Monthly Archives: August 2016

Insured Must Fulfill Policy Conditions

Refusal to Appear for Examination Under Oath is Fatal to UIM Claim It seems lawyers and litigants refuse to accept what I have stated until I am blue in the face that insurance contracts are mutual agreements where both parties … Continue reading

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No Property Damage or Bodily Injury No Duty to Defend

Supplying Drugs for Abuse Is Not Covered Because the state of West Virginia was faced with a serious prescription drug and abuse problem causing great expenses in police and care for the abusers they sued the distributors of the drugs … Continue reading

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Stipulated Judgment Must Be Supported by Evidence

It Isn’t Always Wise to Take A Judgment Subject to a Covenant Not to Execute Some litigants and lawyers believe they hit the jackpot when an insurer wrongfully refuses to defend opening up its policy limits and conditions to infinity. … Continue reading

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Evidence Required to Obtain Emotional Distress Damages

Bad Faith Conduct Not Enough to Support Emotional Distress Damages Insurance companies, like every other business, err. When they breach the implied covenant of good faith and fair dealing, they must pay damages to the plaintiff that are proven. Juries … Continue reading

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An Insurance Company is the Victim of Insurance Fraud

Payment of Restitution When a person is convicted of a property crime, like insurance fraud, restitution is ordered to put the victim of the crime back in the position he or she was in before the crime. Restitution is only … Continue reading

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Coverage First then Try Bad Faith

Mandamus Granted to Sever Bad Faith from Contract Action When an insured litigates an uninsured motorist or Underinsured motorist UM/UIM) claim against his or her insurer the insured must prove that there is a policy in effect, that he or … Continue reading

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Notice-Prejudice Rule Now the Law In Wyoming

Court Rewrites a Policy To Adopt Notice-Prejudice Rule  Insurance companies insuring people against the risk of loss due to heir negligence require notice as soon as possible so that the insurer can conduct a complete and thorough investigation to properly … Continue reading

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Two Excess Policies are Repugnant

Even True Excess Policies Must Share Loss Pro-Rata When two or more insurance policies have excess clauses that say they owe nothing until another policy pays out its limits the true excess policy pays nothing until the other policies are … Continue reading

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Child Molestation is Always an Intentional Act

Intoxication Does Not Eliminate Intent to Molest a Child  Some intentional conduct is inexcusable. Getting drunk and molesting a minor is an inexcusable act and, for insurance purposes, should never be the type of fortuitous conduct that can be insurable. … Continue reading

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Cancellation for Failure to Respond to Underwriting Proper

Dangerous to Ignore Requests from Insurer North Carolina has an assigned risk plan for workers’ compensation where insurers are required to take a business assigned to the insurer. The insurer can, after accepting the risk, seek additional information to properly … Continue reading

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You Only Get What You Pay For

Clear and Unambiguous Policy Term Must Be Applied People believe that only insurance lawyers actually read insurance policies. They are, in most situations, wrong because people are compelled to read their policy. However, after a loss, people and their lawyers … Continue reading

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The Need For A Professional, Well Trained & Experienced Claims Staff

Excellence in Claims Handling In search of profit, insurers have decimated their professional claims staff. They laid off experienced personnel and replaced them with young, untrained, unprepared people. A virtual clerk replaced the old professional claims handler. Process and computers … Continue reading

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Policy Lapse Not Cancellation

Failure to Timely Pay Premium Causes Policy to Expire Insurance, like all other contracts, requires that there is first an offer, the offer is accepted and consideration passes between the person accepting the offer and the person making the offer … Continue reading

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The Role of The Insurer’s Lawyer in a Fraud Investigation

Zalma’s Insurance Fraud Letter August 15, 2016, Volume 2, No. 16   At Least, This Time, Fraud Doesn’t Pay In this, the Sixteenth issue of the 20th year of publication of Zalma’s Insurance Fraud Letter (ZIFL), Barry Zalma, on August … Continue reading

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Even Innocent Clients May Not Benefit From The Fraud Of Their Attorney.

At Least, This Time, Fraud Doesn’t Pay Although insurance is not mentioned in the following case there is little doubt in my mind that Chevron’s defense involved some of its insurers. In Chevron Corporation v. Donziger, — F.3d —-, United … Continue reading

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Flood Insurance Procurement Not a Federal Issue

National Flood Doesn’t Preempt State Court Action Against Broker The National Flood Insurance Program (NFIP) is different from commercial insurance since all claims are paid from the treasury of the United States. For that reason the NFIP is strictly construed … Continue reading

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A Party Must Act Fairly When Seeking Equity

The Anti-Subrogation Rule And Equity Under the “anti-subrogation rule,” an insurer has no right of subrogation against its own insured for a claim arising from the very risk for which the insured was covered. In other words, an insurer may … Continue reading

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Primary Insurer’s Failure to Settle Within Limits Allows Excess Insurer to Sue

Excess Insurer Can Recover From Primary Excess of Limits from Primary A primary insurer owes the same good faith and fair dealing to an excess insurer to settle within policy limits that it has owed to the insured since the … Continue reading

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When a Roof is not a Roof

Component Parts Are Not a Roof Homeowners insurance, for dozens of years, have attempted to limit the coverage provided for damages caused by entry of water into the residence unless the roof is damaged as a result of windstorm. Of … Continue reading

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Bad Injuries Cause Interesting Litigation

What’s My Limit? Insurance policy interpretation can be convoluted and difficult for the parties, especially when there are arguments over the jurisdiction of the court involved. If there is jurisdiction a federal court can issue a declaratory judgment interpreting an … Continue reading

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HHS May Not Amend a Law

Insurers and Those Insured May Purchase Whatever Coverage they Want An insurance company is entitled to determine for itself what risks it will accept.  It has the unquestioned right to select those whom it will insure may wisely discriminate in … Continue reading

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The Role of the Insurer’s Lawyer in a Fraud Investigation

The Examination Under Oath A good, thorough, examination under oath (EUO) is the insurer’s most effective weapon to defeat fraud. Lawyers, whose job it is to ask questions, will usually do a more thorough job of examination under oath than … Continue reading

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No Breach of Contract – No Bad Faith

Limit of Liability is Cost Actually Spent to Replace Destroyed House Homeowners policies, except in a valued property state, agrees to first pay actual cash value (ACV) first and the difference between ACV and replacement cost value (RCV) after the … Continue reading

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Contractor Controlled Insurance Program

A CCIP Provides Immunity to The General Contractor Major construction projects involve many contractors serving under a general contractor. a general contractor that implemented a contractor controlled insurance program (CCIP) can, if properly formulated, provides the general contractor protection from … Continue reading

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Zalma’s Insurance Fraud Letter – August 1, 2016

State Fraud Investigation Files Not Subject to Discovery by Subpoena   Zalma’s Insurance Fraud Letter August 1, 2016, Volume 20, No. 15 State Fraud Investigation Files Not Subject to Discovery by Subpoena  Welcome to the August 1, 2016 Issue of … Continue reading

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