Monthly Archives: October 2014

Chutzpah & Fraud

Zalma’s Insurance Fraud Letter  November 1, 2014 In the 21st  issue of its 18th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma, on November 1, 2014, continues the effort to reduce the effect of insurance fraud around … Continue reading

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When Reserves Are Not Discoverable

Loss Reserves Are Estimates Whenever a plaintiff sues an insurer the plaintiff wants to know what the insurer estimated to be the amount of loss hoping to show a difference between the amount reserved and the amount offered to show … Continue reading

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What is a Real Estate Manager

Tenant Is Just a Tenant An unwritten rule of law is that an appellate brief or an appellate opinion should never truly be brief. The 11th Circuit Court of Appeal in Georgia broke the rule in dealing with Moon v. … Continue reading

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Waiver of Stacking

Action Of Named Insured Binds All Insureds Insureds work diligently to reduce the premium they pay. Since none believe they will ever have a loss and claim, insureds are willing to waive coverages like the right to stack coverages, uninsured … Continue reading

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Failure to Secure Insurance

Accrual of Statute of Limitations for Agent’s Error Insurance agents, like everyone else, will make a mistake. In Michigan, an insurance agent can be held liable in negligence for failing to acquire the insurance ordered by the insured. The agent … Continue reading

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Intentional or Criminal Act Uninsurable

Insurance Agent Can’t Buy Insurance For Criminal or Intentional Act People engaged in criminal conduct or conduct intended to cause damage to another seek insurance coverage in case they are caught in their wrongful conduct. When they do they run … Continue reading

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Lawyers Should Keep Their Promises

Anti-SLAPP Statue Limited Lawyers often make agreements with other lawyers and insurers when cases settle. Often funds are paid into the lawyer’s trust account to be distributed after certain conditions are met. If the conditions are not met and the … Continue reading

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Construction Defects Coverage Guide

Litigation Over Construction Defects Construction defect suits are now flooding the courts of North America in greater numbers every year. The Construction Defects Coverage Guide is designed to help the property owner, builder, construction professional, insurer, insurance professional, construction defect … Continue reading

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The Implied Covenant of Good Faith and Fair Dealing

The Essence of Insurance The principle mantra in the insurance world is “Conduct business in the utmost good faith (uberrima fides).” The first reported decision acknowledging the need for utmost good faith in insurance was stated in the British House … Continue reading

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Making Insured Whole Not Enough

Consumer Protection Statute Claim Survives Belated Payment of Claim It is axiomatic in bad faith claims that there can be no bad faith if the insurer did not breach the contract. However, many states have enacted consumer protection statutes trying … Continue reading

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Restitution Limited to Real Damages

Actual – Not Billed – Medical Charges Only Assessed Retail medical billing bears little resemblance to reality. Where a two cent dose of aspirin can be billed at $50 insurance companies and government based medical programs have established contracts with … Continue reading

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Agent Owes No Duty to Public At Large

Negligent Procurement Suit Requires Duty to Plaintiff Insurance agents owe a duty to their customers to obtain the insurance the customer asks that be obtained. When an insurance agent obtains the insurance limits requested by the insured may a third … Continue reading

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Zalma’s Insurance Fraud Letter — October 15, 2014

Agent Takes Premium from Clients to Fund Campaign for Congress In the 20th issue of its 18th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma, on October 15, 2014, continues the effort to reduce the effect of … Continue reading

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Failure to Promptly Appeal Denial of Claim Expensive

Statute of Limitations Defeats Disability Claim Disability policies seem arcane and difficult to understand by most people who acquire disability insurance. Most such policies allow an administrative review of a denial. Failure to seek the administrative review or file suit … Continue reading

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Certificate Must Be Honored

Cancellation Without Proper Notice Ineffective Insurance policies are nothing more than a set of promises made by an insurer to an insured and insured to an insurer. Certificates of insurance are also promises made by an insurer or its agent … Continue reading

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Fraud By Insurance Agent Requires Jail

Insurance Agent Used Diverted Premium to Fund Campaign for Congress The Ninth Circuit Court of Appeal made clear that although Congressmen may write the law they are not above the law. Former Arizona Congressman Richard Renzi learned this lesson the … Continue reading

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Policy Needs Void For Fraud Language

Fake Doctor & Innocent Co-Insureds Medical malpractice insurance is designed to protect doctors who accidentally cause injury to their patients. The insurance policy is issued based upon the truth of facts reported in applications for insurance. In Evanston Ins. Co. … Continue reading

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Insurers Have The Right To Chose Who and What It Will Insure

ACA May Prevent the Right to Negotiate Insurance It is axiomatic in insurance law that an insurer has the unquestioned right to determine who, and against what risks, it is willing to insure. The Patient Protection and Affordable Care Act … Continue reading

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Three Shots at Head Not an Occurrence

Killing Two Is Not an Accident After State Farm intervened in a wrongful death action the trial court granted an insurer summary judgment and found State Farm owed neither defense nor indemnity to a person who was convicted of negligently … Continue reading

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Duty to Defend

Potential for Coverage In every property and casualty insurance policy an unwritten exclusion applies and requires that every loss must be fortuitous. That is, insurance, by definition can only insure against a contingent or unknown risk of loss and that … Continue reading

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Underinsured Motorist Coverage Is to Assure Insurance Coverage

Underinsured Motorist Not Effected by Governmental Liability Cap This case arises from a collision between a vehicle driven by Barry Hunt and a snow plow owned by Dane County. Wisconsin and operated by a county employee. Barry Hunt and his … Continue reading

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No Punitive Damages Under Jones Act

Federal Statutes Trump Common Law Rights of Injured Seamen The Fifth Circuit Court of Appeal was asked to decide whether the seaman plaintiffs in this case, both the injured seamen and the personal representative of the deceased seaman, can recover … Continue reading

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Full Credit Bid Defeats Claim

Mortgagee Hoist On Its Own Petard Mortgage holders seldom understand or consider insurance and potential insurance claims when the mortgagor fails to pay on the mortgage as promised. They should. Failure to understand insurance and the effect of making a … Continue reading

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35 Years and Counting

Zalma’s Insurance Fraud Letter October 1, 2014 Thirty five years ago today I left my last employer and started my own law firm. On October 1, 1979,  Alan Worboys of a syndicate at Lloyd’s, London, called me at 8:10 in … Continue reading

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