Monthly Archives: September 2016

Policy Ambiguity Requires Coverage

Insurers Must Carefully Write Policy Wording New York appellate courts are noted for their opinions. Castillo v. Prince Plaza, LLC, — N.Y.S.3d —-, 2016 WL 5400641, 2016 N.Y. Slip Op. 06192, Supreme Court, Appellate Division, Second Department, New York (9/28/16) … Continue reading

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Marine Warranty Is Inviolate

Sunken Containers of Pollutants Not Pollutants Marine insurance is usually based upon multiple warranties that must be complied with by the insured to allow insurance to apply. Therefore, after a dry dock, loaded with barrels of oil, sank during a … Continue reading

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Additional Insured Agreement Must Be Clear

Contracts Must Be Clear to Bind an Insurer Liability insurance policies allow insureds, by contract, to cause a person to be an additional insured on the policy. Failure to make the contract clear, even thought both parties have similar or … Continue reading

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Liability Risk Retention Act of 1986 Preempts State Insurance Law

Federal Preemption in Favor of An RRG Risk Retention Groups (RRGs) are insurers of last resort created by federal statute to provide coverages not available under state statutes. As a result, the RRG founding papers and policy wording, will always … Continue reading

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Not All Firebombing an Arson-For-Profit

Stupid or Unlucky Arsonists Some people believe every arson fire is designed to allow the owner to profit as part of an insurance claim. In fact, arson is most often an act of spite or an attempt to harm the … Continue reading

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Failure of Insured to Prove Loss Fatal to Claim

No Bad Faith For Reasonable Dispute People insured by a first party property insurance policy are obligated to prove that there was a loss due to a peril insured against and the extent of that damage. Only after the insured … Continue reading

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Qui Tam Action Takes the Profit Out of Fraud

Judgment In Favor of Qui Tam Plaintiff Insurer Can Be Enforced In California an insurer can, on its own behalf and on behalf of itself and the state as a qui tam action. When the state does not join in … Continue reading

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Court Can’t Rewrite Insurance Policy

A Rockfall Is Earth Movement Bad facts create litigation. When a 2700 ton mass of rock and earth fell 1000 feet onto a house killing the occupants and totally destroying the house, garage and a car, insurance coverage was required … Continue reading

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Posted in Zalma on Insurance | 2 Comments

Pay Before Accident to Reinstate Cancelled Policy

No Excuse for Failure to Timely Pay Premium Insurance premiums are hard to pay. Anyone who owns a car would prefer to only pay insurance premiums until after they have a loss so that they can collect and pass the … Continue reading

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Ownership Not Required to Have an Insurable Interest

Every Interest in Property Where a Peril May Cause Damage to the Insured is an Insurable Interest Insurance is a contract of personal indemnity. It does not insure property. Rather it insures the person insured against the risk of loss … Continue reading

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Conviction for Health Care Fraud Upheld

It is a Crime to Cheat Insurers The government’s case against Theresa Fisher was strong, predicated in part on the following evidence: testimony by five witnesses who claimed to have been coached by Fisher; testimony by a co-conspirator that both … Continue reading

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Immunity for Insurers

 Zalma’s Insurance Fraud Letter September 15, 2016, Volume 20, No. 18 Barry Zalma In this, the Eighteenth issue of the 20th year of publication of Zalma’s Insurance Fraud Letter (ZIFL), Barry Zalma, on September 15, 2016 continues the effort to … Continue reading

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Clear & Unambiguous Language Not Enough

Latent Ambiguity Trumps Policy Wording Although the law allows an  insurer to enter into any contract terms it desires that is agreeable to the insured, seriously injured people and a court’s desire to help the injured person, raise a public … Continue reading

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Clear & Unambiguous Policy Language Must Be Enforced

Insurer May Decide What It Wants to Insure This case involves an insurance coverage dispute arising from a wrongful death and products liability claim. Lindsey King (“King”), individually and on behalf of her deceased minor child Peyton Wilt (“Wilt”), appealed … Continue reading

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Insurance Companies Have the Right to Limit Coverage in any Manner Desired

Duty to Defend Limited to Time on Risk in Louisiana When a defendant is uninsured for a particular risk and plaintiffs sue for injuries and illness allegedly incurred of periods of time when the defendant was uninsured and some where … Continue reading

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Set-Up of Injured Plaintiff Fails

Clear and Unambiguous Exclusion Must be Applied When a liability insurer is presented with a claim seeking defense and indemnity and the facts appear to exclude all coverage it will provide a defense under a reservation of rights so that … Continue reading

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UIM Coverage Not Available For Driver’s Negligence

UIM Coverage Only Available When Insured Injured by a Third Party Uninsured Motorist (UM) and Underinsured Motorist (UIM) coverages are designed to provide indemnity to an insured who is injured by an uninsured or underinsured motorist’s negligence. It is not … Continue reading

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Advertising Injury Requires A Fortuitous Loss

Defendant’s Business Saved by Brilliance of Insurer I have over the last 1700 posts to this blog advised against entering into a stipulated judgment and granting a viable defendant a covenant not to execute in the hope of a windfall … Continue reading

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Rescission of PIP Policy Available For Fraud

The “Innocent Third Party Rule” Does Not Eliminate Right to Rescind When an insured obtains a policy of insurance by misrepresentation of a material fact or fraud the insurer may rescind the policy in Michigan. However, when an innocent person … Continue reading

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Georgia Refuses to Adopt Continuous Trigger

CGL Not Limited to Insuring Injury Taking Place During the Policy Period When an insured has a continuous loss where pollutants leak into the soils and cause damage over a long period of time it can be held for the … Continue reading

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There Ain’t No Such Thing as A Free Lunch

Court Refuses to Rewrite Insurance Policy to Require Insurer to Pay for Damages Incurred When It Did not Insure Third party liability insurance policies are designed to provide coverage protecting its insured against risks of losses that occur during the … Continue reading

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STOLI is Dangerous to Health & Liberty

Zalma’s Insurance Fraud Letter September 1, 2016 In this, the Seventeenth issue of the 20th year of publication of Zalma’s Insurance Fraud Letter (ZIFL), Barry Zalma, on September 1, 2016 continues the effort to reduce the effect of insurance fraud … Continue reading

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