Monthly Archives: July 2016

Failure to Disclose Known Loss Fatal to Malpractice Claim

Malpractice Insured Must Report all Potential Claims When a probate lawyer committed malpractice, she knew she had committed malpractice, and did not report that fact to her insurer at renewal, she knew that her insurer properly denied her claim for … Continue reading

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STOLI Fraud Voided

STOLI Fraudsters Can’t Get Back Premiums Paid Usually, when an insurance policy is declared void, the parties are placed in status quo ante with the policies returned to the insurer and the premiums returned to the insured. However, in the … Continue reading

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No Cover For Sexual Assault

“Professional Services” Do Not Include Sexual Misconduct of a Doctor There are certain types of misconduct that no insurer is willing to insure. Sexual assault is one type of conduct that an insurer, especially one insuring medical professionals, is unwilling … Continue reading

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Exclusive Remedy Applies to Subcontractors

There is no Reason why a General Contractor and a Subcontractor Would Enter an Agreement for Joint Coverage & Still Be Subject to Tort Damages It is axiomatic that workers’ compensation is an exclusive remedy to an injured worker. Problems … Continue reading

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Argument Must Be Tethered to Facts

Duty to Defend Even if Plaintiff Pays For Damage to Others It is axiomatic that the duty to defend is broader than the duty to indemnify. This is especially so in a four corners state where the determination of coverage … Continue reading

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New E-Books From Barry Zalma

E-Books Available From Barry Zalma Random Thoughts on Insurance – Vol. IV Since 2010 I have been writing a blog post at least five days a week. This e-book is a collection of those posts that reveal my interest in … Continue reading

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Equitable Mootness

Sit On Rights & You Lose Insurance Benefits When a fire loss occurs during the negotiation for the sale of real property the sale can be completed by the seller assigning its rights to recover from the insurer the benefits … Continue reading

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Insurers Must Write Their Policies Carefully

All Risks Covers Everything Not Clearly and Unambiguously Excluded All risk policies cover every possible risk of loss except those specifically and unambiguously excluded. It is difficult to write clear and unambiguous exclusions and when they are written a court … Continue reading

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Good Faith Requires Insured to Keep Promises

Breach of Condition Eliminates Coverage for Loss Insurance policies are made of of mutual promises. In the Eastern United States, where winters can be severe, the basic insurance policy requires that the insured – if the home is to be … Continue reading

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When a Condition Precedent Is Not a Condition

Notice Prejudice Rule Defeats Clear & Unambiguous Condition Courts are quick to claim that parties have the right to enter into any contract as long as its terms are not criminal or violate public policy. Insurance contracts  dealing with large … Continue reading

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It’s Not Nice To Lie to Get Life Agency Appointment

Obtaining Life Insurance Agency Agreement by Misrepresentation is Criminal & Collection of Commission is Theft Insurance companies involved in a business of utmost good faith believe applications presented to them by licensed insurance agents and brokers who wish to represent … Continue reading

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Zalma’s Insurance Fraud Letter July 15, 2016, Volume 20, No. 14

False Alarm Warranty Allows Insurer to Void Coverage In this, the fourteenth issue of the 20th year of publication of Zalma’s Insurance Fraud Letter (ZIFL), Barry Zalma, on July 15, 2016 continues the effort to reduce the effect of insurance … Continue reading

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Claims Legend Award

Zalma Receives Claims Legend Award Industry Icon Honored for a Lifetime of Education Insurance consultant and recovering attorney Barry Zalma, was honored with the Claims magazine Legend Award at the recent America’s Claims Event (ACE) conference in Minneapolis, Minn. Zalma, … Continue reading

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No Fortuity No Coverage

Known Loss Defeats Claim For an insured to recover for a loss it must be fortuitous, i.e., contingent or unknown at the time the policy was acquired. In Construction Contractors Employer Group, LLC v. Federal Insurance Company, United States Court … Continue reading

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General Damages Prohibited

Operating a Motor Vehicle Without Insurance in California Eliminates Right to General Damages The state of California enacted a statute to encourage people to carry automobile liability insurance by prohibiting a person injured in an automobile accident from recovering general … Continue reading

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Body Shop – Not an Insured – Can’t Sue On Anti-Steering Statute

Only Parties to Insurance Contracts Can Sue Based on Anti-Steering Statutes Legislatures, with the odd belief that insurers are in business to take advantage of those they insure have enacted statutes to protect insurance consumers from wrongful conduct by their … Continue reading

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Policy Limits Irrelevant in UIM Trial

Jury Should Not Hear Available Limits When Deciding Bodily Injuries Underinsured Motorist (UIM) coverage is designed to protect its insured and provide indemnity over and above the insurance available from the underinsured motorist. It reacts as if the underinsured tortfeasor … Continue reading

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Known Loss Defense Fails

Failure to Seek Appropriate Jury Instruction Defeats Insurer’s Defense The North Dakota Supreme Court was faced with a jury verdict against an insurer and its agent for damages resulting from, what appeared to be, a known loss since the insured … Continue reading

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Genuine Dispute Defeats Bad Faith Claim

Argument Over Scope of Loss not Bad Faith Sometimes, when adjusting a property claim, no good deed goes unpunished. Insurers are obligated, under the terms and conditions of a first party property insurance policy to pay indemnity for the losses … Continue reading

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Vague Conclusory Statements Not Sufficient to Plead

No Right to Sue Lender on Force Placed Insurance if Placed in Compliance With Contract Mortgage holders require, as a matter of course, that borrowers insured the property that is the security for the loan, against certain risks of loss, … Continue reading

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Another Assignment to Sue Insurer to Enforce Judgment Fails

Bird in Hand Is Worth More than $1.8 Million on the Come There is a strange assumption in the world of litigation that if an insurer refuses to defend its insured it has automatically committed the tort of bad faith. … Continue reading

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Rescission & Video Training

The right of an insured of a receive the benefits of an insurance policy cease when the insured misrepresents or conceals material fact when applying for a policy of insurance exists in most states of the United States and many … Continue reading

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The Hazards of Using a Professional Employer Organization

Exclusive Remedy Only Applies to Employee Injured in Scope of Employment Across the nation Workers’ Compensation is an exclusive remedy for an employee injured on the job. However, modern practice allows employers to use Professional Employer Organizations (PEOs) or employee … Continue reading

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Case Against Insurance Agent Assignable

Putative Insured Can Assign Case Against Agent Who Did not Obtain Insurance Ordered For centuries it has been impossible to assign a cause of action against a professional, like a lawyer, because of the personal relationship between the client and … Continue reading

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Health Fraud Case Lawyers Removed

Zalma’s Insurance Fraud Letter July 1, 2016, Volume 20, No. 13 Barry Zalma Welcome to the July 1, 2016 Issue of ZIFL Click here to receive the current issue In this, the thirteenth issue of the 20th year of publication … Continue reading

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