Indianapolis foundry of Daimler Chrysler Corporation, … Continue reading
WHEN “SUDDEN” IS NOT
SUDDEN & ACCIDENTAL MAY JUST MEAN “UNEXPECTED” The Supreme Court of New Mexico was required to interpret the meaning of a single word, “sudden,” within a pollution exclusion clause in a series of liability insurance policies barring coverage for certain … Continue reading
Comparative Fault Requires Setoff-with-Contribution When One Joint Tortfeasor Settles
Common Law Release Rule Is No More The California Supreme Court has been very busy dealing with insurance and tort law, allowing stacking of policies on continuing third party claims, limiting plaintiffs to actual charges for medical services rather than … Continue reading
Insurer Must Control Defense in Good Faith
Counsel Appointed by Insurer Must Protect Insured’s Right to Coverage When an insurer appoints an attorney to defend its insured subject to a reservation of rights the attorney appointed owes a duty to represent the insured vigorously, must not become … Continue reading
Workers’ Compensation Is Not Always an Exclusive Remedy
Right to Augment Workers’ Comp Benefits Limited to Worker In California, where an employee is injured in the course and scope of his or her employment, workers’ compensation is generally the exclusive remedy of the employee and his or her … Continue reading
RIGHT TO JURY TRIAL IN DECLARATORY RELIEF ACTION
Failure to Fish or Cut Bait In Allen M. Entin v. the Superior Court of Los Angeles County, No. B239642 (Cal.App. Dist.2 08/20/2012) the insurer filed a declaratory relief action that was pending while the benefits of disability insurance policies … Continue reading
Waiver of Stacking Upheld
The Right to Stack UM Coverage Can Be Waived People who insure their cars in Pennsyvania have the right to stack coverages for uninsured motorist (“UM”) or Underinsured Mortorist (“UIM”) coverages if they insure more than one vehicle with their … Continue reading
“However Caused” Exclusion Applies
Exclude Result Rather Than Cause When insurers first began to insure people against the risk of loss of property they specified the risks of loss they would insure, such as “fire” or “windstorm”. To sell more policies insurers offered “all … Continue reading
CONVICTION FOR INSURANCE FRAUD AND ARSON AFFIRMED
PUNISHMENT FOR ARSON MUST BE SEVERE Arson is the most serious form of insurance fraud because innocent people and firefighters die or are injured as a result of the crime. The punishment for this crime cannot, in my opinion, be … Continue reading
ARBITRATION DECISION CAN MAKE CONDOMINIUM DEVELOPERS MORE INSURABLE
Effective Underwriting Requires Review of CC&R’s Every insurer that insures developers of condominium projects in California for their liability for claims of construction defects should carefully review the decision of the California Supreme Court in Pinnacle Museum Tower v. Pinnacle … Continue reading
Rejection of UM/UIM Coverage Upheld
NEED DOES NOT CREATE COVERAGE Herman Duke and Gayle Duke (the “Dukes”) appealed a summary judgment granted in favor of , Sentry Select Insurance Company (“Sentry”). The trial court found that uninsured motorist coverage had been validly rejected by the … Continue reading
Private Limitations of Action Enforced
PRUDENT INSURER WARNS INSURED OF TIME TO SUE Joseph D. Elias (Elias) sued his insurer, for breach of an insurance contract. The trial court granted summary judgment to defendant Farmers Insurance Exchange (Farmers) on the ground that the action was … Continue reading
INSURANCE FRAUD CONTINUES UNABATED
Zalma’s Insurance Fraud Letter August 15, 2012 Continuing with the sixteenth issue of the 16th Year of publication of Zalma’s Insurance Fraud Letter (ZIFL) reports in its August 15, 2012 issue that Alabama adds statutes to aid in its fight … Continue reading
Excess Owes No Duty to Defend
Insurer v. Insurer — Both Lose, One Loses More Than Another When one insurer sues another trying to transfer the risk taken to the other both will probably lose because of the costs of defending or prosecuting the suit. In … Continue reading
