Author Archives: Barry Zalma

False Statements on Life Policy Application Sufficient to Void Coverage Life insurance applications are used by insurers to determine – assuming the good faith and fair dealing of the insured – to make a decision whether to insure or not … Continue reading →

If You Don’t Mean It Don’t Agree to Release Claim Insurance adjusters are in the business of settling claims made against people insured by the adjuster’s employer. When an adjuster reaches agreement with a claimant to settle a claim the … Continue reading →

Illumeo Announces Certifications in Corporate Liability Insurance and Corporate Property Insurance Illumeo’s corporate liability certifications will provide top quality education for practitioners and peace of mind for their companies. Silicon Valley, CA (PRWEB) July 25, 2017 Corporate liability professionals don’t … Continue reading →

Colorado Makes It Impossible to Make an Additional Insured Against Its Own Negligence Subrogation is an equitable remedy that allows an insurer to stand in the shoes of its insured and recover whatever it paid from a tortfeasor. It cannot, … Continue reading →

Zalma’s Insurance Fraud Letter, Volume 21, No. 16  Attorney General Sessions Announces Opioid Fraud and Abuse Detection Unit In the last 50 years that I have been in the business of insurance I have learned the one thing that is … Continue reading →

It Doesn’t Pay to Run Before Trial Complete Regardless of the public’s belief, insurance fraud is a serious crime. Perpetrators of insurance fraud think, perhaps because of its reputation, that the crime is not serious enough to be exposed to … Continue reading →

Insurance Only Covers Contingent, Unexpected or Unintentional Losses Because they live in the house with their parents children are insured’s of a homeowners policy. As insureds they are entitled to defense and indemnity for their negligent conduct. However, for coverage … Continue reading →

Failure to Follow New Jersey No-Fault Law Deprives Plaintiff of Coverage When a person is injured in an auto accident they will do almost anything to get indemnity, especially when the person causing the injury was uninsured. In Denise V. … Continue reading →

Scope of Coverage Limited by Wording Must Be Enforced Title insurance is different than property, casualty or liability insurance. It provides a coverage limited by its terms. Title insurance is fundamentally different from other types of insurance because it is … Continue reading →

California SIU Regulations    Zalma’s Insurance Fraud Letter, Volume 21, No. 15     Every Insurance Adjuster Must Be Trained About Insurance & Fraud In the last 50 years that I have been in the business of insurance I have … Continue reading →

Cancellation and Lack of Coverage for Long Term Damage Defeats Suit Against Insured When an insured’s vacation home was discovered to have two floors of the home flooded, the wood had peaked, mold had grown two or three feet off … Continue reading →

Specific Litigation Exclusion Enforced Claims made and reported policies – Directors and Officers or Errors and Omissions – are based upon an application telling about litigation history. When the insured discloses a prior lawsuit or pending claim in an application … Continue reading →

Assault or Battery Excluded Regardless of Allegations in Complaint Intentional acts are, by definition, not insurable since they are neither contingent or unknown. Because courts prefer to force insurers to defend almost any act the insured may commit. For that … Continue reading →

Only the Arsonist Cannot Recover for Damage He Caused Every state enacted a standard fire insurance policy that sets a minimum wording for fire insurance policies. The wording of the statutory policy is not “easy to read” but is a … Continue reading →

Both Insurers Lose Because of Lack of Proof It is probably a certainty that courts are not thrilled when dealing with a dispute brought by an insured. They often prefer to rule against the insurer in favor of the insured. … Continue reading →

Failure to File Suit Promptly is Fatal to Claim In the last fifty years I have asked hundreds of insured’s under oath whether they read their insurance policy and understood it. Only two answered “yes” and both of them lied. … Continue reading →

Chlorine Is a Pollutant When a claim is denied based on a clear and unambiguous exclusion like the “Total Pollution Exclusion” the insured seeks coverage by claiming the policy was illusory and the exclusion should not be enforced or or … Continue reading →

 STOLI Fraudsters Can’t Get Back Premiums Paid   Zalma’s Insurance Fraud Letter, Volume 21, No. 14   Every Insurance Adjuster Must Be Trained About Insurance & Fraud In the last 50 years that I have been in the business of insurance … Continue reading →

Additional Insured May Attempt To Create Coverage by a Cross Claim Insurance is a risk transfer device. General contractors use that risk transfer device by requiring its subcontractors to cause the general contract to be named as an additional insured … Continue reading →

Insurer v. Insurer It is seldom wise for one insurer to sue another over a coverage issue since the decision – whether successful or nor – can set a precedent that is not favorable to the plaintiff. This is the … Continue reading →

