Monthly Archives: December 2016

Racial Discrimination is Not an “Occurrence”

All Racial Discrimination Acts are Intentional Racial discrimination is wrongful under all circumstances. By definition discrimination is an intentional act. Girard and Lindsay Jones appeal a judgment dismissing their state and federal disparate treatment housing discrimination claims against John Baecker. … Continue reading

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Courts Lack the Authority to Change an Insurance Contracts Purported to be Contractual Interpretation

Ambiguity Can’t Be Created to Change Clear Wording As I have said since I began this blog, insurance policies must be read as written. People who are injured always seek to recover from every tortfeasor and every insurance policy that … Continue reading

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Claims Made and Reported Policies Limited to One Claim

There Can Only be one Policy Covering Claims Made Loss Dr. Kyrsten E. Sutton reported a potential loss to her insurer; on expiration of that policy she acquired insurance with another insurer; and when a formal claim was reported presented … Continue reading

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What the Heck is Peremption?

Peremption and Statutes of Limitation Require Evidence Since the beginning of the common law four centuries ago those who sat on their rights and took years to file suit were prevented from moving forward by statutes of limitation and Peremption … Continue reading

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Time To Grow Up

There is No Insurance To Avoid Hard Work Modern students have grown up in a system where no one wins and no one loses. They get trophies for participating. Competition is discouraged if not totally eliminated. To those who graduate … Continue reading

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More on the Dam Case

ACV Judgment Limited to ACV and Not Future Replacement Cost Depending on the wording of an insurance policy actual cash value (ACV) is a method of determining the amount payable to an insured on a replacement cost policy even if … Continue reading

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Assault or Battery Exclusion Applies

RTFC Before A Claim Arises It continues to be amazing and stupid to me the failure of people who are insured, their agents, brokers and lawyers, to read an insurance policy before making a claim or filing suit on an … Continue reading

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Qui Tam Suit Can’t Survive on Mere Allegations

Qui Tam Relator Must Allege & Prove Fraud to Government Program Qui Tam suits do what the government may not – the ferret out fraud against the government or government programs. They exist because the person making the claim of … Continue reading

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A Claim Denial Must State All Bases for Denial

Estoppel Limits Defenses But Insured Must Still Prove Loss is Within Coverage The covenant of good faith and fair dealing requires that the insured honestly and fully report to the insurer the risk it is taking. A concealment or misrepresentation … Continue reading

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Insurance Coverage Lawyer Work Product Protected

Coverage Memoranda Protected by Attorney Client & Work Product The reason courts apply the attorney client privilege and the work product protection to keep one party from reading the plans and recommendations of the lawyer for the opponent. The protection … Continue reading

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Mysterious Disappearance Exclusion Effective

Insured Must Produce Physical Evidence of Loss Insurance policies invariably contain a condition that requires the insured to produce a sworn statement in proof of loss that establishes a first party loss due to a peril insured against and not … Continue reading

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Zalma’s Insurance Fraud Letter – December 15, 2016

Merry Christmas and a Happy Hannukah   ZIFL publishes this story at Christmas time every year.      I hope you like it again Christmas & Insurance Fraud Every Insurance Adjuster Must Be Trained About Fraud In the last 49 … Continue reading

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Claims Made & Reported Policy Conditions Must Be Fulfilled

It Takes Skill or Stupidity For An Insured to Violate the Reporting Condition of Two Policies Insurers who write claims made and reported errors and omissions insurers are entitled to honest, prompt and accurate reports of potential claims that occur … Continue reading

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Why Do States Believe an Insurance Company Cannot Be a Victim?

Every Victim of Crime Is Entitled to Restitution State legislators, like those in the State of Iowa, seem to think that when an insurer pays an insured for a loss due to a criminal act is not a victim of … Continue reading

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Florida Adopts Concurrent Cause Doctrine for First Party Claims

No Difference Between First and Third Party Insurance in Florida California invented the concurrent case doctrine in State Farm Mut. Auto. Ins. Co. v. Partridge, 10 Cal.3d 94, 109 Cal.Rptr. 811, 514 P.2d 123, 133 (1973). The doctrine made sense … Continue reading

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Texas Requires Insured to Live at “Residence Premises” for Coverage to Apply

No Cover Unless an Insured Resides or Intends to Reside In the “Residence Premises” First party property insurance policies insure people against the risk of loss of certain described property. It does not insure the property. When an insurance policy … Continue reading

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Violation of Seal Provision Does Not Require Dismissal of FCA Suit

U.S. Supreme Court Upholds Fraud Judgment Against State Farm The False Claims Act (FCA) allows individuals to file suit on behalf of the United States if they can prove that a person or entity is involved in defrauding the United … Continue reading

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UM Policy’s Excess Clause Applied

When a Policy’s Language is Clear and Unambiguous it Must Be Enforced It is very difficult to write an insurance policy that is clear and unambiguous. When that task is accomplished the work of a court called upon to interpret … Continue reading

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Criminal Conviction Of Fraudster Estops Defense to Civil Case

$122,500,000 Judgment Affirmed Against Crooked Doctor Who Tried to Kill Accuser An Arkansas doctor who was involved in multiple schemes to defraud insurers, Medicaid and Medicare, tried to stop the investigation into his criminal activities by killing the doctor in … Continue reading

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“Fairly Debatable” Claim Denial Avoids Bad Faith

When an Insurer Has a Reasonable Basis to Deny a Claim It Does Not Act In Bad Faith Insurable interest is often difficult for lay insureds and claims people to understand. It is simply an interest where the insured can … Continue reading

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Say It Isn’t So – Judge Guilty of Insurance Fraud

Judge Guilty of Fake Assault to Get Opioids I have, since I started in the business of insurance in 1967, articulated that insurance fraud is an equal opportunity crime, performed by every race, religion, national origin, gender, or occupation. The … Continue reading

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Zalma’s Insurance Fraud Letter – December 1, 2016

“Good Cause” Fraud Every Insurance Adjuster Must Be Trained About Fraud  In the last 49 years that I have been in the business of insurance I have learned the one thing that is a certainty: the quality of insurance fraud … Continue reading

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