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.

Fraud Investigation & Punitive Damages

Tort Damages for Failed Fraud Investigation Insurance fraud investigations by Special Investigation Unit (SIU) have saved the insurance industry millions of dollars that would have been paid to fraud perpetrators without the SIU investigation. Even though states require the existence … Continue reading

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Insured Must Prove Whether Insurance Conditions Were Satisfied

Even a Stopped Watch Is Correct Twice a Day The often reversed Ninth Circuit Court of Appeal gets things right once in a while. In this brief and clear opinion the Ninth Circuit granted an insurer declaratory relief because the … Continue reading

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Travelers Avoids $36 Million Verdict

“Arising Out Of” Not Ambiguous In Pennsylvania Decades of litigation over the effects of pervasive asbestos use have yielded a financial burden borne across an array of industries. A historical manufacturer of asbestos-containing products and its insurer disputed the rightful … Continue reading

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Assault & Battery Exclusion Unambiguous

 An Insurance Company May Limit Coverage in any Manner Alcoholic beverages tend to have an effect on the ability of those who consume it to lose their ability to control their tempers. People who work in bars to protect the … Continue reading

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Insurance is an Important Part of Every Commercial Lease

Two Cases Confirm the Importance of Insurance I admire New York appellate courts because they write opinions that are truly brief, concise, and state the law without fluff or attempts to look wise when a simple paragraph will do. The … Continue reading

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When Joint Venture Is Insured Joint Venturer is Insured

To Prove Bad Faith Plaintiff Must Prove Malice, Oppression, Wilfulness or Reckless Indifference Insurers, like every business, will often err, be lazy, or just fail to treat their insured properly. When that happens the insured will invariably sue or cross-claim … Continue reading

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Zalma’s Insurance Fraud Letter – April 15, 2017

Zalma’s Insurance Fraud Letter The Essential Resource For The Insurance Fraud Professional    Zalma’s Insurance Fraud Letter, Volume 21, No. 8 Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have been in the business … Continue reading

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Broker Responsible to Assure Policy Provides Coverage Ordered

Broker May Not Rely on Representation of Underwriter About Coverage Provided It is axiomatic that an insurance broker is responsible to obtain the coverage required by the insured. As an insurance professional the broker is required to read the policy … Continue reading

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Washington State Turns TPA Into a Virtual Insurer

Washington State Court Finds TPA Subject to Bad Faith Law I has been axiomatic across the country that only an insurer may be liable for the tort of bad faith. For example, in 1973 Gruenberg v. Aetna Ins. Co. (1973) … Continue reading

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Happy Passover

Passover 2017 – In English Passover is a time when every Jewish father and mother tell their children the story of the Exodus of the Jews from slavery in Egypt. It is a story that Jewish people have told every … Continue reading

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Fraudulent Claim Voids Coverage

When Insured Admits Tax and Bankruptcy Fraud They Should Be Prosecuted Making false reports to the IRS and to Bankruptcy Courts about the value of a business or its property to avoid taxes and paying legitimate debts seems to be … Continue reading

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Punished for Not Reading Policy

Broker Can Be Negligent For Failing To Acquire Insurance Requested Insurance brokers transact insurance with but not on behalf of insurers. They act as the agent of the insured to acquire the insurance required by their client. By so doing … Continue reading

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Justice Gorsuch and Insurance

Two Insurance Cases Written by the New Supreme Court Justice Today, Justice Neil Gorsuch will be appointed to the U.S. Supreme Court. Since I and my readers are interested in insurance matters I thought it might be useful to see … Continue reading

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Police Officer Immune as a Result of Dog’s Bite

Immunity Exists for Policy Officer Unless The State Has Insurance A state government in Arkansas, and its employees, are immune from suit unless and only up to the amount of available insurance. In Jason Harris v. Norman Beth, Supreme Court … Continue reading

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Zalma At The Atlantic Claim Executive Association Spring Conference

Resources to Defeat Insurance Fraud Yesterday I was honored to speak before the Atlantic Claim Executive Association Spring Conference at the Hammock Beach Resort in Palm Coast, Florida.  The slide show is at the link below. ACA-INSURANCE FRAUD & WEAPONS … Continue reading

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Zalma’s Insurance Fraud Letter – April 1, 2016

The Essential Resource For The Insurance Fraud Professional Now Available Rescission for Fraud by Default in Bermuda Not Binding    Zalma’s Insurance Fraud Letter, Volume 21, No. 7   Every Insurance Adjuster Must Be Trained About Fraud In the last … Continue reading

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Dangerous Immature Driver Loses License

Uninsurable Driver Refused License by DOI Zachary Phillips, at age 16, drove recklessly in an accident that resulted in the death of his passenger. He claimed he was not driving but evidence established he was driving the vehicle that resulted … Continue reading

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Insured Must Treat the Insurer With Good Faith & Fair Dealing

Federal Court Will Not Recognize a Fake Attempt at Defeating Diversity When I was a young lawyer plaintiff’s bad faith lawyers wanted to avoid federal jurisdiction because California state courts were more likely to return a verdict in favor of … Continue reading

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Settlement Resolves All Disputes

It is Not Always Logical to Accept Policy Limits Policy limit demands are made in almost every serious injury case. They usually result in a settlement. However, when there is underinsured motorist (UIM) coverage available the plaintiff and counsel must … Continue reading

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Why Insurers Should Not Sue Each Other

Neighbors Who Hate Each Other Are Not Enough to Create a Professional Liability Claim When neighbors sue each other – especially when one neighbor was the realtor who sold the property to the neighbor under false pretenses – creates multiple … Continue reading

