Monthly Archives: August 2014

Policy Condition Rules

It’s Not Nice to Lie To Your Insurance Company Insurance companies that suspect a claim is fraudulent have the right to conduct a thorough investigation including a sworn examination under oath [EUO]. This has been the case in the United … Continue reading

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Insurer’s Lose Right to Counsel in Washington

Lawyer Just a Claims Handler In Washington State In 1967 I became a claims adjuster and served in that capacity until 1972 when I started a 40 year career representing insurers as their lawyer in first party claims presented in … Continue reading

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New From Barry Zalma

The National Underwriter Company to Publish The Zalma Insurance Claims Library Erlanger, KY, September 1, 2014 –National Underwriter today announced that it will be publishing the popular series of insurance resources known as the Zalma Insurance Claims Library. As a … Continue reading

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False Imprisonment by Employer Excluded

Policy Wording Concerning Employment Related Actions are Clear & Unambiguous The insurance market makes available to businesses Employment Practices Liability Insurance (EPLI) to protect the employer against claims by employees for tortious conduct in the course of employment. Most Commercial … Continue reading

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Policy Must Incorporate Statute Terms

Statutory Language Trumps Policy Wording Insurance is usually nothing more than a contract. If the policy’s terms and conditions are clear and unambiguous, those terms will be applied. However, legislatures have the power to, and in fact do, enact laws … Continue reading

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No Proof of Loss – No Coverage

Decomposing Body Not an “Explosion” Most homeowners policies provide all risk of direct physical loss for structure and only named peril coverages for personal property. If not excluded a cause of loss is covered for the structure. Personal property coverage … Continue reading

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Not Disabled Enough

Able to Earn More than Benefits Defeats Claim Disability claims are almost always contentious. It is much more comfortable to receive tax free benefits from an insurer when you are hurting than go to work and make more than the … Continue reading

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UIM Limitation Acrues At Denial

Private Limitation Unenforceable Underinsured Motorist Insurance (UIM) is different than most since it acts as if the insurer insured the underinsured motorist and is required to indemnify its insured as if the insured was seeking tort damages from a different … Continue reading

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Good Intentions Abuse Basic Rights

Government May Not Prevent the “Free Exercise” of Religion It has been said that the road to Hell is paved with good intentions. There is no question that the Patient Protection and Affordable Care Act of 2010, 124 Stat. 119 … Continue reading

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No Good Deed Goes Unpunished

Negligence of Adjuster Not Basis for Bad Faith Insurance adjusters are people knowledgeable in insurance retained by an insurer for the purpose of assisting the insured in proving a loss to the insurer. A person who expresses to the insured … Continue reading

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Contract Must Require Additional Insured

Failure of Risk Management New York appellate courts, as readers of Zalma on Insurance, are well aware are brilliant at writing opinions ins succinct and straightforward manner. General Motors, LLC v. B.J. Muirhead Co., Inc. — N.Y.S.2d —-, 2014 WL … Continue reading

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The Federal Government Is Not a “State.”

Because The US Government Created an Exchange for the State It is a “State Exchange” In my summary of Halbig v. Burwell — F.3d —, 2014 WL 3579745 I tried to explain why  the Patient Protection and Affordable Care Act (ACA)  … Continue reading

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It’s Hard to Fight Fraud

Zalma’s Insurance Fraud Letter August 15, 2014 In the 16th issue of its 18th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma, on August 15, 2014, continues the effort to reduce the effect of insurance fraud around … Continue reading

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Settlement Must Be In Writing

Meeting of Minds Required to Enforce Settlement Litigants understand that the best resolution of a lawsuit is a settlement. Most are entered into with the assistance of mediators and multiple contacts with counsel. Sometimes one party thinks there is a … Continue reading

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Suit Against Tenant Not Subrogation

Owner May Sue Negligent Tenant for Uninsured Loss Almost every commercial lease of multi-unit structures contain waivers of subrogation or an agreement that the building owner’s fire insurance is purchased for the benefit of both the owner and the tenants. … Continue reading

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Ambiguity Saves Claim

 When Insurer and Insured Err Insured Wins Malpractice policies contain language requiring notice of a claim within the policy period and that the tort must happen within the effective dates of the policy. States, like Maryland, by statute impose a … Continue reading

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IRS Exceeded Authority When It Tried to Change Statute

Congress, Not Courts, Must Cure Statute Problems The DC Circuit Court of Appeals was asked, in  Halbig v. Burwell — F.3d —, 2014 WL 3579745 (C.A.D.C., July 22, 2014), to interpret a provision of the Patient Protection and Affordable Care Act … Continue reading

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Privilege Weakened

Insurance Lawyers’ Opinions Not Privileged Before Claim Denied When an attorney states his or her opinion to a client it is privileged. When an attorney does work that includes his or her thought processes, it is protected from disclosure to … Continue reading

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Barry Zalma on WRIN.tv

Personal Assistance Programs are the biggest health insurance fraud problem in the U.S. Medicaid system. Barry Zalma returns to World Risk and Insurance News with another series of “Who Got Caught? programs looking at healthcare fraud. Here, the noted fraud and claims … Continue reading

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Crime by Lawyer Does Not Pay

Lawyer Who Steals From Client Must Be Disbarred When a lawyer does a criminal act he or she puts the license to practice law in jeopardy. The public believes that such a criminal act is sufficient to jail the lawyer … Continue reading

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Personal Injury Offenses Must Be Alleged

No Coverage — No Duty to Defend Business relationships are often contentious. When a contract to sell a product devolves into a dispute by selling the product under a slightly different name. Suits are filed. Insurance is designed to protect … Continue reading

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No Right to Contribution in Florida

Who’s On First Matters When more than one liability insurer insures against the same risk there is always a dispute over which insurer should take the lead in the defense of the insured; whether the insurers should share in the … Continue reading

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Can’t Make a Purse from a Sow’s Ear

Claims Handling Cannot Create Coverage Where None Existed Under state law contractors whose work is defective are given the opportunity to cure their error before litigation by repairing and replacing the defective work. When a contractor exercises the option before … Continue reading

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Fraud Alerts

Anti-Fraud Efforts Expand In the 15th issue of its 18th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma, on August 1, 2014, continues the effort to reduce the effect of insurance fraud around the world. This months … Continue reading

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