Monthly Archives: November 2013

THANKSGIVING 2013

What I am Thankful For My family and I have much to be thankful for this year, not the least of which is you, my friends, clients and readers of my blog “Zalma on Insurance”, “Zalma’s Insurance Fraud Letter,” and … Continue reading

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Contra Proferentem – Not Always

When In Doubt – Rule Against the Insurer The doctrine of contra proferentem, which ordinarily guides courts to interpret ambiguous insurance contract language against the insurer-drafter and in favor of finding coverage for the insured policy holder, does not always … Continue reading

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NFIP’s Draconian Conditions

No Timely Proof of Loss – No Coverage The National Flood Insurance Program (NFIP) pays claims from the Treasury of the United States, not the assets of an insurance company. It is a creature of statute and as a result … Continue reading

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Easy Success at Fraud Encourages Arson

Arson Requires Planning and Skill Those of us who deal with insurance and insurance fraud regularly understand that, as long as the fraud is small, it is easy to defraud an insurance company. Often, the ease of committing a small … Continue reading

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Filed Rate Doctrine Controls

Courts Should Never Be Involved in Premium Setting A group of plaintiffs, faced with a $2,683 additional premium asked the courts of New York state to change the way premiums are charged in the state as approved by the insurance … Continue reading

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Insurance Fraud “Chutzpah”

No Mercy for Insurance Criminal This case concerns the criminal conduct of the owner of an insurance business, formerly known as Associates Insurance Agency, Inc., owned and operated by the Defendant-Appellant, Tina Woods Butler, in Dyersburg, Tennessee. On February 13, … Continue reading

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Clear Exclusion Applied

Bird in Hand Better than Two in Bush Angela and Rodney Gilpin were murdered inside an apartment building owned and operated by Dennis and Sandra Prenger (collectively, the “Prengers”). Plaintiffs, survivors of the victims, obtained wrongful death judgments against the … Continue reading

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Insured or Not Insured – That is the Question

UIM Coverage Only Available to an Insured The husband and daughter of a pedestrian killed by an underinsured motorist sued Farmers Insurance Exchange and others (Farmers). The complaint alleged that coverage provided by Farmers to the decedent’s father also provided … Continue reading

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Car Crusher Not a Trailer

Underwriting Is a Risk Taking Exercise An insurance company is entitled to determine for itself what risks it will accept, and therefore to know all the facts relative to the condition of the applicant’s property. It has the unquestioned right … Continue reading

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Zalma’s Insurance Fraud Letter — November 15, 2013

Insurance Fraud – An Equal Opportunity Crime Continuing with the twenty second issue of the 17th year of publication of Zalma’s Insurance Fraud Letter (ZIFL), Barry Zalma, in the November 15, 2013 issue, continues the effort to reduce the effect … Continue reading

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Fraud & The ACA

Policies Acquired Through the ACA Are Voidable Assuming that the policies issued through Exchanges created to implement the Affordable Care Act (Obamacare) are insurance they are contracts that are based upon the utmost good faith of the insurer and the … Continue reading

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A Tangled Web From Criminal Deceit

I’m Tired but Not Exhausted An excess insurance policy provides coverage only after underlying insurance coverage is exhausted, paid more than the limit of liability stated in the policy. Quellos Group LLC appealed summary judgment dismissal of the lawsuit against … Continue reading

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Insurer Has Right to Change Coverage

Proof of Mailing Sufficient to Prove Addition of Exclusion Lead based paint has caused severe injuries to young people across the country and, as a result, was banned by the federal government. It can no longer be manufactured or used. … Continue reading

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Public Policy Must be Set by the Legislature Not the Courts

“Any” Means “All” Arkansas, by statute, makes joint and several liability only several with each party causing injury shares in judgment only up to the party’s percentage of liability. Uninsured (UM) and underinsured motorist (UIM) coverages only provide coverage if … Continue reading

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The ACA is Not About Insurance

Seventh Circuit Stops HHS’ Infringement of Exercise of Religion In Korte v. Sebelius, 12-3841, 13-1077 (7th Cir. 11/08/2013), the Seventh Circuit, in a lengthy opinion reminded the Congress and Executive Department of the meaning of the First Amendment’s free exercise … Continue reading

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Only Insured May Claim Indemnity

Liability Insurance is Not Written to Protect Injured Third Parties Farmers Insurance Company (Farmers) was granted summary judgment in Sebastian County, Arkansas Circuit Court. The trial court found that Rentco could not be considered a third-party beneficiary of an insurance … Continue reading

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Bordereaux Proves Payment

When an Insurer is Not an Insurer Sophisticated insurance people create sophisticated arrangements to transfer risk. Sometimes the arrangements are so complicated that the parties aren’t sure what they are agreeing to and how the contract must be fulfilled. When … Continue reading

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Zalma Webinars Next Week

The Ethical Dilemma Faced by Fighting Insurance Fraud Tuesday, November 12, 2013 Toll Free: +1-510-857-5896 Description: The course covers the obligation imposed on insurers by state law to actively investigate and defeat attempts at insurance fraud and the ethical dilemma … Continue reading

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No Good Deed Goes Unpunished

Proper for Mortgagee to Acquire Force Placed Insurance at Expense of Borrower Home-mortgage lenders often require the borrower to maintain hazard insurance on the mortgaged property to protect the lender’s interest in the collateral. If the borrower fails to keep … Continue reading

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The Ethical Dilemma Faced by Fighting Insurance Fraud

The Ethical Dilemma Faced by Fighting Insurance Fraud Toll Free: +1-510-857-5896 Name : Barry Zalma Product ID : 500166 Description: The course covers the obligation imposed on insurers by state law to actively investigate and defeat attempts at insurance fraud and … Continue reading

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Who’s On First?

Insurance Contract Controls Major corporations and businesses find it necessary to carry liability insurance in layers with different insurers taking on various portions of the risk to be protected. The first layer of insurance is called “primary” and is required … Continue reading

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Binder Interpretation Problems

Oral Evidence May Be Used to Interpret Binder T & G Enterprises, Inc. (“T & G”) sought insurance coverage on certain real property located in Dalton, Georgia. Georgia Farm Bureau Mutual Insurance Co. (“Georgia Farm”) issued an insurance binder on … Continue reading

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Proactive Fraud Fight

Zalma’s Insurance Fraud Letter Continuing with the twenty first issue of the 17th year of publication of Zalma’s Insurance Fraud Letter (ZIFL), Barry Zalma, in the November 1, 2013 issue, continues the effort to reduce the effect of insurance fraud … Continue reading

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