Monthly Archives: July 2015

Insurance Fraud – An Overview

A Continuing Education Presentation for Insurance Professionals I have created for Proformative Academy a webinar called “Insurance Fraud – An Overview” that is available at  http://www.proformative.com/courses/insurance-fraud-prevention with a 10% Discount for my friends and clients who sign up and enter … Continue reading

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How to Lose A Judgment by Taking an Assignment

Don’t Take Defendant’s Case Against His Insurer in Lieu of a Collectable Judgment Greed often overrules common sense. When an insurer refuses to defend or indemnify its insured the plaintiff will take an agreed judgment against the defendant, then agree … Continue reading

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A Horse is a Horse, of Course

A Horse is Not “Mobile Equipment” As Mr. Ed once said, cogently, “a horse is a horse, of course,” and it is nothing more. Although insurance terms and conditions can be interpreted to cover a multiple of sins, it cannot … Continue reading

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No Nonsense Application of Plain Meaning of Exclusion

Reasonable Expectations Can’t Be Used to Change an Unambiguous Policy Exclusion Everyone wants to live peacefully and happily in their homes. When a neighboring business causes fumes to travel to your property and make you live with noxious odors the … Continue reading

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How to Defeat an Arson for Profit Attempt

Suspected Arsonist’s Bad Faith Suit Fails Arson-for-profit is the most dangerous of all methods of attempting insurance fraud. When an insurer has sufficient evidence to suspect an arson for profit attempt and denies the claim it will expect that the … Continue reading

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Crime Doesn’t Pay

Running Over Victim In the Course of a Robbery Is not an Accident Insurance, as I have said often, only insures against fortuitous events. If the event is either contingent or unknown it can be insured against. In Smith v. … Continue reading

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Insurance & The Absolute Litigation Privilege

Lawyers Are Obligated To Vigorously Defend Their Clients No one likes to lose a lawsuit. Unable to accept that the case they brought was not viable or their own lawyers were incompetent, the losers strike out at whoever they can … Continue reading

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Why Insurance is Expensive

Statutes to Protect Consumers Not Intended to Allow Insureds to Profit States, like Pennsylvania, have enacted statutes to protect consumers from insurers who cancel insurance without proper reason and after a policy has been in effect for more than 60 … Continue reading

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Can Murder Ever Be Accidental?

Tenant is Not an Insured By definition liability insurance never applies to an intentional act. When a person rents a room in her house to a convicted felon with a history of violence and then gives the tenant a gun … Continue reading

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How to Lose Auto Coverage Without Trying

Insurable Interest Required for Coverage to Apply Insurance is a contract of personal indemnity. It does not insure cars or property of any kind but insures people against the risk of loss of their property. People who know nothing about … Continue reading

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How to Obtain Coverage for Malicious Prosecution

Court Determines When Malicious Prosecution Arises When two insurers insure a loss over a period of time it becomes necessary to determine in which insurer’s policy period the event occurred. Rather than work together some insurers will take a hard … Continue reading

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How to Lose an Insurance Coverage Case

Insured Has Burden to Establish Coverage Making a claim is not sufficient. It is the obligation of the insured first to establish that there is coverage for the loss that is the subject of the claim. It is never automatic … Continue reading

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How to Plead a Consumer Fraud Case for Denial of a Claim

Win Some, Lose Some When people are unhappy with their insurance company they refuse to limit themselves to a suit for breach of contract and obtain the indemnity promised by the policy. Rather, they file lawsuits seeking tort damages for … Continue reading

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Zalma’s Insurance Fraud Letter – July 15, 2015

 Prosecutions Continue for Perpetrators of Health Insurance Fraud In this, the fourteenth issue of the 19th year of publication of Zalma’s Insurance Fraud Letter (ZIFL) Barry Zalma, on July 15, 2015 continues the effort to reduce the effect of insurance … Continue reading

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Is Breach of Contract Required for Bad Faith?

Payment of Appraisal Award Fulfills Policy Promises An insurance company and its insured disagreed on the scope of damage due to hail. Eventually appraisal was demanded and an award was rendered and paid, including interest. Regardless, the insureds, unhappy, sued … Continue reading

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Why a Risk Manager in Louisiana Should be Licensed as an Agent

Risk Manager Can Be Liable For Failing to Provide Coverage Ordered Insurance Risk Management companies help their client obtain insurance by negotiating on behalf of an insured with insurance agents and brokers. The insured uses a risk manager to take … Continue reading

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Should a Signed Rejection Of UM/UIM Cover Be Ignored?

Can an Insurance Agent Be Negligent for Not Obtaining UM Coverage After the Insured Rejects Coverage? In Arizona, like most states, a statute requires that an insurer offer each insured both Uninsured Motorist and Underinsured Motorist Coverage and holds that … Continue reading

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Insurance Fraud Is Epidemic

The Most Difficult Problem Facing Insurers Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number because most attempts at insurance fraud succeed. Estimates of the extent … Continue reading

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Can Murder Be Accidental?

Conviction of Murder Establishes Beyond a Reasonable Doubt that Killing Was Intentional It seems that some judges believe that insurance is an entitlement rather than a contract that can be interpreted beyond reason to provide benefits to victims of persons … Continue reading

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How Do You Set Aside an Appraisal Award?

Umpire Must Be Unbiased Appraisal awards are almost impossible to set aside. However, if it is shown that the umpire is biased or even has a potential for bias, the award can be set aside. In Zurich American Ins. Co. … Continue reading

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What Is Needed to Refuse a Defense?

Duty to Defend Is Difficult to Disclaim on Summary Judgment It is axiomatic that the duty to defend is broader than the duty to indemnify. Whenever there is a potential for coverage an insurer must defend. If the insurer believes … Continue reading

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Why Insured Should Never Sign a Release Without Advice of Counsel

Release Means What It Says and Says What it Means When an insured and insurer cannot agree on the amount of a loss sometimes an insurer will pay more than it believes it owes in exchange for a general release … Continue reading

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You Can’t Con an Honest Person

Insured Must Read Application For Insurance As I have repeated until I am blue in the face the covenant of good faith and fair dealing incorporated in every policy of insurance applies equally to each party to the policy of … Continue reading

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Sometimes Insurance Fraud Doesn’t Pay

Zalma’s Insurance Fraud Letter July 1, 2015 Compliance With The California SIU Regulations To sign up for the live webinar by Barry Zalma, Esq., CFE on July 8, 2015 at 8:00 a.m. Pacific Time and 11:00 a.m. Eastern time, go … Continue reading

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