Monthly Archives: April 2013

Sudden & Accidental

Gradual Is Never Sudden Insurance policies are the least read of all contracts. Although every state has a law requiring that policies be easy to read and that the provisions of the policy be conspicuous, plain, and clear, neither the … Continue reading

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New E-Book From Barry Zalma

Zalma on Insurance Fraud – 2013 The Complete Authority on Insurance Fraud in the United States © 2013 Barry Zalma, Esq., CFE Barry Zalma has totally rewritten his seminal E-Book on insurance fraud that is now over 1100 pages and … Continue reading

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Mortgagee Bound by Exclusion

Mortgage Clause Does Not Expand Coverage American Family Mutual Insurance Company refused to pay because its businessowners policy does not cover loss or damage caused by water damage, vandalism or theft if the property is vacant for more than sixty … Continue reading

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When Damage Is Just “Marring”

Ejusdem Generis & Clear Exclusion Benjamin Ergas dropped a hammer on his tile floor, causing it to chip. He filed a claim for the damage with his homeowner’s insurance company which denied coverage, because it claimed that the damage constituted … Continue reading

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Where’s Waldo’s Domicile?

No Fault Insurance Requires Domicile An auto accident occurred July 29, 2009, on I-196 in Allegan County. Plaintiffs, Gerardo Tienda and Sylvia Gomez, were passengers in a Ford Expedition owned by Tienda’s uncle, Lorenzo. When the accident occurred, Lorenzo was … Continue reading

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What a Difference 12 Hours Make

Renew Your Policy Promptly By tradition and state law insurance policies provide coverage to those insured from 12:01 a.m. standard time on the first day of coverage and expire at 12:01 a.m. standard time on the last day of the … Continue reading

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Poor Policy Drafting

Beware Defending Under a Reservation of Rights The tort of bad faith has created – by the potential of a suit for bad faith alone – difficult decisions for insurers who believe the policy provides no coverage. Rather than denying … Continue reading

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No Good Deed Goes Unpunished

Right to Enforce Deal With Foreign Corporation Asbestos exposure has resulted in thousand of lawsuits and hundreds of cases dealing with insurance. Insurance companies have learned that the litigation is difficult and often never ending. For that reason they often … Continue reading

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Incomplete Structure Is Vacant

Vacant 60 Days A developer, Joy Investment Group (“Joy”), obtained a construction loan from a bank, and began construction on a multi-unit condominium complex. The bank required the developer to maintain builder’s risk insurance on the property and to identify … Continue reading

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Health Insurance Fraud

CGL Does Not Insure Against Fraud and Conspiracy Charges Midwest Open MRI (“Midwest”) asked West American Insurance Company (“West American”) to defend and indemnify it to a suit brought by a competitor. West American filed a declaratory judgment action seeking … Continue reading

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Negligence Per Se

Don’t Ride Bike on Sidewalk Almost every automobile accident involves insurance even if the word “insurance” is never mentioned by the parties or the courts of Appeal. It is important, therefore, that insurance professionals understand the meaning of negligence and … Continue reading

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Untimely Notice

Additional Insured Must Report Claim Promptly The Supreme Court, New York County (trial court judge Doris Ling-Cohan, J.), entered an order that granted Mt. Hawley Insurance Company’s (Mt. Hawley) motion for summary judgment declaring that it has no obligation to … Continue reading

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Sometimes Insurance Fraud Loses

Sometimes Insurance Fraud Loses Continuing with the eighth issue of the 17th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma reports in the May 1, 2013 issue on: Why a doctor who provides fake health care and … Continue reading

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Don’t Change The Risk

Insurer Need Only Respond to Risk It Agreed to Insure In Seneca Insurance Company, Inc., Plaintiff-Appellant-Respondent v. Cimran Co., Inc., et al., Defendants-Respondents-Appellants., No. 9226 (N.Y.App.Div. 04/09/2013) the parties brought an appeal that provided the New York Appellate Division with … Continue reading

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Fraud Must Occur on Premises

Limitation of Coverage for Fraud in a Financial Institution Policy Banks are often used by criminals to effect a fraud against a depositor who keeps funds in the bank. Banks insure their exposure with a Financial Institution policy that protects … Continue reading

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Evidence of Mailing Sufficient

No Right to Coverage After Nonrenewal Insurance companies, as a matter of course, will send notices of non-renewal and notice of cancellation by means of the United States Postal Service. When they do so they do not go to the … Continue reading

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“Crash for Cash”

Barry Zalma Reports on WRIN.tv Staged Accidents, or “Crash for Cash” scams, are a major concern for law enforcement, as well as auto and fleet insurers. In fact, police in Durham broke up one of the largest ‘Crash for Cash’ … Continue reading

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Medicare Fraud Ignored

Qui Tam Case Not Original Medicare and Medicaid fraud is rampant. Some estimates indicate that as much as $300 billion is taken by fraud perpetrators each year. Federal authorities are loathe to expend the funds necessary to prove that fraud … Continue reading

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To Stack or Not to Stack

The Effect of Limit Per Occurrence The courts of California faced with a need to obtain the benefits of either a primary or excess policy are faced with a dilemma and must decide which insurer is forced to pay more … Continue reading

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Family Exclusion

Child Was In Care of Mother’s Cohabitor Tina Sellers, as the personal representative of her daughter’s estate, and Marcus Degen appeal the trial court’s determination that Hanson Farm Mutual Insurance Company of South Dakota (HFMIC) had no obligation to indemnify … Continue reading

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Vicarious Liability of an Auto Lessor

Federal Law Always Trumps State Law Since the U.S. Constitution was first written a principle engraved in the founding document was that federal law preempts state law if the two laws are in conflict. The Supreme Court of Florida was … Continue reading

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Prejudice Presumed

Prejudice Presumption Must Be Rebutted by Insured Insurers place notice requirements in a policy of insurance to protect it from the obvious prejudice when it is unable to promptly investigate the cause and extent of the claimed damage. Regardless of … Continue reading

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Don’t Buy a Stolen Car

Seizure by Police Not Theft or Damage In every private purchase of an automobile is the risk that the person selling the vehicle did not own it. Ownership documents can be forged. Purchasers can be trusting and take – if … Continue reading

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Barry Zalma on WRIN.tv

World Risk and Insurance News, has decided it is important for the insurance industry to learn more about insurance fraud. They gave me the opportunity to explain. The first of several programs is now on line at WRIN.tv. Barry Zalma … Continue reading

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He Who Testifies Best

When an Expert is Not an Expert Insurance claims are often presented to insurers by people working for the insured whose professions will usually be considered expert and would usually require, under federal practice, that they be designated as experts … Continue reading

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Home Inspection Contract Limitation

Limitation of Liability Enforceable Home inspection companies are often essential to a fair and reasonable real estate transaction because they often disclose hidden damages not even known to the seller. Home inspectors are seldom big businesses. More often than not … Continue reading

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Sometimes Insurance Fraud Loses

Sometimes Insurance Fraud Loses Continuing with the seventh issue of the 17th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma reports in the April 15, 2013 issue on: 1.    Why a person was sentenced to one to … Continue reading

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