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.

Information Needed by Every Lawyer, Claims Person or Insurance Management

Books for Every Insurance Claims Professional  For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, public insurance adjusters) to survive and perform their duties appropriately it is absolutely necessary that they maintain insurance … Continue reading

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Mutually Repugnant Clauses Cannot Be Enforced

Other Insurance Clauses that are Mutually Repugnant Require Pro Rata Sharing Plaintiff Vermont Mutual Insurance Company sued Defendant Cincinnati Underwriters Specialty Insurance Company seeking a declaratory judgment as to which party is contractually obligated to provide primary coverage for a … Continue reading

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A Copy in Each Law Office is Needed

Resources for the Claims Professional For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions of the insurance policy, … Continue reading

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Court Required to Give Deferential Review to ERISA Claim

No Policy in Effect No Coverage Employer provided life insurance under the Employee Retirement Income Security Act (“ERISA”) usually requires that the employee actually work for the employer before the employer provided life insurance benefit comes into effect. If you … Continue reading

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Needed in Every Claims Office

Resources for the Claims Professional For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions of the insurance policy, … Continue reading

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Broker has no Obligation to Advise on Limits Without Special Relationship

Bad Faith Requires More than a Failure to Pay What the Insured Wants People who select policy limits and insurance coverages based upon the premium offered then, after a loss, sue to get the coverages they should have bought rather … Continue reading

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How to Train Up Adjusters to Claims Professionals

Do You Want a Staff of Insurance Claims Professionals? For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions … Continue reading

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Zalma’s Insurance Fraud Letter – February 15, 2019

Zalma’s Insurance Fraud Letter   Clear Insurance Policy Language Must Be Applied Zalma’s Insurance Fraud Letter, Volume 23, No. 4    Clear Insurance Policy Language Must Be Applied The Need to be Able to Read and Understand the Wording of … Continue reading

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Do You Want a Staff of Insurance Claims Professionals?

How to Train Up Adjusters to Claims Professionals For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions of … Continue reading

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Unjust Enrichment Requires Repayment of Life Insurance Benefit

Beneficiary Must Repay Overpayment as of Date of Notice When a beneficiary makes a claim to a life insurer controlled by the U.S. Government he can usually assume that payments received are appropriate and the money is available to be … Continue reading

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How to Create Insurance Claims Professionals

Everything Needed by the Insurance Claims Professional For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions of the … Continue reading

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Forum Shopping Fails

Presumption of Need for State Declaratory Relief Action Requires Federal Court to Refuse Jurisdiction Like every lawyer who ever practiced law I would prefer the judge to be my favorite uncle and godfather, the jury to be made up of … Continue reading

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Everything Needed by the Insurance Claims Professional

How to Create Insurance Claims Professionals For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions of the insurance … Continue reading

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Don’t Demolish Damage Before Report to Insurer

Twelve Day Delay Sufficient to Eliminate Coverage The key to every insurance policy and claims presented under a first party property insurance policy is to promptly report a loss to the insurer so it can investigate and evaluate the claim. … Continue reading

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An Insurance Coverage Lawyer Provides Legal Advice

An Insurance Coverage Lawyer is Not an Adjuster I was an insurance adjuster from 1967 until 1972 when I was admitted to the California Bar and became a practicing lawyer. Since my career as a lawyer was almost exclusively limited … Continue reading

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Insurance Books for the Insurance Claims Professional

How to Create Insurance Claims Professionals For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions of the insurance … Continue reading

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Squirrel! It Was Not a Concurrent Cause of a Loss

Court Will Never Rewrite a Policy to Provide Coverage Not Purchased The City of West Liberty owns and operates an electrical power plant. Employer’s Mutual Casualty Company (EMC) insured West Liberty’s power plant with coverage effective from April 1, 2014, … Continue reading

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How to Create Insurance Claims Professionals

Insurance Books for the Insurance Claims Professional For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions of the … Continue reading

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Three Squares and a Cot – Arson Doesn’t Pay

Arson Scheme Finally Stopped Elbert Walker, Jr., and his relatives, Shirley and Darryl Burk, were convicted of one count of conspiracy to commit multiple objects, including arson, bank fraud, mail fraud, wire fraud, bankruptcy fraud, possession of a forged security, … Continue reading

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Privity – Protection for Insurance Defense Counsel

Defense Lawyer: Always Create Contract With Insured you are Asked to Defend When I was an insurance defense lawyer I always understood – and explained to the insured – that I was retained to represent the insured by the insurer … Continue reading

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Insurance Books for the Insurance Claims Professional

How to Create Insurance Claims Professionals For the insurance industry to survive and profit it is absolutely necessary that it maintains a staff of insurance claims professionals who can read, understand and apply the terms and conditions of the insurance … Continue reading

