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.

Ninth Circuit Establishes that Unprotected Sex is an Intentional Act

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

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Summary Judgment for Insurers Are Difficult

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

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Fraud Conviction Upheld

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

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Equity Trumps Law in Rhode Island

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

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Guaranty Association’s Attempt to Overcome Exclusive Remedy Fails

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

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Ignorance, Sloth, and Stupidity Defeats Suit Against Agent

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

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Zalma’s Insurance Fraud Letter – June 15, 2017

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

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Insurance Brokerage Expert Must State More than His Personal Opinion

Insurance Broker Obligated to Advise Not Force Insured to Buy Coverage Insurance brokers transact insurance with, but not on behalf of, and insurer. They represent their client, as a prospective insured, to obtain the insurance ordered and to advise the … Continue reading

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What is a Motor Vehicle Accident?

To Recover PIP Cover There Must be an Auto Accident When a person becomes ill, parks his car, and falls out of it onto the pavement, is he operating the vehicle for personal injury protection (PIP) no fault insurance coverage … Continue reading

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Insured’s Lose Default by Incompetent Proof

Default Judgment Reversed Because Plaintiff Failed to Admit Policy When an insurance company is served with a suit and fails to respond the plaintiff insured will normally win an enforceable judgment. All they need do is prove the existence of … Continue reading

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Insurers Do The Right Thing to Protect Insured

Who’s on First? Prudent insurers who dispute which is responsible for an insured’s loss must apply the covenant of good faith and fair dealing owed to the insured. To do so they resolve the tort claim against their mutual insured … Continue reading

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Waiver of UM/UIM Coverage Can be Performed by Co-Insured

Waiver by One Named Insured is Binding on all Named Insureds Pundits have properly claimed that if a person wants something done right he must do it himself. When a person delegates the purchase of insurance to another he or … Continue reading

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Another Reason to Do Away With Bad Faith Suits

Cashing Settlement Check Defeats Bad Faith Suit Almost every insurance claim is resolved by settlement. The few that are not resolved become lawsuits. Almost every lawsuit is settled and become judgments. When there is a dispute over payment bad faith … Continue reading

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You Only Get What You Pay For

Trial Court May Not Torture Policy Language to Compel Payment of More than Is Owed People buy a multi-car auto policy to save money on premium. In such a situation the Uninsured Motorist/Underinsured Motorist (UM/UIM) coverages apply to each injured … Continue reading

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Court’s Mercy Results in New Crime

Mercy Reversed: Ten Years for Insurance Fraud Courts often grant mercy to insurance fraud criminals only to have their mercy slap the judge in the face. In Shearer v. State, Court of Appeals of Texas, Not Reported in S.W.3d, 2017 … Continue reading

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The Phantom Moose & Insurance Fraud

Lie to Your Insurance Company & Go to Jail Some people try to save money by only buying comprehensive coverage and eliminating collision coverage from their auto policy. By so doing the premium, as well as the available coverage is … Continue reading

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Zalma’s Insurance Fraud Letter – June 1, 2017

DOJ Intervenes in Whistleblower Suit Against UnitedHealth for $1 Billion   Zalma’s Insurance Fraud Letter, Volume 21, No. 11    Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have been in the business of … Continue reading

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Lawyer Sanctioned for Helping Insured’s Fraud

Lawyer’s Lack of Competence Assists in Client’s Fraud Costs at His Expense Every lawyer is required to investigate the propriety of a lawsuit he or she files for a client and to litigate with the opponent fairly and in good … Continue reading

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Court Rewrites Fire Policy

Insurer Punished For Following Advice of California Supreme Court It is axiomatic that an insurer has the unquestioned right to select those whom it will insure and to agree with an insured about the terms and conditions of a policy … Continue reading

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Business Pursuits Exclusion Effective

Homeowners Policy Does Not Cover Liability Arising From Business The liability coverages provided by a homeowners policy are extensive and effectively provides defense and indemnity to a homeowner from suits seeking damages from the insured. Of course, a homeowners policy … Continue reading

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No Excuse for Not Reporting Loss as Soon as Practicable

Waiting Until You Lose a Suit to Report the Loss to the Insurer Breaches Material Condition Claims made and reported policies require prompt reporting within the policy period. When an insured is sued, the prudent insurer will immediately report the … Continue reading

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No Good Service From Agent Goes Unpunished

Agent Fulfilled Duty to Advise Insured of Changes in New Policy When an insured seeks coverage from an insurance agent or broker it is obligated to answer all application questions accurately. When a trucking firm advised its agent of product … Continue reading

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Love In The Air – Wife Shoots Husband

When Your Estranged Wife Shoots You, Don’t Expect Coverage As June approaches and love is in the air courts are faced with interesting cases arising from love and marriage proving they don’t always go together like a horse and carriage. … Continue reading

