Author Archives: Barry Zalma

About Barry Zalma

An insurance coverage and claims handling author, consultant and expert witness with more than 48 years of practical and court room experience.

Don’t Change Your Mind After Accident

Waiver of Stacking UM/UIM Cover Upheld Insurance is a contract. An insured saves money by agreeing to limit the coverage available because the insured does not believe it would be needed. Only after an accident does an insured reconsider the … Continue reading

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Workers’ Compensation Policy Does Not Cover Defense of Third Parties

No Cover for Liability Assumed by Contract Workers’ Compensation is required by statute to provide coverage to employees who are injured in the course of employment without a need to prove liability, negligence or any other tort. Workers’ Compensation policies … Continue reading

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When is an Appraiser Disinterested?

What is “Competent and Disinterested”? California Insurance Code, at § 2071 provides a method by which an insured and insurer may quickly, and informally, resolve disputes concerning the amount of loss. Although called “appraisal” it is really a contractual arbitration … Continue reading

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No Good Deed Goes Unpunished

Pay the Premium or Lose Coverage States across the U.S. have passed statutes regulating the cancellation of insurance policies. The statutes impose strict notice to the insured and how cancellation for failure to pay premium can be cured. In Anthony … Continue reading

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Insurance Claims In a Catastrophe

Insurance Claims In a Catastrophe If your house was damaged or destroyed by a wildfire, accidental fire, windstorm, flood, hurricane or earthquake, as a result of state declared catastrophes and you had a fire, homeowners, flood insurance, tenant’s homeowners or … Continue reading

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Convicted Insurance Fraud Perpetrator Sues Insurer for Reporting Him

“Chutzpah” by Fraud Perpetrator Fails “Chutzpah” is a Yiddish term meaning unmitigated gall. The best definition I have heard is when a man is convicted of murdering his parents and pleads for mercy because he is an orphan. In David … Continue reading

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Zalma’s Insurance Fraud Letter – October 15, 2017

Zalma’s Insurance Fraud Letter The Essential Resource For The Insurance Fraud Professional Barry Zalma, Inc.  October 15, 2017   Any Medical Provider Convicted of Fraud in California Will Be Suspended The liens of a physician, practitioner or provider and the … Continue reading

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Trademark Infringement Claim Places Insured at Land’s End

Advertising Injury Coverage & Exclusion Clarified Trademark infringement lawsuits are often complex and difficult for insurers to deal with. Some provide coverage without dispute while others rely on exclusions written to limit the coverages provided. Since insurance coverage grants are … Continue reading

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Oklahoma Statute Deprives UM/UIM Insurer of the Equitable Remedy of Subrogation

Oklahoma Statute Takes Away Insurer’s Right of Subrogation Against UM/UIM Insurer Subrogation is an equitable remedy that allows an insurer who pays a claim to an insured due to the actions of a tortfeasor to sue the tortfeasor as if … Continue reading

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I’m Dead – Really I Am!

Life Insurance Fraud Fails Nigeria seems to be the birthplace of different types of fraud. Everyone in the U.S. has received a letter, e-mail or fax offering millions from some Nigerian prince or government official if only the recipient gives … Continue reading

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Incorrect Statement of Values Allows Rescission

Innocent Material Misrepresentation Sufficient to Allow Rescission Insurance, as I have said over and over again, is a business of the utmost good faith that requires both parties to do nothing that will deprive the other of the benefits of … Continue reading

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The Duty to Select Type and Amount of Insurance Belongs to the Insured

Insurance Agent Only Required to Provide Insurance Ordered Unless they take on a fiduciary obligation an insurance agent or broker is only required to provide the insurance it was asked to acquire. The agent or broker need not – unless … Continue reading

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No Occurrence – No Fortuity – No Coverage for Defense or Indemnity

Lack of the Potential for a Covered Claim Defeats Bad Faith Suit The ability to allege and prove a right to a defense under a liability insurance policy is usually fairly simple. All that is required of the insured is … Continue reading

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Restoration of Ill Gotten Gains Not Insurable – Fraud Doesn’t Pay

Neither an Intentional Nor a Criminal Act is Fortuitous From the first insurance coverage issued on a clay tablet in ancient Sumeria every insurance claim required a fortuitous loss – one that is either contingent or unknown at the time … Continue reading

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Who Pays Black Lung Victim When His Employer and Its Insurer are Insolvent?

