Monthly Archives: January 2017

Four Corners Rule Strikes Again

Employee’s Suit Against Employer For Mesothelioma Barred by Workers’ Compensation Exclusivity Every state in the United States has a workers’ compensation system where, to avoid the need to prove liability of an employer who is believed to have negligently injured … Continue reading

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Injury to One Spouse Not Injury to Other

Creative Argument Fails Lawyers are creative people. They try to protect their clients and provide benefits to their clients by making creative arguments. Those creative arguments are often effective but are often just plain ridiculous. In Lambert v. Nationwide Mutual … Continue reading

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Undisputed Material Misrepresentation Sufficient to Support Rescission

Misrepresentation to Save Premium Eliminates Coverage People who have no experience with insurance when faced with a potential savings of insurance premium if the insured does not present true facts to the insurer is exceedingly expensive and can surprise the … Continue reading

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Material Misrepresentation Sufficient to Rescind PIP Policy

Innocent Party Doctrine Not Applicable to Commercial Insurance I continue to report, until I turn blue in the face, that the covenant of good faith and fair dealing applies equally to the insured as it does to the insurer. Insurance … Continue reading

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Lie on Health Insurance Application Is Criminal

Stupidity is No Defense to Insurance Fraud Crime In an appeal from a judgment of the Lucas County Court of Common Pleas that found appellant Marvin Arnold guilty of one count of insurance fraud, a felony of the fourth degree, … Continue reading

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It is Expensive if an Insured’s Lawyers Don’t Read and Understand Policy

Insured May Not Expect Payment if it Settles Claim Without Insurer’s Consent Lawyers have an obligation to protect their clients from wasting money and need to understand insurance before entering into an agreement to settle a third party law suit. … Continue reading

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It’s Not Nice to Apply Policy Condition but it is Proper

No Excuse for Failure to Promptly Give Notice of Loss New York law, unlike most states, properly requires that an insured must comply with the condition requiring prompt notice and refuses to apply the so-called notice-prejudice rule. U.S. Courts, like … Continue reading

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Consent to Call Defeats TCPA Suit

Robo-Calls Are Not Always Wrongful I, like everyone else, hate receiving unsolicited robo-calls. They are especially annoying during the political season or from surveyors who want my opinion on products I would never use. The Congress enacted Telephone Consumer Protection … Continue reading

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Strained, Forced or Unrealistic Construction Of Insurance Not Allowed

Ambiguity Is not Certain When Term Not Defined Insurance policies cover many and varied causes of loss. Insurance policies do not cover every possible cause of loss. Even the most broad all risk policy of insurance contains exclusions describing risks … Continue reading

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Insured v. Insured Exclusion

A D&O Policy Does Not Apply To a Suit by an Insured Against a Co-Insured Almost every policy of liability insurance contains an exclusion that prevents coverage to apply when one insured sues another. The reason for the exclusion is … Continue reading

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Zalma’s Insurance Fraud Letter – January 15, 2017

The New Year’s Reminder of Red Flags of 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 … Continue reading

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Cannot Create Coverage by Waiver

Insured Only Gets Coverage Purchased There are many reasons for which people buy insurance. Insurers provide multiple coverages on a homeowners policy from the basic ISO form and additional coverages provided by endorsement for an extra premium. The insured is … Continue reading

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Ketchup on Heinz’ Face Because it Lied to its Insurer

Policy Void From Its Inception if Obtained by a Lie Every policy of insurance includes an unwritten covenant – promise – to deal fairly and in good faith with the parties to the contract. The promise to deal fairly devolves … Continue reading

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The Purpose of An Insurance Fraud Investigation

 Insurance Fraud Investigations The purpose of an insurance fraud investigation is to gather evidence to establish whether a suspected fraudulent claim is legitimate or is, in fact, an attempt to defraud the insurer. If the facts reveal the claim is … Continue reading

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Broker Not Responsible for Fraudulent Insurer

 Broker Must Owe A Duty To Be Held Responsible for Failure of Insurance Complex insurance programs are required to properly insure major property owning organizations require the services of multiple brokers and sub-brokers. Because of the complexity of the insurance, … Continue reading

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Imperfect Claims Handling Not Bad Faith

Insured is Obligated to Assist Insurer in Effecting Settlement No plaintiffs’ lawyer with a high value case will accept policy limits from an insurer without first learning whether the insured has assets that are collectible if a judgment is entered … Continue reading

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Insurers are Only Obligated to Provide the Insurance Ordered

Insured Must Take Responsibility For His Policy Insurance is a contract between the insurer and the person insured. Insurance companies sell to the insured the coverage requested. Insurers have no obligation to force, or even advise, the insured about the … Continue reading

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The Problem With Easy to Read Policies

By Making Insurance Companies Write “Easy to Read” Policies Ambiguities Are Created In an attempt to protect people from insurance companies almost every state has enacted statutes or regulations that require all policies be written in “easy to read” language … Continue reading

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Litigation Only Because Mortgagee Failed to Confirm Existence of Insurance

Premature Motion for Summary Judgment Fails It is essential that when a contract requires a person who buys a property must insure against fire must be careful to confirm that the buyer actually maintains a policy.  When the parties to … Continue reading

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Lie on Application — Lose All Coverage

Rescission Appropriate When Applicant Misrepresents Use of Vehicle When a prospective insured seeks insurance he or she submits an application to an insurance company as the set of facts used by the insurance company in determining whether it is willing … Continue reading

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Zalma’s Insurance Fraud Letter – January 1, 2017

2017 and Insurance Fraud May you all have a Happy and profitable New Year and may all fraud perpetrators spend 2017 in prison. Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have been … Continue reading

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