Author Archives: Barry Zalma

A Video Explaining How To Become a Professional Liability Claims Adjuster

The Third-Party Liability Claim See the full video at https://youtu.be/Ia5UQlvS758 The investigation of a liability insurance claim is conducted to fulfill the promise made by the insurer to defend and indemnify the insured in the event of a contingent or … Continue reading

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Ninth Circuit Affirms a Mold Exclusion

Insurers Should Never Sue Other Insurers for Bad Faith CSAA Insurance Exchange (“CSAA”) is a homeowner’s insurance company. Premier Restoration and Remodel, Inc. (“Premier”) is a home-repair contractor in CSAA’s network whose misapplication of an anti-mold chemical caused property damage … Continue reading

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Insurance Books from Barry Zalma

Everything Needed by the Insurance Claims Professional Read the full article at https://www.linkedin.com/pulse/everything-needed-insurance-claims-professional-from-barry-12c and Go to the Insurance Claims Library –https://zalma.com/blog/insurance-claims-library/ THE HOMEOWNERS INSURANCE POLICY HOW TO BUY AN APPROPRIATE HOMEOWNERS POLICY AND SUCCESSFULLY MAKE A CLAIM TO THE INSURER … Continue reading

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Zalma’s Insurance Fraud Letter – December 1, 2020

ZALMA’S INSURANCE FRAUD LETTER Read last two issues of ZIFL here. See the full video here https://youtu.be/Phva0x6RNYQ Evidence of A Prior Fire Is Available to Prove Fraud Arson for Profit Conviction Affirmed Evidence that is “inextricably intertwined” with the charged … Continue reading

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A Video Explaining Ethics and the Development of the Covenant of Good Faith

The Development of the Implied Covenant of Good Faith and Fair Dealing See the full video at https://youtu.be/hNzPoyGxw2s The Covenant of Good Faith and Fair Dealing is a general assumption of the law of contracts, that people will act in … Continue reading

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No Harm, No Foul When Instruction Error Favorable to Defendant

Podiatrist Jailed for Participation in Kickback Scheme Prescribing Compounded Medications Solely to Obtain Kickbacks Dr. Alap Shah was convicted of participating in a Kickback scheme where he was paid for prescribing expensive compounded medications in United States Of America v. … Continue reading

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A Video Explaining Some Appellate Decisions on the Equitable Remedy of Rescission

A Video Explaining Some Appellate Decisions on the Equitable Remedy of Rescission See the full video at https://youtu.be/VCvRj0DsWoo Resure, Inc. v. Superior Court In Resure, Inc. v. Superior Court, 42 Cal.App.4th 156, 49 Cal.Rptr.2d 354 (Cal.App. Dist.2 01/31/1996) the California … Continue reading

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Evidence of a Prior Fire is Available to Prove Fraud

Arson for Profit Conviction Affirmed Evidence that is “inextricably intertwined” with the charged arson conspiracies is admissible in an arson for profit trial especially when the earlier fire was used as a “playbook” for the fire that is the subject … Continue reading

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Everything Needed by the Insurance Claims Professional from Barry Zalma

Insurance Claims Library Over the last 53 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 make it for … Continue reading

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A Video Proposal to Defeat Insurance Fraud Because It Takes Courage to Fight Insurance Fraud

There Must be a Special Unit of Insurance Fraud Prosecutors in the Offices of the Attorneys General See the full video at https://youtu.be/JkdqUDDK-s0 The legislatures of the various states, the United States Congress, the National Association of Insurance Commissioners, The … Continue reading

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The Covenant of Good Faith Requires Insured to Honestly Report Health Conditions on Application for Life Insurance

Material Misrepresentations on Life Insurance Application Requires Rescission Howard Tenzer (Howard) appealed from the district court’s grant of summary judgment in favor of Minnesota Life Insurance (Minnesota Life) in Howard Tenzer, Legal Guardian on behalf of A.T. v. Minnesota Life … Continue reading

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A Video Explaining Insurance Fraud by “Staged” Losses

The Staged Loss See the full video at https://youtu.be/qf-ZGRwQ8sc Some losses are fictions created for the sole purpose of presenting a claim like those engaged in by convicted attorneys in my book, Insurance Fraud, Volume I. The number of variations … Continue reading

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No Good Deed Goes Unpunished

Bad Faith Attempted Set Up Fails Nya Yanitza Montanez appealed the district court’s grant of summary judgment for Liberty Mutual Fire Insurance Company on her bad faith claim. The son of Defendant’s insured caused an automobile accident involving two other … Continue reading

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A Video Explaining the Preparation Necessary for a Statement or an Examination Under Oath