Guaranty Fund Is More Responsible than the Federal Black Lung Trust Fund Island Fork Construction v. Jimmy Bowling; Director, Office Of Workers’ Compensation Programs, No. 16-4319, United States Court Of Appeals For The Sixth Circuit (September 29, 2017) Jimmy Bowling … Continue reading

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Why Pennsylvania Made it Easier to Prove Insurer Bad Faith

No Need to Prove Ill-Will or Self-Interest to Prove Bad Faith Since its creation as a tort in the 1950’s and 1960’s the tort of bad faith required proof the the insurer will do nothing which will injure the right … Continue reading

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Zalma’s Insurance Fraud Letter – October 1, 2017

Zalma’s Insurance Fraud Letter The Essential Resource For The Insurance Fraud Professional October 1, 1979 – 2017 Another Anniversary   Thirty eight years ago today I left the world of the employed and became an entrepreneur by opening my own … Continue reading

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20 Years after Notice of Claim Violates Notice Condition

Service Of a Lawsuit Requires Prompt Notice to Liability Insurer The reason insurance companies put a notice requirement in a liability insurance policy is to protect the insurer against stale claims and fraud. Everyone who has ever run a business … Continue reading

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He Who Represents Himself in Court Has a Fool For a Client

Facts Stating a Cause of Action Required to Stay in Court Normally, I digest reported decisions to make them easier to digest. Today, in Harold Greene v. USAA Casualty Ins. Co., et al., Civil No. JKB-17-1854, United States District Court … Continue reading

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Bankruptcy is Not a Cure of Mortgagor’s Failure to Pay Insurance Premiums

Never Lie to a Judge Mortgages invariably require the property owner to buy, and name as loss payee, the mortgagee. When premiums are not paid and a policy is cancelled the mortgagee has the right to force place insurance to … Continue reading

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It’s Not Nice to Lie to Your Insurer

A Livery Vehicle is not an “Automobile” for No Fault Insurance Purposes When an insured, operating a livery and taxi service obtains an insurance policy covering one of its vehicles as a private passenger vehicle knowing that its application for … Continue reading

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A Jury is not Allowed to Speculate About Damages

When Seeking Coverage Of A Settlement Of Covered and Not Covered Losses the Insured Must Prove Allocation When an insured seeks coverage for a multi-lawsuit settlement where one plaintiffs action is covered by the policy and the other is not, … Continue reading

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Insured v. Insured Exclusion Defeats Claim

Again an Assignment of Claim Is a Loser When will litigants learn that it is not always profitable to take an assignment from tortfeasors. If the tortfeasor has sufficient assets to pay a judgment there is no reason to enter … Continue reading

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Serial Insurance Criminal Ineffectively Tries to Avoid Waiver of Rights

Insurance Criminal Stays in Jail for Five Years If nothing else, insurance criminal have chutzpah – unmitigated gall – when it comes to their sentences for fraud. When the jury was deliberating whether to convict or acquit Chellyn Jones, she … Continue reading

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L’Shana Tova

Happy new year to all who practice Judaism.

