Monthly Archives: August 2013

Health Insurance Fraud

Conviction Affirmed Health Insurance Fraud is rampant. Most people convicted of health insurance fraud are doctors and other health care providers. Where most of the money goes, however, is to people taking advantage of free or subsidized health care benefits … Continue reading

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Appraisal

No Excuse For Failure to Appoint Umpire The Supreme Court of Alabama was asked, in Ex parte Tower Insurance Company of New York Inc., 1120228 (Ala. 08/23/2013), to grant a petition for a writ of mandamus filed by an insurance company, … Continue reading

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Posted in Zalma on Insurance | 1 Comment

Earth Movement Exclusion

Clear & Unambiguous Exclusion Enforced Insurance of construction risks are never protection of every possible risk faced by the builders and developers. Every insurance policy contains some exclusions that limit the rights of the insured to indemnity. Failure to read … Continue reading

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No Conflict – No Right to Independent Counsel

Not Every Reservation of Rights Raises a Conflict An insurer that reserves its rights under a policy of insurance will usually raise a request by the insured for independent counsel. However, unless the reservation actually raises the need for the … Continue reading

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Cleveland Indians Win In Michigan

Certificate Must Be Accurate An accident occurred at a “Kids Fun Day” event before a Cleveland Indians baseball game. Douglas Johnson and David Brown were attending the game as spectators. They were looking at an exhibit outside the Kids Zone … Continue reading

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Texas Changes Meaning of Policy

Words of Policy Do Not Apply Unless the Insurer Is Prejudiced Courts across the nation give lip-service to the fact that insurance contracts are contracts that must be interpreted like every other contract. However, like the creatures in George Orwell’s … Continue reading

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Insurable Interest Required

Foreclosure Destroys Insurable Interest Every first party property policy of insurance requires that the person insured have an insurable interest in the property, the risk of loss of which was sought to be insured. The policy limits coverage to the … Continue reading

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Insurer Must Defend Frivolous Claim

Employers’ Liability Insurance Requires Defense National Casualty Corporation (“Safety National”) sold an excess liability insurance coverage policy to TKK USA, Inc. The policy covered excess losses resulting from liability imposed on TKK “by the Workers’ Compensation or Employers’ Liability Laws” … Continue reading

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No Cover If Vacant

Vandalism and Theft Losses Excluded Most policies insuring against the direct risks of physical loss exclude vandalism or theft losses if the structure has been continuously vacant for 30 or 60 consecutive days. In New London County Mutual Insurance Company … Continue reading

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Posted in Zalma on Insurance | 1 Comment

More From The Sequoias

My Son took this complete picture of the General Sherman Tree Using an I Phone. The General Sherman Tree in Sequoia National Park is the largest (by volume) tree in the world. Computing the volume of a standing tree is … Continue reading

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No Right to Independent Counsel

No Harm No Foul Since the California Court of Appeal decided San Diego Federal Credit Union v. Cumis Ins. Society, Inc. (1984) 162 Cal.App.3d 358 (Cumis) a conflict between an insurer and its insured has been found to be sufficient … Continue reading

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I Actually Took Some Time Off

If you noticed that I did not post a case on Friday or Monday it was because my wife, son, daughters, their significant others and my grandson took a few days together at Sequoia National Park to see and enjoy … Continue reading

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Posted in Zalma on Insurance | 3 Comments

Government Is Not Insurance

Insurance Is Not a Government Function The Commonwealth Court of Pennsylvania, in Hospital & Healthsystem Association of Pennsylvania v. Ins. Commissioner, 939 C.D. 2011 (Pa.Commw. 08/09/2013) was called upon to decide whether a governmental entity – acting like an excess … Continue reading

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Mistake Not Enough for Reformation

Not Always Wise to Take Assignment of Claim Against Insurer When an insurance company refuses to pay a claim because of a condition in the policy the person who obtained the judgment against an insured will often take an assignment … Continue reading

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Invitation to Fraud

Florida PIP Statute Does Not Allow EUOs Merly Nunez (“Nunez”), a class representative, appealed the district court’s dismissal of her complaint for failure to state a claim and its order denying her motion for reconsideration. Nunez argued that examinations under … Continue reading

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Stop insurance fraud before a policy is written…Barry Zalma explains how.

Barry Zalma on WRIN.tv Fraud continues to be a major issue for the insurance industry. With poor economic conditions and high unemployment, insurers are seeing more suspicious claims than usual. In this report from Barry Zalma, a noted insurance attorney and … Continue reading

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Default Judgment = Prejudice

Failure to Advise Insurer of Service of Suit Voids Coverage Every liability insurance policy requires that the insured immediately or as soon as practical advise the insurer when the insured is served with a suit. Usually there is no problem … Continue reading

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Evidence Required to Prove Materiality

Immaterial Misrepresentation Does Not Void Coverage The Court of Appeals of North Carolina was called upon to deal with, what it described as, the plain language of an auto insurance policy that provides coverage to the driver of the covered … Continue reading

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Lawyer Protect Yourself

Lawyer’s Negligence Not Imputed to Insurance Agent In the more than 45 years I have been involved in the business of insurance I have asked people from all walks of life if they have read and understood their insurance policy. … Continue reading

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Posted in Zalma on Insurance | 2 Comments

Bad Faith Requires Covered Loss

Insured Must Prove a Covered Loss Lexington Insurance Company (“Lexington”) challenged a breach of contract and bad faith judgment in favor of JAW The Pointe, LLC (“The Pointe”). Lexington asked the Texas Court of Appeal to reverse the trial court’s … Continue reading

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Vicarious Liability Not Avoided by Contract

Insurer Vicariously Liable for Agent’s Breach of Regulation It is often said that bad facts make bad law. The Washington State Supreme Court, in Chicago Title Insurance Company v. Washington State Office of Insurance Commissioner, 87215-5 (Wash. 08/01/2013) was called … Continue reading

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A New Way to Sue Insurers

Unfair Competition Law Allows Direct Action Against Insurer In Zhang v. Superior Court (California Capital Insurance Company), S178542 (Cal. 08/01/2013) the California Supreme Court was called upon to determine if the California Unfair Competition Law (UCL) and the Unfair Insurance … Continue reading

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Property Insurance Only Insures the Interest of The Person Insured

Only the Risk of Loss of Property Is Insured The Seventh Circuit Court of Appeals was asked to determine that although no repairs were performed on a damaged structure the insured was entitled to recover the depreciation holdback because it … Continue reading

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Arson for Profit

Zalma’s Insurance Fraud Letter August 1, 2013 Continuing with the fifteenth issue of the 17th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma reports in the August 1, 2013 issue on: 1.    How an Arson for profit … Continue reading

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