Monthly Archives: March 2013

No Harm, No Foul

Insurer Victim of Fraud Not Perpetrator When a crooked lawyer, acting as trustee, steals from the estate he was required to protect as a fiduciary the victims of the fraud should not be responsible for the theft. FACTS Thomas Tessier … Continue reading

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Insured Must Prove Disability

Total Disability Required Disability insurance policies have various definitions of disability. Depending on the definition the ability to obtain the benefits of the policy is easier or more difficult. Because of this litigation over disability benefits are frequent. One such … Continue reading

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Technicalities Lose

Settlement Negotiations Can Avoid Rule Insurance companies are not popular. The public, and judges who are part of the public, believe that insurance companies will use any tactic to avoid paying a claim. That the facts are otherwise, that more … Continue reading

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Medicaid Pre-empts State Law

Medicaid Recipients Must Allocate Settlement Amounts States administering the Medicaid programs that provide medical care to those who cannot afford it or do not have insurance protection run into problems when they obtain a tort recovery. The state administering Medicaid … Continue reading

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Something Borrowed

The Problem with Not Reading The Entire Policy When people are severely injured in automobile accidents they do everything possible to draw as much insurance coverage into the case as possible. The efforts are often joined in by courts who … Continue reading

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Investigation is a Profession

SIU Investigators are Special When an insurer forms a Special Investigation Unit (“SIU”) it hires highly qualified, trained and experienced investigators to help it avoid paying fraudulent claims. The job of a fraud investigator is different from a factory worker … Continue reading

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Insurer Has Right to Select Those It Will Insure

Insurer May Rely on Him Who Would Be Insured For Accurate Information It should be axiomatic that an insurance company is entitled to determine for itself what risks it will accept, and therefore to know all the facts relative to … Continue reading

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Rescission Appropriate for Misrepresentation

Lies on Application Defeat Suit Against Insurer Insurance is a contract requiring the utmost good faith from both parties to the policy. Insurers rely on he or she who would be insured to provide the information needed to make a … Continue reading

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Causal Connection Required

Limited Coverage for Additional Insured When one insurer sues another to share in the cost of defending and indemnifying an insured, it is essential that the plaintiff carefully analyze the issues. An insurer that seeks contribution from another insurer whose … Continue reading

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Insurer is Not Insured’s Mommy

Good Faith Limited to Policy’s Promises The implied covenant of good faith and fair dealing is broad but it is not unlimited. Insurers have a duty to investigate claims presented to it that deal with the coverages provided by the … Continue reading

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Insurer’s Lawyer’s Advice Not Privileged

Washington Supreme Court Creates Presumption Against Attorney Client Privilege More than a century ago George Orwell wrote a book about the dangers of communism called Animal Farm. When the question of equality arose in the operation of the farm the … Continue reading

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Foolish Insurance Fraud Continues

Foolish Insurance Fraud Continues Continuing with the sixth issue of the 17th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma reports in the March 15, 2013 issue on: The knowledge of insurance needed to investigate insurance fraud. … Continue reading

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Go Directly To Jail

Insurance Fraud as Serious a Crime as Armed Robbery Health care fraud is seriously depleting the earnings of insurers and the coffers of the United States and its Medical Insurance plans like Medicare and Medicaid. Some unscrupulous medical providers are … Continue reading

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Murder, Torture, Kidnapping

Intentional Act or Loss Outside Coverage Territory Liability insurance, by definition, can only provide indemnity for losses resulting from fortuitous acts. Intentional acts should never be an insurable risk of loss. In Chiquita Brands v. National Union Fire, 2013 -Ohio- … Continue reading

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Murder on High Seas

Person Making Claim Must Be Named on Policy Every insurance contract has conditions precedent to making a claim. Failure to fulfill the conditions deprives the party of the right to make a claim. Because insurance is a contract of personal … Continue reading

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Contract of Personal Indemnity

Who’s On First? First party property insurance is a contract of personal indemnity. It only insures the person(s) named in the policy against certain risks of loss to property in which that person has an interest. A person who has … Continue reading

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Diminution or Repair Costs

Diminution or Repair A first party property insurance company is only required to make the insured whole. A property insurer, when the insured decides not to rebuild and sells the damaged property without repair, is only entitled to recover the … Continue reading

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Don’t Sit on Your Rights

No Excuse For Waiting to Sue for 1995 Accident Steven Pham, representing the estate of the driver of a car involved in a traffic accident, along with the deceased driver’s parents and the five passengers in his car at the … Continue reading

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Surety & Bankruptcy

Surety’s Security is New Value Surety is a type of insurance where the surety insurer agrees to fulfill a contractual obligation of its insured if, for some reason, the insured fails to accomplish its obligation. Before agreeing to be a … Continue reading

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Failure to Object Terminal Error

Fifth Amendment Should Never Apply to Civil Plaintiff When a plaintiff sues an insurance company for damages, he places in issue all factual matters relevant to any exclusion clause in that policy including fraud. The gravamen of the lawsuit is … Continue reading

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Contribution by Excess Insurers

Vicariously Liable Insured Contributes Last While working as a pastor for Crosswinds Community Church (Crosswinds) and Christian Evangelical Assemblies (CEA), and while driving his own car, Gary West struck and severely injured Robert Jester, who was riding his motorcycle. Jester … Continue reading

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Commit Insurance Fraud – Go Directly to Jail

Commit Insurance Fraud – Go Directly to Jail Continuing with the fifth issue of the 17th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma reports in the March 1, 2013 issue on: 1.    How an insurer in … Continue reading

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