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Charging Fraud Without Sufficient Evidence Is Fatal to the Charge

Inadequate Evidence Requires Fraud Charges to be Dismissed I wrote an article at http://zalma.com/blog/its-sinful-to-defraud-church-mutual/ that I called “It’s Sinful to defraud Church Mutual” where, in my digest of the case where I opined: Church Mutual has done something that should … Continue reading

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If you do the Crime You Must Do the Time

Once Convicted Criminals Refuse to Accept the Sentence Rendered People who conspire to distribute the deadly opiods with physicians who defraud insurers, Medicare and Medicaid, are vicious and responsible for many over dose deaths of those to whom the opiods … Continue reading

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It Pays to Write a Clear & Unambiguous Policy

No Insurance Policy Covers Every Possible Eventuality Everyone who buys insurance wants it to cover every possible eventuality where a suit may be brought against it. Of course, that belief is as accurate as the claim that Elvis lives as … Continue reading

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Zalma’s Insurance Fraud Letter – September 15, 2017

 Zalma’s Insurance Fraud Letter Volume 21, No. 18 Evil Incarnate – Stealing Life Insurance Proceeds from Beneficiaries of the Elderly In the last 50 years that I have been in the business of insurance I have learned the one thing … Continue reading

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Nothing is Certain or Immutable in the Law

Depriving Criminal Defendant of Fifth Amendment Right Not Subject to Insurance The U.S. Constitution prohibits requiring a person to testify against himself. When a person is deprived of his Fifth Amendment rights and is, as a result, wrongfully convicted, he … Continue reading

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Catastrophe Claims

Claims In A Catastrophe © 2008 Barry Zalma ClaimSchool, Inc. In 2008 I wrote this article to help those faced with catastrophic losses. I reprint it here because of Hurricane Harvey and Irma in hopes it will help those victims … Continue reading

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New Jersey Finds Broker Has Fiduciary Duty to Insured

Broker’s Failure to Properly Value Property Liable to Insured for Losses An insurer’s basic duty is to transact insurance with an insurer on behalf of the insured as ordered by the insured. Neither the broker nor the insurer are obligated … Continue reading

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Conviction Stands for Care Giver’s Stealing from Old & Sick

Evil Incarnate – Stealing Life Insurance Proceeds from Beneficiaries of the Elderly When we get old and sick, close to death, the family turns over care of the elderly relatives to professional care givers who are expected to care for … Continue reading

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Insured’s Agreement to Endorsement Adding Exclusion Is Fatal to Its Assets

Insured Saved Premium by Agreeing to Loading Exclusion & Must Defend Itself People who are not insurance professionals think the price of insurance is more important than the coverages provided. As a result they are often willing to limit the … Continue reading

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Summary Judgment Hard to Obtain

Excess Insurer Loses Claim of Lack of Exhaustion of Primary Insurance Excess insurance policies are designed to function only in catastrophes and have no obligation until the primary insurance policies are exhausted. In addition the insured is required to advise … Continue reading

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Insured Must Meet Burden or no Coverage

Insured Obligated to Prove Loss Is Due to Covered Peril Insurance companies have no interest in insuring against losses due to wear and tear or deferred or incompetent maintenance because such losses are not fortuitous. Losses that are caused by … Continue reading

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Representing Insureds in a Catastrophe

Available from the American Bar Association at https://shop.americanbar.org/eBus/Store/ProductDetails.aspx?productId=218303&term=zalma

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No Case Against Prosecutors for Malicious Prosecution

Prosecutors Immune From Suit For Charging Police Officers With Fraud When a prosecutor obtains a grand jury indictment for fraud only to later learn than there was inadequate evidence to prove a case against them and dismisses the charges, the … Continue reading

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Insured Must Prove That Claim Falls Within Insuring Agreement

Insured Learns No Insurance Policy Insures Against Every Risk People who buy liability insurance want it to cover every possible risk faced by the insured. When a loss or claim occurs the read the policy, perhaps for the first time, … Continue reading

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Hurricane Harvey & Work to Defeat Anticipated Fraud

Hurricane Harvey & Fraud The following was published in the September 1, 2017 issue of Zalma’s Insurance Fraud Letter available, free, at – http://www.zalma.com/ZIFL-CURRENT.htm. If you are working with insurers dealing with damage due to Hurricane Harvey you should find … Continue reading

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