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.

Ordinary Meaning v. Expert Testimony

When is a lie on an Application Potentially Truthful? Insurance contracts are based upon an application – a request for an offer of insurance – from the potential insured. The facts stated in the application must be absolutely true and … Continue reading

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A Video on Insurance Fraud Basics

Insurance Fraud Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number because most attempts at insurance fraud succeed. We can only make educated guesses about the … Continue reading

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No Coverage – No Defense – No Indemnity

Short, Simple and Direct Decision from the USDC When an insurer believes it has no coverage for a loss presented it may seek relief from a United States District Court and ask for a decision interpreting the policy. In Commerce … Continue reading

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A Video Presentation Answering: What is First Party Property Insurance?

First Party Property Insurance Insures Against the Risk of Loss of Property Insurance policies are contracts between an insurer and an insured that are designed to provide indemnity from the insurer to the insured. The language of insurance contracts are … Continue reading

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Hallelujah: Texas Allows a Fraud Exception to the Eight Corners Rule

Texas Finds a Chink in the Eight Corners Rule The eight-corners rule of insurance contract interpretation about duty to defend directs Texas courts to determine a liability insurer’s duty to defend its insured based on: the pleadings against the insured … Continue reading

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$64 Million Lost on Appeal

Reinsurance Attaches only after Reinsured Expends Underlying Limit Where the losses in question did not exceed the limits stated for bodily injury in the Schedules, the reinsurer, Fireman’s Fund, claimed it had no obligation under the reinsurance contracts to pay … Continue reading

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A Video About Claflin v. Commonwealth and the Examination Under Oath

The Supreme Court of the U.S. Found a Lie at EUO was Fraud Even if the Insured Did not Intend to Defraud the Insurer A false answer as to any matter of fact material to the inquiry, would be fraudulent. … Continue reading

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Coverage Never Available to a Sexual Predator

Sexual Assault Is Not An “Occurrence” Because The Consequent Harm Is Always Intended By The Insured A state court action asserted nine causes against various defendants including Lewis Croft, all based on Croft’s sexual abuse of his granddaughters from 1994 … Continue reading

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Lying to an Insurer Can Cause A Policy to be Voided

Insurers Can Void a Policy if the Insured Lies About a Material Fact See the full Video Here In almost every policy of insurance, there is a clause declaring the policy void if the insured misrepresents or conceals material facts … Continue reading

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Ethics and the Basis for Rescission

Everything Needed by the Insurance Claims Professional from Barry Zalma Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books … Continue reading

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ZALMA’S INSURANCE FRAUD LETTER – MAY 1, 2020

ZALMA’S INSURANCE FRAUD LETTER – May 1, 2020 Read the full text of the May 1, 2020 ZIFL at https://lnkd.in/g9wwKHd I’m Not a Carjacker – I was Only Helping an Insurance Fraud Positing one of the most ridiculous defenses and ground … Continue reading

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Health Insurance Fraud Convictions for April 2020

Video Explaining Convictions for Health Insurance Fraud ADAPTED FROM ZALMA’S INSURANCE FRAUD LETTER Volume 24, Issue 9 – May 1, 2020, Subscribe to e-mail Version of ZIFL, it’s Free!  Read last two issues of ZIFL here. Go to the Barry Zalma, … Continue reading

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Four Corners Rule Requires Defense for Person who Shot Plaintiff in the Face

Estate of Murderer Gets Defense for Injuries to Visitor who Arrived During Murder Suicide Attempt When Mr. Carley interrupted McCuctcheon’s murder of his ex-wife he was assaulted and shot in the face by McCutcheon. Carley alleged the shooting was negligent … Continue reading

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Everything Needed by the Insurance Claims Professional from Barry Zalma

Insurance Claims Library Insurance Claims Regulations and Insurance Ethics Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and … Continue reading

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A Video Proposal to Create Claims Professionals

How to be a Professional Claims Handler See the full video at https://youtu.be/1nVg3ZqtDpA To avoid claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers must maintain a claims staff dedicated to excellence … Continue reading

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Sending a Check After Expiration of Policy Does Not Automatically Reinstate Policy

Failure to Pay Premium Causes Life Insurance Policy to Expire A key condition of every insurance policy is the payment of premium when due. When the insured of a life insurance policy failed to pay the premium his policy lapsed … Continue reading

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Zalma’s Insurance Claims Library

Property and Liability Insurance Claims Adjusting Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to … Continue reading

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A Video Explaining Marine Insurance Warranties

Marine Insurers Invented The Warranty In An Insurance Policy The video is available at Zalma on Insurance on YouTube at https://youtu.be/Vjb1PKEs3K8 Marine insurers invented the warranty in an insurance policy. So, it is fitting that a boat was involved in … Continue reading

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Claiming Total Loss When Evidence Does Not Support Claim Can Be a Fraudulent Act

Appraisal Inappropriate When Coverage Issues Must Be Resolved Plaintiff Kathy Cox sued Defendant State Farm Fire and Casualty Company (“State Farm”) for breach of contract, appraisal, and statutory interest. Plaintiff alleges Defendant failed to pay her the full value of … Continue reading

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How the Unintended Consequences of Bad Faith Generated Insurance Fraud

Bad Faith & Insurance Fraud The Law of Unintended Consequences and the Tort of Bad Faith The concept of unintended consequences is one of the building blocks of economics. Adam Smith’s “invisible hand,” the most famous metaphor in social science, … Continue reading

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Video Explaining Conditions Precedent in Insurance Policies