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The Reason for the Examination Under Oath

An Important Tool to Resolve Insurance Claims Courts that construe submission to an EUO as a condition precedent to recovery generally do not require the insurer to prove that it suffered actual prejudice from an insured’s unexcused refusal to submit … Continue reading

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Ethics for the Insurance Professional

The Covenant of Good Faith Is a Force for Ethical Behavior People who are insured are obligated to treat their insurer equally and in good faith. It is no answer for a person insured to say that the error or … Continue reading

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A Policy In Evidence is Needed to Prove Coverage

How to Lose a Declaratory Relief Action by Not Trying When a person seeks insurance coverage he or she is required to prove that a policy of insurance exists and that there is evidence that allows a finding that the … Continue reading

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Lover Scorned Admits to Aiding Insurance Fraud

Conviction for Aiding Insurance Fraud Affirmed Although love remains a many splendored thing when love dissolves and vengeance is attempted it can be a doubled edged sword.  Joseph Anthony Mauro was convicted by a jury finding him guilty of insurance … Continue reading

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An Insurer Cannot Safely Refuse Defense and Indemnity in Illinois

Illinois Finds Failure to File a Declaratory Relief Action Vexatious The Valuable Dead Dog Country Mutual Insurance Company appealed the trial court’s grant of summary judgment to plaintiff, Sabas Soto, finding defendant acted vexatiously and unreasonably and awarding plaintiff attorney … Continue reading

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Misrepresentation of Material Facts on Application Requires Rescission

Dr. Lies on Application & Policy Rescinded As I have reported multiple times in this blog that the covenant of good faith and fair dealing applies equally to the person insured as the insurer. When a doctor applies for insurance … Continue reading

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Zalma’s Insurance Fraud Letter – May 15, 2017

Insurance Fraud & Politics   Zalma’s Insurance Fraud Letter, Volume 21, No. 10      Every Insurance Adjuster Must Be Trained About Fraud Certified Expert in Corporate Property Insurance Program Now available from Illumeo and Barry Zalma: A comprehensive program enabling … Continue reading

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Lawyer Fails Trying to Make an Application an Insurance Policy

Read Your Policy or Else An insurance application is nothing more than a request presented to an insurer seeking an offer of insurance. It is not a contract. It is not even an offer. It is a request for an … Continue reading

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Agent Should Explain Effect of Coinsurance

Promise of Coverage Without Explanation of Coinsurance Can Be Fatal To Insurance Agent No one seems willing to read the insurance policy they purchased. When they have a loss an the failure to read the policy costs the insured money … Continue reading

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Various Types Of Insurance Fraud Found by FBI

The FBI lists the following common insurance fraud schemes in its Insurance Fraud Report at https://www.fbi.gov/stats-services/publications/insurance-fraud: Premium Diversion Premium diversion is the embezzlement of insurance premiums. It is the most common type of insurance fraud. Generally, an insurance agent fails … Continue reading

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Appropriate to Effect “Force Placed Insurance”

Pay Your Mortgage & Keep Insurance or Lose Many people have – especially in the last ten years – difficulty paying their mortgage and keeping the property insured as required by the mortgage documents. When the lender exercises its rights … Continue reading

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Heads I Win, Tails You Lose

Insurance Fraud by Divine Right The story that follows is based on fact. It is, however, a work of fiction. The names, places and descriptions have been changed to protect the guilty. Any resemblance to real people is purely coincidental. … Continue reading

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“Doc-in-the-Box” Scheme Defeated

Chiropractors Cannot Own & Control Medical Practice Insurance fraud appears in many different schemes. When a chiropractor wishes to increase his practice and the fees charged in order to defraud insurers who compensate people injured in accidents, creates a “Doc-in-the-Box” … Continue reading

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Eleventh Circuit Refuses to Create Ambiguity When None Exists

Clear Exclusion Enforced Although appellate decisions concerning insurance issues are seldom noted for their brevity sometimes an issue is so clear that the appellate court needs only state the obvious and logical decision.  When a lawyer does not read the … Continue reading

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Arson-for-Profit Fails – Life In Prison Without Parole

Stupid & Vicious Attempt at Insurance Fraud Fails I have reported often that arson-for-profit is the most dangerous, deadly, and stupid way to steal money from insurance companies because there is always evidence left after the fire and people are … Continue reading

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Insurer Victims Must Be Provided Restitution From Criminal

Insurers That Pay A Theft Claim Are Victims States like Ohio believe that a person who is smart enough to insure against theft and other criminal acts suffer no loss if insurance exists to pay for the loss. Acting on … Continue reading

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Zalma’s Insurance Fraud Letter – May 1, 2017

 Happy Law Day From The Essential Resource For The Insurance Fraud Professional   Innocent Young Lawyer Falls Into Fraud Trap Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have been in the business of … Continue reading

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