When You Sleep With Dogs You Will Get Fleas Scott Rothstein created a Ponzi Scheme through his law firm. He used the services of Gibraltar Private Bank and Trust Company to fund the scheme. When the Ponzi Scheme was discovered … Continue reading →

There is No Good Reason to Misrepresent Facts To Insurer When an insurer evaluates the potential risks faced by an insured it needs to know the properties where the insureds live and, if they have more than one home, the … Continue reading →

False Material Statement in EUO Sufficient to Deny Claim In the last 50 years of my work in insurance the inadequacy of insurance fraud perpetrators seems to grow. That, as inadequate and incompetent they are in committing fraud the latest … Continue reading →

“As Soon as Practical” is Not Nine Months Errors and omissions (E&O) policies are usually “claims made” or “claims made and reported” policies. As a result, the insured is compelled to report any claim made against it promptly upon receiving … Continue reading →

Named Insured Must Be Liable for Additional Insured to Get Coverage The purpose of additional insured coverage is to apportion risks. By hiring a subcontractor, a general contractor exposes itself to liability risks, including vicarious responsibility for its subcontractor’s negligence … Continue reading →

Substantial Impairment of structural Integrity Is Not A Collapse Insurance companies need to define essential terms to avoid litigation over the meaning of a key coverage issue. Because Mid-Century failed to define the word “collapse” in Tustin Field Gas & … Continue reading →

Reasonable Expectations Must Be Reasonable Although the common law in the United States continues to acknowledge that the covenant of good faith and fair dealing devolves equally on the insured as it does on the insurer, people continue to refuse … Continue reading →

A Tool to Defeat Fraud:  Fortuity Required   Zalma’s Insurance Fraud Letter, Volume 21, No. 13   Every Insurance Adjuster Must Be Trained About Insurance & Fraud In the last 50 years that I have been in the business of insurance … Continue reading →

Pleading Can’t Change A Battery Into Negligence Insurance companies don’t want to insure a bar against assault and battery because of the frequency of barroom fights causing injuries to patrons or employees of the bar. Some courts fall prey to … Continue reading →

Insurance Claims Prove Insureds Committed Bankruptcy Fraud Every investigation of a major fire loss should include questions concerning bankruptcy filings by the insured and review of bankruptcy court filings. In United States Of America v. Roscoe Benton, III and Desi … Continue reading →

For Coverage to Exist Under a Homeowners Policy You Must Be an Insured and Have an Insurable Interest For reasons unknown to me many people believe a homeowners policy insures the property. It does not. A homeowners policy only insures … Continue reading →

Court Must Enforce an Exclusion that is Neither Ambiguous, Convoluted Nor Opaque Insurers are entitled to write a policy wording that an insured is willing to accept. For decades liability insurance policies have included an insured v. insured exclusion. The … Continue reading →

Trial Court Erred When It Ruled on Insurance Issue Without Policy in Evidence When attempt to reassign the risks of loss contracting parties often require the vendor to indemnify the contracting party and simultaneously make the contracting party an additional … Continue reading →

No Potential for Coverage For liability insurance to provide defense or indemnity to an insured the event causing the injury must be contingent or unknown to the insured. For that reason insurance may not provided defense or indemnity to an … Continue reading →

Louisiana Court Refuses to Read Policy as Written Insurance policies are written – by statute – in “easy to read” or “Sesame Street” English that allows a court to interpret the language in a manner different from that intended by … Continue reading →

Scheme to Defraud Homeowners and Lenders Fails Fraud is rampant in the United States. People create schemes to defraud individuals and corporations because it is fairly easy, exceptionally profitable, and seldom prosecuted. When prosecuted successfully the defendant – attempting to … Continue reading →

Court Changes Clear and Unambiguous Language of Policy to Provide Benefits Judges are often kind people intent on providing an equitable result for the injured litigants because they feel – when faced with a dispute between an injured person and … Continue reading →

Exclusive Remedy Applies to Guaranty Association The exclusive remedy rule is the most firmly entrenched doctrine in workers’ compensation law. An employer who maintains workers’ compensation insurance for the benefits of its employees may not be sued by the employee … Continue reading →

Statute of Limitations Begins to Run When Policy Delivered People who are insured receive from their broker or agent and insurer when a policy is issued. The insured, although dealing with an agent who has a fiduciary duty to the … Continue reading →

The Phantom Moose & Insurance Fraud   Zalma’s Insurance Fraud Letter, Volume 21, No. 12   Every Insurance Adjuster Must Be Trained About Insurance & Fraud In the last 49 years that I have been in the business of insurance I … Continue reading →