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.

“Chutzpah” or how a Guilty Plea to Insurance Fraud Defeats Claim

A Plea of Convenience is Still a Plea of Guilty “Chutzpah” is a Yiddish word meaning “unmitigated gall” where, for an example, a person who murdered his parents asks the court for clemency because he is an orphan. In Sonya … Continue reading

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Another Failure of Stipulated Judgment to Get Insurance Money

Contract Between Driver & Owner Controls When state law only requires insurance up to minimum statutory limits an insurer whose insured allowed another to permissively drive an owned vehicle was asked to provide full limits rather than those required by … Continue reading

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Giving Away Judgment Against Defendant to Sue Insurer Gets Plaintiff Nothing

Assault and Battery Exclusion Enforced I have warned, multiple times, that it is not necessarily wise to enter into a stipulated judgment for an assignment of a claim. Giving a defendant a covenant not to execute on a stipulated judgment … Continue reading

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Zalma’s Insurance Fraud Letter – January 15, 2018

Zalma’s Insurance Fraud Letter    The Essential Resource For The Insurance Fraud Professional  January 15, 2018  The DOJ Collects Billions from Fraud Perpetrators The Department of Justice obtained more than $3.7 billion in settlements and judgments from civil cases involving fraud … Continue reading

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Why Do Courts Allow Punitive Damages?

Punitive Damages Are Designed to Punish Wrongdoing Every lawyer who represents a plaintiff suing an insurance company for the tort of bad faith or the lawyer defending an insurer against claims that it committed the tort of bad faith, must … Continue reading

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Ethics and Insurance Claims

Uberrimae Fidei This article is adapted from my new book “Ethics for the Insurance Professional” available here. Ethics is a process of systematically applying, using, defending and recommending concepts of right and wrong behavior. Ethical behavior is required of both … Continue reading

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Insurer Can Rescind When Insured Knew of Potential Claim

Persnickety Judge Points out that Grammatically Correct Answer on Application Should not Void Insurance Yet Fails to Carry the Day Rescission is an equitably remedy allowing an insurer to void an insurance policy from its inception if the person insured … Continue reading

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New Books at Amazon.com

“Insurance Fraud & Weapons to Defeat Insurance Fraud” Insurance fraud continually takes more money each year than it did the last from the insurance buying public. No one knows the actual amount with any certainty because most attempts at insurance … Continue reading

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Rescission – New Book Available Only on Amazon.com

Rescission of Insurance Rescission is an equitable remedy as ancient as the common law of Britain. When the United States was conceived in 1776 the founders were concerned with protecting their rights under British common law. They adopted it as … Continue reading

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New Book – The Insurance Examination Under Oath

Now a Kindle Book & A Paperback The following is an excerpt from my new Kindle & Paperback book, The Insurance Examination Under Oath: The Insurance Examination Under Oath (“EUO”) is a formal type of interview authorized by an insurance … Continue reading

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You Only Get What You Pay For

Broker Had No Duty to Force Insured to Buy More Insurance For reasons that only make sense when there is no loss people decide to purchase insurance based solely on price. If more coverage is needed, but it is expensive, … Continue reading

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Zalma’s Insurance Fraud Letter – January 1, 2018

Zalma’s Insurance Fraud Letter The Essential Resource For The Insurance Fraud Professional    As we start the 22nd year of ZIFL we say Happy New Year,  January 1, 2018  Co-Conspirator’s Civil Testimony Convicts Arsonist  When committing a serious crime like … Continue reading

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Insured v. Insured Exclusion Effective

Derivative Claim Exception Fails Liability insurance policies invariably exclude defense or indemnity of one insured sued by another insured of the same policy. The reason is obvious, the potential for collusion and fraud are high. In Sunrise Specialty Company, Inc. … Continue reading

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Adjusting Property Claims

Why is there a First-Party Property Adjuster The insurance adjuster is not mentioned in a policy of insurance. Standard first party property insurance policies, based upon the New York Standard Fire Insurance policy, contain conditions requiring the insured to, within … Continue reading

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Adjusting Liability Claims

The Obligations of the Liability Claims Adjuster Adjusting liability insurance claims requires skill, patience and knowledge of insurance and investigation.  The claims adjuster is faced with the following basic obligations: To understand the law of torts as applied in the … Continue reading

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Statute Must be Interpreted as Written

No Waiver Required When UM Coverage Exceeds Statutory Minimums For reasons difficult to believe people buy more insurance coverage to protect persons they injure than to protect themselves from uninsured or underinsured motorists. When an accident occurs and injuries are … Continue reading

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California Stretches to Find Exception to the Litigation Privilege

The Litigation Privilege Is Limited in California The so-called litigation privilege allows a person to be safe from tort litigation for statements made in court or for reporting a crime to authorities. It should be an unlimited privilege since it … Continue reading

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Co-Conspirator’s Civil Testimony Convicts Arsonist

Criminal Should Never Trust Another Criminal Arson is a serious crime that often injures or kills the innocent. Whether set to defraud an insurer or just for spite it cannot be allowed to succeed without serious punishment. When committing a … Continue reading

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No Premium, No Consideration, No Insurance

Why Wasn’t it Obvious that Failure to Pay Premium Fatal to Claim? Insurance is nothing more than a contract. For a contract to be formed there must be evidence of an offer, acceptance of the offer and payment of consideration. … Continue reading

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Insurance Law Deskbook

Introducing Barry Zalma’s Insurance Law Deskbook Barry Zalma’s Insurance Law Deskbook is coming to Full Court Press in 2018. Mr. Zalma has over 50 years of practical insurance claims experience culminating in this indispensable resource. In the course of his … Continue reading

