Monthly Archives: November 2017

Agents Should Never Lie to Insurers

The Responsibility of an Agent or Broker to be Truthful to the Insurer Some years ago my solution to a mid-life crisis was to buy a custom made replica of the Studebaker Avanti, a fiberglass sports car powered by a … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Property Insurance Adjusting

A Basic Manual for First-Party Property Insurance Claims Adjusters © 2017, Barry Zalma, Esq., CFE This is the first part of a long white paper I wrote on how to adjust property claims. If you find it interesting and want … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

What Happens When the Insured Refuses to Testify at EUO?

The Examination Under Oath is a Condition Precedent to Obtain Policy Benefits Since the EUO is an essential weapon in the insurer’s arsenal of tools to defeat insurance fraud these decisions are exceedingly important to every SIU insurance fraud investigator … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Reasonable Grounds to Contest Claim Avoids Charges of Bad Faith

Is It Okay to Lie to an Insurer in Georgia? Since the covenant of good faith an fair dealing applies equally to the insured and the insurer most states allow an insurer to void a policy from its inception for … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Policy Wording Is Inviolate

Insured May Not Change Policy Wording After a Loss Insurance is a contract representing the agreement between an insured and an insurer. If the terms of the contract are clear and unambiguous an insured – no matter how much has … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Insured Must Fulfill Protective Safeguards Requirement

For Lack of a Sprinkler System Coverage was Lost Commercial properties present serious risks of loss by fire. Many commercial property policies contain a protective safeguards endorsement (PSE) requiring sprinkler systems, smoke detectors and burglar alarm systems. Failure to fulfill … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Insurance Fraud Is Not a Victimless Crime

50 Years In Jail for Insurance Fraud and Attempted Murder It is the understanding of most in the public, prosecutor’s offices and court rooms that insurance fraud is a victimless crime since only a rich insurance company is harmed. The … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Slow and Intentional is Not Sudden and Accidental

Slow Destruction by Tenant Intending Remodel Not an Insured Against Loss When an insured rented a house to a tenant he expected the tenant to simply live there and do nothing to modify the structure. In fact, the lease, prohibited … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Fortuitous Event Needed to Obtain Liability Insurance Coverage

No Accident, No Coverage I have often, here, quoted the simple, clear and unambiguous definition of insurance provided by the California Insurance Code that states: “Insurance is a contract whereby one undertakes to indemnify another against loss, damage, or liability … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

A Thanksgiving Message From Barry Zalma

What I Am Thankful For We Americans have celebrated Thanksgiving when we were just a colony of Great Britain to give thanks for the good things in life at least once a year. It took Abraham Lincoln, our greatest President, … Continue reading

Share
Posted in Zalma on Insurance | 3 Comments

Determination of Efficient Proximate Cause of Loss Controls

The Concurrent Cause Doctrine Does Not Always Apply First party property insurance provides broad coverages subject to certain limiting exclusions. When a loss occurs that is due to a peril excluded there can be no coverage. Insureds’ do not like … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Payment of Appraisal Award Defeats Bad Faith Claim

There can be no Tort of Bad Faith if there is no Breach of Contract When a first party property insurer disagrees with its insured on the amount of loss the policy allows the dispute to be resolved by a … Continue reading

Share
Posted in Zalma on Insurance | 1 Comment

Sexual Abuse of a Minor is Always an Intentional Act

Liability Insurance Policies Invariably Exclude Intentional Acts When a teacher abuses a minor student, rapes the minor student, and has constant sexual acts on a minor he or she acts intentionally to harm the minor as a matter of law. … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Sexual Abuse of a Minor is Always an Intentional Act

Torts are Different than a Coverage Issue

Severance of an Insurer from Tort Claim Not Always Required Usually a court will not allow a tort claim to be joined with an insurance coverage issue because it might prejudice the jury. When the trial court refused to sever … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Torts are Different than a Coverage Issue