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Excess Insurer May Not Unilaterally Refuse Reasonable Settlement

Insured and Primary Policy May Settle When Excess Refuses to Participate Excess insurers often do not like the decisions of a primary insurer and an insured that would require payment by the excess insurer to effect a settlement. The state … Continue reading

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Insured Only Allowed One Appraisal

Insured’s Post-Appraisal Estimate Cannot Be Considered An appraisal is a contractual obligation in a first party property policy that allows the insured and insurer to resolve the amount of loss when the insured and insurer cannot agree.  When an insured … Continue reading

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Rescission by Default in Bermuda Not Binding

Comity Not Available Rescission of an insurance policy is appropriate if the policy was acquired by a misrepresentation or concealment of material fact. However, when a plaintiff is damaged by a default judgment of rescission in a foreign jurisdiction without … Continue reading

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A Court May Not Make Language of Policy Nugatory

Avoiding Making Worthless Excess Policy Language Liability insurance can be primary or excess. When multiple policies of insurance apply to a loss disputes over who owes what to the insured and in what proportion brings about litigation that resembles an … Continue reading

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City Cannot Compel Police Officers to Buy Primary Insurance

Municipality May Not Preempt State Law Police officers have a difficult and dangerous job. They should be honored for their service not punished by the citizens of the city where they live and work. In an attempt at a wild … Continue reading

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For Want of a Word In Policy Insurer Loses

Hit and Run Driver Who Forces One Vehicle into Another Allows for UM Coverage Uninsured motorist (UM) coverage covers injuries caused by a phantom vehicle that causes injury and runs from the scene – a classic hit-and-run accident. Because of … Continue reading

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Court Improperly Lets Parties to Change a Battery to Negligence

An Assault or Battery Away from Auto Does Not Arise Out of Use of Auto Automobile liability coverage requires that for coverage to apply injuries to a third party must result from the use of the automobile. Unlike broad liability … Continue reading

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Injuries Resulting from Intentional Acts Not an Occurrence

No Benefits for Deliberate Acts Resulting in Injury The USCA for the Ninth Circuit – contrary to its often stated court of reversal – wrote a clear, unambiguous, appropriate and proper decision that was even more brief than decisions from … Continue reading

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Zalma’s Insurance Fraud Letter – March 15, 2017

Zalma’s Insurance Fraud Letter Criminal Intent Proved by Circumstantial Evidence Zalma’s Insurance Fraud Letter, Volume 21, No. 6 Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have been in the business of insurance … Continue reading

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Broker is Not Agent of Insurer

Binder is Only Temporary Insurance Insurance companies issue binders to provide temporary coverage to a potential insured. They are not insurance policies but only evidence that, if certain conditions are met, a policy will be issued. Many contain conditions requiring … Continue reading

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If you Don’t Read Policy at Least Read Notice

Pretending to Be Ignorant Does Not Toll Statute of Limitations In my experience, and in the experience of the Supreme Court of Rhode Island, no one reads insurance policies. Even professionals, whether physicians or lawyers, fail to read the policy. … Continue reading

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No Coverage to Replace Defective Work

Settlement Agreement Contrary to Its Intent Eliminated Coverage As I have opined in these pages taking an assignment from a tortfeasor to get the right to sue an insurer is not a wise or profitable course of action. Although insurance … Continue reading

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FRAUD AND THE TORT OF BAD FAITH

How To Stop Fraud Insurance fraud is more often than not, successful. No one knows how much is taken by insurance fraud perpetrators from the insurance industry. It has been estimated to take as little as $80 billion to as … Continue reading

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What is Insurance?

Easy to Read & Understand Insurance policies are contracts. To form a contract an insurer must make an offer that is accepted by a potential insured who then pays consideration – premiums – for the promises made by the insurer. … Continue reading

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Private Limitation of Action Enforced in Oregon

Insurer’s Consistent Requirement that Insured Follow Policy Conditions Honored Insurance contracts – to protect against stale claims – contain a private limitation of action provision that requires filing of suit within a set period of time, usually one or two … Continue reading

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“Arises Out Of” is Unambiguous

Ninth Circuit Supports Clear and Unambiguous Exclusion Although the Ninth Circuit has been called the court of reversal it also will often write clear decisions that make logical and legal sense. Therefore, when a contractor sued its insurance company for … Continue reading

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Criminal Intent Proved by Circumstantial Evidence

36 Months in Jail For Fraudulently Taking $19.9 Million From Medicare Defrauding the United States of America has become a popular sport and profit center for those health care providers that disposed of their moral and ethical compass. It is … Continue reading

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Insured Can’t Pass Its Mistake to the Broker

Insurance Broker Sued for Doing What the Insured Asked It to Do The primary duty of an insurance agent or broker is to fulfill the orders presented to the agent or broker by the insured. If it errs in fulfilling … Continue reading

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Zalma’s Insurance Fraud Letter – March 1, 2017

Some Interesting and Important Words Zalma’s Insurance Fraud Letter, Volume 21, No. 5  The Current Issue Contains the Following heck in every day for a case summary at http://zalma.com/blog Some Interesting and Important Words Illumeo Continuing Education California SIU Regulations … Continue reading

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Prima Facie Evidence of Insurance Needed

Insurer Must Prove Adverse Vehicle is Insured to Avoid UM Arbitration I often praise the New York Appellate Courts for their ability to resolve a dispute in concise, clear and brief opinions. Fiduciary Ins. Co. of America v. Greenidge, Supreme … Continue reading

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