KISS A FROG AND ALL YOU GET IS AN ANGRY FROG
Clear Policy Language Must be Enforced When serious injuries and death result from an accident parties and their lawyers often grasp at any possibility to obtain insurance coverage from insurers that neither intended to nor agreed to provide protection for … Continue reading
California Allows Stacking of CGL
A CASE OF FIRST IMPRESSION AND IMPORTANCE The state of California is a financial basket case. It has been ordered by a federal court to clean up the pollution caused by the construction and use of the Stringfellow Acid Pits … Continue reading
No Coverage If Not an Insured
AMBIGUITY CAN’T BE CREATED FROM WHOLE CLOTH The Illinois Court of Appeal was asked to resolve a dispute between an insurer and its insured over the meaning of an exclusion in Sandra Knezovich, Personal Representative of the v. Hallmark Insurance … Continue reading
The Danger Of Withdrawing Defense
Breach Duty to Defend and Lose Right to Attack the Settlement Two insurance carriers that provided consecutive coverage to a mutual insured asked the Texas Court of Appeal whether Audubon Insurance Company (Audubon) should receive contribution and reimbursement from Great … Continue reading
CONDITIONS PRECEDENT CONTROL
No Right to Benefits for Failure to Fulfill Condition On September 20, 2005, the plaintiff/appellant, Daniel Shaw (hereinafter “Shaw”), was involved in a one-vehicle car accident. On September 27, 2007, Shaw filed a lawsuit against Nationwide Insurance and Robert … Continue reading
The Danger of a Covenant Not to Execute
MALICIOUS LAWYER LOSES COVERAGE Lawyers who filed and maintained a maliciously prosecuted; when sued for malicious prosecution, the lawyers entered into a settlement with the injured party for a $4.5 million verdict that could only be executed against the lawyers’ … Continue reading
Random Thoughts on Insurance
NEW E-BOOK RANDOM THOUGHTS ON INSURANCE A COLLECTION FROM BARRY ZALMA’S BLOG ZALMA ON INSURANCE Since 2010 Barry Zalma has been writing a blog post at least five days a week. This e-book is a collection of those posts that … Continue reading
Deny Defense & Lose Right to Belatedly Control Defense
INSURER SHOULD NEVER DENY A DEFENSE UNLESS ABSOLUTELY CERTAIN NO POTENTIAL FOR COVERAGE The District Court, Northern District of California, granted a motion for summary judgment in favor of KB Home in part against the Travlers in Kaufman & Broad … Continue reading
HE WHO SITS ON HIS RIGHTS LOSES THEM
Never Ignore the Statute of Limitations The Wisconsin Court of Appeal was called upon to resolve a dispute over the application of a statute of limitations in a suit against American Family Mutual Insurance Company, Gage Creighbaum, Sherry Lagios, and … Continue reading
Slumlord Must Repay Insurer for Settlement Contribution
Insurers Should Never Allow Slumlord to Profit From Bad Acts In Axis Surplus Insurance Company v. Reinoso No. B228332 (2012) WL 2389324) an insurer, under a full reservation of rights, including the right to recover any costs of defense or … Continue reading
Interpleader Not a Defense To Negligence
When Stakeholder Causes Dispute It Can Still Be Sued For Negligence Not Related to Dispute The Ninth Circuit Court of Appeal was asked to determine whether the federal interpleader remedy shields a negligent stakeholder from tort liability for its creation … Continue reading
Always Give Coverage Counsel All Facts
Insurer is Not Bound to Submerge its own Interest in Order that the Insured’s Interests May be Made Paramount Whenever an insurer retains coverage counsel it is essential that coverage counsel is provided the full text of the policy and … Continue reading
Zalma’s Insurance Fraud Letter — August 1, 2012
Money Recovered From Fraud Perpetrators Should Stay With Fraud Fight Continuing with the fifteenth issue of the 16th Year of publication of Zalma’s Insurance Fraud Letter (ZIFL) reports in its August 1, 2012 that monies recovered from insurance fraud perpetrator … Continue reading