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When a Late Report is Prejudicial to the Insurer’s Rights

Failure to Give Prompt Notice of Loss Fatal to Claim in Illinois As I have said, many times before, the duty of good faith and fair dealing applies equally to the insured as it does to the insurer. To make … Continue reading

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Insurer May Not Subrogate Against Its Own Insured

Motor Home Renter as Permissive Driver Is Insured on Motor Home Policy When a vehicle is rented the renter is given permission by the owner to operate the vehicle. If the owner is insured for material damage and its insurer … Continue reading

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Zalma’s Insurance Fraud Letter – December 15, 2017

 The Essential Resource For The Insurance Fraud Professional   December 15, 2017    A Christmas Fable of Fraud  In this, the holiday season ZIFL repeats its annual Christmas Fable of Fraud dealing with the insurance fraud perpetrator who made an excellent … Continue reading

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No Excuse to Lie to Professional Liability Insurer

Poor Advice from Broker Eliminates Professional Liability Coverage Every professional liability insurer asks – because the policy is usually a claims made and reported policy – about the insured’s knowledge of a potential claim or a claim made before the … Continue reading

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Electronically Delivered Policy is the Same as Mail Delivery

Failure to Read Electronically Delivered Policy No Excuse Insurance companies have moved into the 21st Century and now deliver policies by e-mail or other electronic means rather than sending a paper copy of the policy by the U.S. Postal Service. … Continue reading

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Evidence Required to Prove a Fire Claim Over Amount Paid

No Good Deed Goes Unpunished It seems axiomatic that no one is happy with a fire claim settlement.  This is so even when reached by an insurance company even when payment is made within ten days of the adjuster’s inspection. … Continue reading

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Settlement Based on False Information Can Be Rescinded

Mediation Settlement Based On Mistake Cannot be Enforced There is not a court in the country does not approve of mediation and settlement of disputes to avoid trial. Those settlements must be based, however, on a fair reading of the … Continue reading

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Court Should Never “Nudge” a Jury Toward a Verdict

Only Non-Excluded Perils Provide Coverage Insurers who write insurance in catastrophe prone areas limit the coverage available by clear, specific exclusions. In hurricane areas windstorm is excluded, in earthquake prone areas earthquake is excluded and in wildfire prone areas fire … Continue reading

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Plain, Clear and Conspicuous Exclusion Must Be Enforced

Trying Every Possible Argument to Gain Coverage Fails When her husband died in an airplane crash the spouse attempted to claim accidental death benefits despite a plain, clear and conspicuous aviation exclusion. The plaintiff attempted, by suing the insurer for … Continue reading

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The Staged Insurance Claim

Creating Insurance Fraud © 2017, Barry Zalma, Esq., CFE A staged insurance claim is an insurance claim based on a fictitious loss created for the sole purpose of defrauding an insurer. Wherever insurance exists in the world there is insurance … Continue reading

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Four Corners Rule Effectively Destroys Exclusion Again

When is Shooting a Plaintiff in the Face Not an Intentional Act? Many states like Pennsylvania apply the four-corners rule when interpreting insurance coverage and compel that the decision on coverage is based upon the allegations of the complaint rather … Continue reading

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Sewage Backup Exclusion Unambiguous

Court may not Engage in a Strained Construction or Write a Better Policy for the Insured than the one Purchased In New Jersey a clear and unambiguous exclusion was enforced regardless of the multiple attempts of the plaintiff to create … Continue reading

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When is a Personal Watercraft not a Jet Ski?

A Fairly Debatable Coverage Issue Prevents Suit Against Insurer For Fees When a person is sued he or she expects to be defended by their insurer. This is probably so because no one seems to read their insurance policy. No … Continue reading

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Attempt to Sue Fraud Investigator Fails

Insurance Fraud Investigation in Official Capacity is Immune From Suit Eleventh Amendment Rules No one likes to be investigated as the perpetrator of insurance fraud. This became very clear in Robert Amatrone, et al. v. Eric Winkler, et al, Case … Continue reading

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Zalma’s Insurance Fraud Letter — December 1, 2017

The Essential Resource For The Insurance Fraud Professional  December 1, 2017 Prosecutors Waste Time & Effort by not Keeping Case Simple In California, violation of Penal Code Section 550, Insurance Fraud, will result in five years in prison. If the … Continue reading

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Agents Should Never Lie to Insurers

The Responsibility of an Agent or Broker to be Truthful to the Insurer Some years ago my solution to a mid-life crisis was to buy a custom made replica of the Studebaker Avanti, a fiberglass sports car powered by a … Continue reading

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Property Insurance Adjusting

A Basic Manual for First-Party Property Insurance Claims Adjusters © 2017, Barry Zalma, Esq., CFE This is the first part of a long white paper I wrote on how to adjust property claims. If you find it interesting and want … Continue reading

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What Happens When the Insured Refuses to Testify at EUO?

The Examination Under Oath is a Condition Precedent to Obtain Policy Benefits Since the EUO is an essential weapon in the insurer’s arsenal of tools to defeat insurance fraud these decisions are exceedingly important to every SIU insurance fraud investigator … Continue reading

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Reasonable Grounds to Contest Claim Avoids Charges of Bad Faith

Is It Okay to Lie to an Insurer in Georgia? Since the covenant of good faith an fair dealing applies equally to the insured and the insurer most states allow an insurer to void a policy from its inception for … Continue reading

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Policy Wording Is Inviolate

Insured May Not Change Policy Wording After a Loss Insurance is a contract representing the agreement between an insured and an insurer. If the terms of the contract are clear and unambiguous an insured – no matter how much has … Continue reading

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