Insurance Conditions Precedent Video available at https://youtu.be/I1ByB3cE34E.  When used in contract law, the word condition refers to an event, the occurrence or non-concurrence of which alters the previously existing relations of the parties by creating or extinguishing a legal duty. … Continue reading

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Insurance Fraud Conviction Grounds for Deportation

No Viable Excuse for Convicted Green Card Holder not to be Deported After a conviction for insurance fraud, among other things, Omar Osman Mohamed (“Mohamed”) brought a petition for a writ of error coram nobis to the USDC in New … Continue reading

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Insurance Claims Library

Everything Needed by the Insurance Claims Professional from Barry Zalma Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books … Continue reading

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A Video Explaining Why an Agent is Not an Insurer

Private Limitation of Action Provision is Enforceable The video is available at https://youtu.be/RvFP2j0Jpp4 Frankie and Michael Cabral sued for breach of contract, insurance bad faith, conversion, and negligence after defendant Public Storage disposed of personal belongings that plaintiffs had placed … Continue reading

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Surplus Line Broker Not an Insurer

No Action Available Against Surplus Line Broker for Breach of Contract or Bad Faith After her house burned to the ground and her insurer rescinded the policy Suzan E. Taylor sued the insurer and the surplus line broker who obtained … Continue reading

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New Podcasts from Barry Zalma

Zalma on Insurance Podcast Now Available Available at PocketCasts: https://pca.st/ujampbxm; RadioPublic: https://radiopublic.com/zalma-on-insurance-Wel2lZ; Google Podcasts app. You’ll be able to find it at this link, and Breaker: https://www.breaker.audio/zalma-on-insurance Surplus Line Broker Not an Insurer After her house burned to the ground … Continue reading

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The Prime Offering from the Insurance Claims Library

Zalma on Insurance Claims Second Edition Ten Volumes Comprising A Comprehensive Group of Materials on Property & Casualty Insurance Claims Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat … Continue reading

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A Video on How Not to Set an Arson for Profit Fire

The Tale of the Incompetent Arsonist A video from Barry Zalma available at https://youtu.be/ebGEkaL3euc Most people do not understand how hard it is to set fire to a house that destroys the entire dwelling and its contents. Most residences simply … Continue reading

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Two Insurers who Insure the Same Risk of Loss Must Pay Claim Equally

Forced Placed Insurance and Direct Insurance Both Validly Insured the Same Risk When a lender was listed as a mortgagee on a policy and, because it mistakenly believed that policy had been cancelled, protected its interest by initiated forced placed … Continue reading

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Everything Needed by the Insurance Claims Professional from Barry Zalma

Books for the Insurance Claims Professional Read about the following and other insurance books by Barry Zalma at the Insurance Claims Library at https://zalma.com/blog/insurance-claims-library/ The Insurance Examination Under Oath Second Edition A Tool Available to Insurers to Thoroughly Investigate Claims … Continue reading

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Video Explaining the EUO & the Fifth Amendment

Don’t Take “The Fifth” When Your Insurer Asks For An Examination Under Oath If an insured refuses to appear for an examination under oath because he or she might incriminate him or her self, may find the Fifth Amendment doesn’t … Continue reading

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Insured’s Breach of Fiduciary Duty to Clients Excluded

Thievery by Controller Effectively Excluded by E & O Policy Errors and Omissions insurance is designed to protect an insured against liability due to errors and omissions by the insured. It does not, however, cover every potential error or omission … Continue reading

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New Podcast: Zalma on Insurance

The History of Insurance I have started a new podcast called Zalma on Insurance. It is presently available at  https://anchor.fm/barry-zalma Please subscribe if you are interested.

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The Homeowners Policy

A Video Explanation of the Basic Homeowners Policy The video explaining the homeowners policy is now available at https://youtu.be/ua9mKf1QJHM The Homeowners 3 – Special Form A type of Homeowners 3 – Special Form for the American Association of Insurance Services, … Continue reading

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No Coverage After Policy Cancelled for Non-Payment

No Duty to Defend or Indemnify After Cancellation When a bar loses its liquor license and fails to pay the premium on its insurance policy there should be little doubt that the insurer will cancel the policy for non-payment of … Continue reading

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Evaluation and Settlement of the Construction Defect Claims or Suits

Construction Defect Negotiation Negotiation is an art that is impossible to teach. It is not the same as haggling at a bazaar over the value of a brass pot. It is an art by which one person convinces another that … Continue reading

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Judge Properly Advised Jury that Homeowners Policy Does Not Cover Theft of Business Property

Robber Failed in Attempt to Turn Victim into Insurance Fraudster Criminals are, by definition, unreliable and dishonest. In an attempt to obtain a new trial a convicted armed robber tried to convince the Wisconsin Court of Appeal that the victim … Continue reading

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No Duty to Defend for Claims After Policy Expires

No Duty to Defend if no Bodily Injury, Property Damage or Personal Injury Alleged When a plaintiff asks as their own attorneys they tend to have stupid clients and inadequate people pretending to act as a lawyer. Pro se plaintiffs … Continue reading

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YouTube Video About: Agent or Broker Can Be Liable for False Statements on Application

Insurer Entitled to Damages for Fraud From Broker Insurance brokers and agents often find themselves in trouble because of the rescission statutes. In Century Surety Co. v. Crosby Insurance, Inc., 124 Cal.App.4th 116, 21 Cal.Rptr.3d 115 (Cal.App. Dist.4 11/17/2004) an … Continue reading

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Video Explaining Insurable Interest

What is an Insurable Interest? Every first party policy of insurance requires that the insured have an insurable interest in the property that is the subject of the policy of insurance. See the video at https://youtu.be/6Vz0O6S0kGY When multiple interests in … Continue reading

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