Monthly Archives: March 2015

False Application For Health Insurance is a Crime In Connecticut

Probable Cause Defeats False Arrest and Malicious Prosecution Claim Insurance fraud is a serious felony. It is especially wrongful in the health insurance context. In Connecticut, making a false statement on an application for health insurance is a crime. Insurance … Continue reading

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Join Me at the 19th Annual America’s Claims Event

Attend the 19th Annual America’s Claims Event and Get A Discount I will be speaking at the conference on the subject of “Millions for Defense and Not a Dime for Tribute” AGENDA  SPEAKERS  SPONSORS  VENUE  REGISTER AND SAVE Every Angle … Continue reading

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Can Reinsured Allocate Claims Payments?

Are Cedent’s Allocation Decisions Immune from Scrutiny? Reinsurance allows an insurer to lay off part of its obligations to a reinsurer thereby buying insurance against the obligation to pay claims as a direct insurer. Because the agreements are between insurers … Continue reading

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The Use of the Insurance Examination under Oath

A Weapon to Defeat Fraud The “examination under oath”  (EUO) is a formal type of interview authorized by an insurance contract. It is taken under the authority provided by a condition of the insurance policy that compels the insured to … Continue reading

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Plaintiffs’ Lawyers Need to Understand Insurance

Notice-Prejudice Rule Does Not Apply to “Claims Made” Policy   Lawyers who specialize in bodily injury tort claims usually have little or no knowledge about insurance coverage and the obligations required to obtain coverage. They know torts and will invariably … Continue reading

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Is Drunken Brawl Resulting In Death Covered?

Agent Only Responsible for Acquiring Policy Ordered In Atlantic Cas. Ins. Co. v. Norton, Slip Copy, 2015 WL 1293666 (E.D.Tenn., 3/23/15)  a patron at the Grill & Pub died at a tavern owned and operated by Grover Norton in Harriman, Tennessee. … Continue reading

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MCS-90 Controls

Insured May Sue on Behalf of Subrogated Insurer Insurers of people operating trucks in interstate commerce are required to add to their policy a federally mandated endorsement known as the MCS-90 that expands the coverage available under the policy and … Continue reading

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Captive Agent Must Use Ordinary Care

Should a Captive Agent be Treated Differently Than Other Insurance Agents Captive agents are only allowed to sell products from the insurer with whom it has contracted. As a result the markets available to them are limited since most insurers … Continue reading

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No Way to Avoid Workers’ Compensation

On The Books or Not Employee Entitled to Workers’ Compensation It is axiomatic that workers’ compensation benefits are the sole and exclusive remedy of an employee against his employer for injuries in the course of employment. This precludes suits against … Continue reading

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Silica Dust Is a Pollutant

Pollution & Faulty Workmanship Destroy Coverage for Property Loss No insurance policy covers an insured against every possible risk of loss. “All Risk” policies do not cover every potential risk of loss to property. All contain exclusions that limit the … Continue reading

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The Equitable Remedy of Rescission

A Tool to Defeat Fraud Most insurance fraud perpetrators know crime but have no knowledge of insurance. It is difficult to prove fraud in the presentation of a claim. It is relatively easy, on the other hand, to rescind a … Continue reading

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Interview Techniques

The following article dealing with interview techniques is adapted from my E-Book, “Getting the Whole Truth” available from ClaimSchool, Inc. at http://www.zalma.com/zalmabooks.htm.  It will provide you with a few ideas for obtaining the truth in every interview, deposition, examination under … Continue reading

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When Is an Exclusion “Conspicuous, Plain and Clear”

There is no Duty to Defend if There is no Potential for Coverage Insurance policies must be interpreted with care. Since they are contracts of adhesion they are usually interpreted with a bias towards providing coverage for the insured. When … Continue reading

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Zalma’s Insurance Fraud Letter – March 15, 2015

 Fraud by Insurers In the sixth issue of its 19th  year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma, on March 15, 2015 continues the effort to reduce the effect of insurance fraud around the world. The issue … Continue reading

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Must Be Named as Insured On Date of Loss To Recover

Mortgagee Not Required to Buy Liability Insurance for Borrower Insurance companies only sell the insurance requested by the insured not the insurance that the insured should have purchased. Mortgagees, who require insurance on the property that was security for a … Continue reading

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No Cover for Incorrectly Performed Work

Insurance is Not a Guarantee of Good Workmanship Contractors and developers purchase insurance to protect against bodily injury or property damage caused by their negligence. It does not, nor could it do so and still be insurance, guarantee the quality … Continue reading

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Cancellation Waives Right to Rescind

Cancellation is Anathema to Rescission When Grounds for Rescission Exist When a person obtains a policy of insurance by means of a material misrepresentation an insurer has two options available to it when it learns of the misrepresentation: (1) It … Continue reading

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Broad Exclusion – if Plain – Applies

Computer Fraud Not the Same as Check Fraud As Willie Sutton once said about why he robbed banks, “it’s where the money is.” Modern day bank robbers don’t use guns, they use computers, computer viruses, and make transfers of money … Continue reading

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Buyer’s Remorse

No Recourse From General Release Construction defect litigation and arbitrations are complex, expensive and difficult. Suits are often settled only to find later that there were more defects not know about at the time of the settlement.  In Belasco v. … Continue reading

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To Stack or Not to Stack, That is the Question

Can’t Change Policy After a Loss When a person is seriously injured they work very hard to find a way to recover as much as possible from the insurance available. However, when, before the injury the insured only thought about … Continue reading

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Must there be More Than Damage to a Structure to be Structural Damage?

Sturctural Damage Is  Damage Which Impedes the Structural Components from Supporting the Loads That They Are Intended to Support Sinkholes are a serious problem in Florida. Without warning the earth beneath a structure simply opens up and swallows structures, cars … Continue reading

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Should Fraud Be Insurable?

Insurer Seeks Coverage From Its Insurers For Its Fraudulent Acts Since insurance, by definition, only covers contingent or unknown events. Therefore, by definition intentional or fraudulent acts are not covered. Some insurers, in order to cross every “t” and dot … Continue reading

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Only Stupid Fraudsters Get Caught

    Zalma’s Insurance Fraud Letter March 1, 2015 In the Fifth issue of the 19th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma, on March 1, 2015 continues the effort to reduce the effect of insurance fraud … Continue reading

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