Zalma’s Insurance Fraud Letter – 11-15-17

 The Essential Resource For The Insurance Fraud Professional   Barry Zalma, Inc. November 15, 2017   The Law Must be a Harsh Mistress The law demands absolute honesty, loyalty to the needs of the client over the needs of the lawyer, … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Zalma’s Insurance Fraud Letter – 11-15-17

No Subrogation Because Lease Silent and Existence of Mutual Benefit Insurance

Subrogation Remedy Limits Insurer to Rights of its Insured Subrogation is an equitable remedy available to insurers to what they paid an insured as a result of damage to property, the risk of loss of which was insured, from the … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on No Subrogation Because Lease Silent and Existence of Mutual Benefit Insurance

Why Labor Must Be Depreciated to Find ACV

 Materials and Labor Depreciate to Reach Actual Cash Value The intent of a first party property insurance policy is to place the insured, after a loss, back in the same financial situation the insured was in before the loss. Insurance … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Why Labor Must Be Depreciated to Find ACV

Holder of Assignment of Benefits Gets No More Rights than Insured

Eleventh Circuit Enforces Private Limitations of Action Provision of Policy The state of California is often considered to be a leader in insurance coverage litigation that is often followed by multiple states. However, as my last post proved, and as … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Holder of Assignment of Benefits Gets No More Rights than Insured

Failure to Sue Promptly Destroys Bad Faith Suit

Failure to Sue Within Policy’s Limitation Provision Fatal to Suit As I have said multiple times: “insurance is nothing more than a contract.” It is, also, a contract of the utmost good faith that devolves equally on the insurer and … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Failure to Sue Promptly Destroys Bad Faith Suit

Attempted Insurance Fraud Is as Criminal as Actual Fraud

Insurance Fraud Happens When a Person Presents or Causes to be Presented a Fraudulent Document to an Insurer Insurance fraud is so easy and so seldom prosecuted that when a person is caught and convicted they tend to appeal to … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Attempted Insurance Fraud Is as Criminal as Actual Fraud

No Workers’ Compensation Unless Injured on the Job

Driving to Job Site to Start Work Not in Course & Scope of Employment Workers’ compensation is designed to protect an employee injured on the job of the need to prove the negligence or intentional tort obligation of the employer. … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on No Workers’ Compensation Unless Injured on the Job

Proof of Mailing Sufficient to Effect Cancellation

Court Trusts the United States Postal Service For an insurance contract to exist consideration – premium – must be paid. When an insured fails to pay the premium as required by the policy the insurer had the unquestioned right to … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Proof of Mailing Sufficient to Effect Cancellation

Insurance Policy Exclusion Must Be Enforced

Public Policy Only Applies if it Injuriously Affects a Material and Substantial Part of the Public Insurance exclusions, and all provisions of an insurance policy, must be enforced as long as they are clear and unambiguous unless the exclusion is … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Insurance Policy Exclusion Must Be Enforced

Insurer Not Severed from Indemnity Action Brought Against It and Insurer

No Concern for Insurer Joined in Suit Against Additional Insured Additional insureds who seek defense from their insurer will often sue seeking declaratory relief but try to keep the case limited to the dispute with the insurer. In what has … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Insurer Not Severed from Indemnity Action Brought Against It and Insurer

Fraud Scheme Fails

Performing Expensive Unnecessary Test for Insured and Not for Uninsured is Fraud Health insurance fraud is extremely profitable and seldom discovered and prosecuted. When it is successfully prosecuted the defendants, who have made millions by fraud, have sufficient funds to … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Fraud Scheme Fails

A “Wells Notice” is a Claim

Notice of Circumstance is not a Claim The Securities and Exchange Commission (SEC) has various rights, duties and obligations. It can investigate and it can prosecute after finding sufficient facts to do so. Liability insurance only provides coverage for an … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on A “Wells Notice” is a Claim

Zalma’s Insurance Fraud Letter – September 1, 2017

The Essential Resource For The Insurance Fraud Professional What is Insurance Fraud? An intentional perversion of the truth for the purpose of inducing another in reliance upon it to part with some valuable thing belonging to him or to surrender … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Zalma’s Insurance Fraud Letter – September 1, 2017