Monthly Archives: May 2014

Reliance on Experts Raises Genuine Dispute

Failure to Cooperate With Insurer Defeats Bad Faith Claim When a person is injured by an underinsured motorist (UIM) he promises to cooperate in the tort and medical investigation of the insurer. The insured should not, after failing or refusing … Continue reading

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Don’t Lie to Your Insurance Company

Plaintiff Loses $581,234.90 Judgment by Taking Assignment from Defendant Against His Insurer Unless the defendant has no assets that can satisfy a judgment it is always useless to take an assignment from the defendant against his insurer and give the … Continue reading

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No Sworn Proof of Loss – Insured Loses

Failure of Condition Precedent Defeats Suit Against Insurer When a person acquires a homeowners policy a promise is made by the insured that, among other things, the insured will submit to the insurer a sworn statement in proof of loss. … Continue reading

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Who’s on First?

Contract Language Determines Which Insurer is Primary Construction contracts are rife with requirements that subcontractors and contractors make the owner and general contractor additional insureds on the subcontractors and contractors liability insurance. It is a well worn method of shifting … Continue reading

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Insurance Fraud is Not a Victimless Crime

Life Insurance Motive for Murder Life insurance is usually purchased to protect his or her spouse and children in the event of an untimely death. Sometimes life insurance is purchased for a malicious purpose. Insurers have paid benefits to a … Continue reading

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Experts Wrongfully Excluded

Bad Faith & Expert Witnesses After a flood occurred in the warehouse of a business that purchased and resold electronic parts, a dispute arose between the business and its insurer. The insured sued, alleging express breach of contract and breach … Continue reading

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Fortuity Rules Insurance Interpretation

No Fire Insurance For Preexisting Condition of Property Every insurance contract is based on the concept of fortuity. Insurance must, by definition, only indemnify the insured against a contingent or unknown risk of loss. No one should be able to … Continue reading

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Breach of Warranty Eliminates Coverage

Fail to Set Alarm Can Defeat Claim Mr. Justice Jay, sitting in the England and Wales High Court (Queen’s Bench Division) was called upon to resolve a dispute concerning the failure of an insured, Milton Furniture, Ltd. to maintain a … Continue reading

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Opinion Not Defamatory

Defamation Requires Malice Insurance industry publishers often publish their opinions concerning the financial viability of insurance companies. When the opinion is derogatory and the insurer believes it is false or misleading, litigation results. In Regis Insurance Company v. A.M. Best … Continue reading

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Separate Contract With Mortgagee

The Standard or Union Mortgage Clause First party property insurance policies usually insure the named insured and a mortgagee. Under a Standard or Union Mortgage Clause the insurer agrees to a separate contract with the mortgagee and that acts by … Continue reading

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Insured Must Select Insurance Required

To Prove Agent’s Duty Expert Required Insurance agents and brokers transact insurance with insurers on behalf of their client, the insured. The agent or broker have a general duty to procure the insurance required by the insured. They are not, … Continue reading

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False Sales Presentation Punished

Reasonable Expectations Trump Policy Wording For more than 42 years I have asked people insured whether they read and understood their policy. Most laughed at me. Two answered “yes.” Both lied. Insurance contracts, written in Sesame Street English, easy to … Continue reading

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Application Is Not a Policy

Application With Conditions Unmet Prevent Policy From Issuance Life insurance policies are often issued only after certain conditions, like a medical examination, are met and an underwriter decides the appropriate premium. Premiums calculated by insurance agents are often preliminary and … Continue reading

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Zalma’s Insurance Fraud Letter, May 15, 2014

Lawyers Pay To Stop Representing Fraud In the tenth issue of its 18th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) its author,  Barry Zalma, on May 15, 2014, continues the effort to reduce the effect of insurance fraud … Continue reading

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Just for Fun

The Robin Hood Syndrome The story that follows is based on fact. The names, places and descriptions have been changed to protect the guilty. This story was written for the purpose of providing insurers, those in the insurance business, and … Continue reading

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Sorry

I’m in Washington DC to testify in an arbitration so I haven’t been able to post to the blog. I’ll be back with summaries soon. BZ

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To Arbitrate or Not Arbitrate – That is the Question

Fraud Is Not A Claim No fault insurance plans like those in the state of New York and Florida, have become magnets for fraud perpetrators. By requiring payment of medical treatment claims within 30 days the insurer has little time … Continue reading

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WC Insurer’s Attempt to Avoid Benefits Fails

Workers’ Comp Insurer’s Rights to UIM Settlement Limited In Louisiana, and many states, a workers’ compensation insurer is entitled to credit from settlements the employee may receive from a tortfeasor responsible for the employee’s injury. When the employee enters into … Continue reading

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Family Exclusion Rules

Son Seeks Coverage For Injuries Caused to His Father Because of a fear of collusion and fraud almost every third party liability policy contains an exclusion refusing to defend or indemnify an insured against liability owed to a family member, … Continue reading

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The Importance of Proof of Mailing

If Premium Not Paid Policy Cancelled Insurance is, by definition, a contract whereby the insurer, for consideration, agrees to defend or indemnify another against a contingent or unknown risk. For an insurance policy to exist, therefore, the person insured must … Continue reading

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Insurance Fraud Scheme Charged as Conspiracy

Cop Guilty Of Extortion In Auto Fraud  Insurance fraud is not a charge prosecutors like. Although it is an easy crime to prove since all it requires is a single document used with an intent to defraud an insurer, prosecutors … Continue reading

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Who’s on First?

“In the Business Of” Trucking Acceptance Casualty Insurance Company (Acceptance) seeks review of a published decision of the court of appeals affirming the circuit court’s grant of summary judgment in favor of Great West Casualty Company (Great West). Both Acceptance … Continue reading

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HAPPY LAW DAY

Crooked Police Officer Tempted to Fraud In the ninth issue of its 18th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma, on May 1, 2014, continues the effort to reduce the effect of insurance fraud around the … Continue reading

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