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Just Fat Not Sufficient for Bariatric Weight Loss Surgery

ERISA Fiduciary only Needs a Scintilla of Evidence to Support Denial of Health Insurance Claim Health insurance plans governed by ERISA are not bound by the same rules as insurance claims. They are bound only by the federal statute that … Continue reading

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Books to Help You Grow a Staff of Insurance Claims Professionals

Insurance Books for the Insurance Claims Professional Barry Zalma, Esq., CFE has created a library of insurance claims books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals. Over the last … Continue reading

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Arbitration of Insurance Disputes Must Be Taken Seriously

Defending Crop Claim Requires Presentation of Evidence of Basis of Refusal to Pay Crop insurance is a creature of the U.S. Government whose terms and conditions are mandated by federal statutes. Disputes over coverage, based on the statutes, are required … Continue reading

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More Books to Grow a Staff of Insurance Claims Professionals

Insurance Books to Help Create the Insurance Claims Professional Barry Zalma, Esq., CFE has created a library of insurance claims books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals. Over … Continue reading

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Splitting Cause – Duplicative Suits – Dismissed

Insurer Must Defend Itself When Prosecutors Arrest and Fail to Convict Fraud Perpetrator Insurance companies are compelled by state law to investigate suspicions of insurance fraud and to turn over to the authorities any facts when they believe a fraud … Continue reading

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Books to Grow a Staff of Insurance Claims Professionals

Insurance Books to Help Create the Insurance Claims Professional Barry Zalma, Esq., CFE has created a library of insurance claims books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals. Over … Continue reading

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Zalma’s Insurance Fraud Letter – February 1, 2019

Zalma’s Insurance Fraud Letter  Zalma’s Insurance Fraud Letter, Volume 23, No. 3       Insurance Fraud Takes Many Different Forms  Falsely Promising a Customer That a Shipment is Insured Is Criminal  Insurance fraud is usually a crime by an individual against … Continue reading

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Everything Needed by the Insurance Claims Professional

Insurance Books to Help Create the Insurance Claims Professional Barry Zalma, Esq., CFE has created a library of insurance claims books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals. Over … Continue reading

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Never Sue a Defendant Who Is Broke

Is Lawyer’s Failure to Determine Insurance and Assets of Defendant Malpractice? One of the most important things a plaintiff’s lawyer does when he or she takes on a case is determine if the defendant has liability insurance or assets sufficient … Continue reading

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California Claims and SIU Regulations, Ethics and Rescission

Everything Needed by the Insurance Claims Professional Barry Zalma, Esq., CFE has created a library of insurance claims books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals. Over the last … Continue reading

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If you do the Crime You Must Do the Time

Arson Conviction Upheld As I have written often, arson for profit is a stupid crime. It leaves physical evidence. Lies about the cause can usually be countered by physical evidence. Fire never totally destroys a property in a large city … Continue reading

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Recognizing Insurance Fraud

Investigating Fraud The purpose of an insurance fraud investigation is to gather evidence to establish whether a suspected fraudulent claim is legitimate or a fraud. If the facts revealed by the investigation establish that the claim is legitimate the fraud … Continue reading

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Weapons to Defeat Insurance Fraud & Claims Handling

Everything Needed by the Insurance Claims Professional Barry Zalma, Esq., CFE has created a library of insurance claims books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals. Over the last … Continue reading

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A Reinsurance Participation Agreement is Insurance

When an RPA and Workers’ Compensation are Jointly Issued they become an Integrated Insurance Contract Creative people create creative schemes to save customers money when dealing with insurance. When the scheme did not work and premiums increased exponentially the insurer … Continue reading

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Construction Defect claims, Mold and Fungi Claims and Why to Rescind the Tort of Bad Faith

Everything Needed by the Insurance Claims Professional Over the last 51 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 … Continue reading

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An Ambiguity in Contract Terms Can Only Exist if the Differences are Reasonable

The Entire Policy Must Be Read in Context to Interpret its Meaning The most difficult task faced by an insurer is to write a clear, unambiguous and easy to read contract of insurance. Because rules of insurance contract interpretation require … Continue reading

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COIL, The Homeowners Policy and Zalma on Insurance Claims

Everything Needed by the Insurance Claims Professional Over the last 51 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 … Continue reading

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Comedy of Errors by Everyone Involved Causes Multiple Appeals

Settlement Without Knowledge of All Available Insurance is Dangerous When a person is injured in an automobile accident, even one involving a moped and an auto, it is the obligation of the injured person and the injured person’s lawyer, to … Continue reading

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Construction Defects and Insurance Claims

Investigation of the Construction Defect Claim Construction defect suits are now flooding the courts of North America in greater numbers every year. Construction Defects and Insurance is a series of books available at Amazon.com designed to help the property owner, … Continue reading

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