The Six Key Questions Whose Answers are Needed to Complete Every Statement or EUO See the full video at https://youtu.be/8YSmZL8PZKI Every interview is directed toward determining the answer to six questions: Who? What? When? Where? Why? How? When these key … Continue reading

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Expert Testimony Needed to Prove Insurance Agent’s Duty of Care

Summary Judgment for Agent Because Plaintiff Had No Expert Testimony Proving Breach of Fiduciary Duty While Omar Alabassi, was covered by an insurance policy obtained through T.I.B. Insurance Brokers (“TIB”), he was involved in a hit-and-run collision with another driver … Continue reading

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A Primer on Rescission

The Insurance Advocate Cover Story Primer: Rescission of Insurance The article starts out as follows: An insurance policy is nothing more than a contract. It is a special type of contract because – by law – it contains an implied … Continue reading

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A Video Explaining The Role of the Insurer’s Attorney After Ending the EUO

The Need for the Advice of the Coverage Lawyer Who Takes the EUO See the full video at https://youtu.be/6LSCmmwDhtM A well-executed EUO is not only one of the insurer’s most effective weapons against fraud. It can also be highly instructive … Continue reading

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Lie to Your Insurer in Louisiana and You Lose Everything

In Louisiana an Intentional Misrepresentation on an Application Supports Rescission of Policy Insurance is a business of utmost good faith. Both the insured and the insurer owe to the other an obligation to do nothing that will deprive the other … Continue reading

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A Video Explaining the Consideration for Early Settlement of a Construction Defect Suit

Considerations for Early Settlement See the full video at https://youtu.be/uj04AxGJ41U It is an axiom followed by almost every attorney that the sooner a suit is settled the less it will cost the defendants. Invariably as suits drag on, as discovery … Continue reading

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Ninth Circuit Concludes Breach of Contract Exclusion is Enforceable

No Coverage for Defense of Indemnity of Suit Arising Out of Liability Under any Contract or Any Breach of Contract Courts dealing with insurance issues often issue opinions that are lengthy and convoluted before getting to the point. In Office … Continue reading

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Some Videos Available from Me on Rumble

Rumble Insurance Videos 14m15s Analyzing A Video Explaining the Statutes of Repose The Importance of Statutes of Repose Generally, in California and many other states, a lawsuit alleging a latent construction defect must be brought within three or four years … Continue reading

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Barry Zalma’s Insurance Claims Library

Everything Needed by the Insurance Claims Professional from Barry Zalma Over the last 53 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 the Statutes of Repose

Statutes of Repose See the full video at https://youtu.be/G0OYCeMAaVw Generally, in California and many other states, a lawsuit alleging a latent construction defect must be brought within three or four years (depending on the theory of recovery) after the plaintiff … Continue reading

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Assert Rights Promptly or Lose

Insurer Reopening Investigation After Denial Subject to Reservation of Rights is Effective It is common practice for an insurer to deal fairly and in good faith with its insured. It is not required, however, for an insurer to give up … Continue reading

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A Video Explaining Some Grounds for the Tort of Bad Faith

Grounds for Finding Bad Faith When an insured asks a question of his or her insurer an answer is expected. An insurer should respond to all inquiries promptly, and in no event later than 15 days. If an insured submits … Continue reading

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One Request for Declaratory Relief is all that is Needed

Policy Changes Must Be Agreed to by Both Parties Plaintiff Pilkington North America, Inc. (“Pilkington”), a Delaware manufacturer, moved to dismiss counterclaims brought by Defendant Mitsui Sumitomo Insurance Company of America (“MSI” or “MSI-US”), a New York insurance company. In … Continue reading

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A Video Explaining The Statutory Fair Claims Settlement Practices Statute and Regulations

California’s Fair Claims Settlement Practices & Regulations See the full video at https://youtu.be/lYlbUYJgoKQ California Insurance Code Section 790.03 (h) (a)   In an action for the breach of an obligation not arising from contract, where it is proven by clear and … Continue reading

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Zalma’s Insurance Fraud Letter – November 15, 2020

Zalma’s Insurance Fraud Letter Insurance Fraud Is Epidemic Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. Most attempts at insurance fraud succeed. Estimates of the … Continue reading

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A Video Explaining Ethics and the Public Insurance Adjuster

The Public Adjusting Profession See the full video at https://youtu.be/Rb9F_pM4Fkc When insured’s are busy professionals they simply do not have the time or patience to deal with the details of a first party property claim. The public insurance adjuster exists … Continue reading

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HMO’s In State Limitation Upheld

When an HMO Provides the Same Limitations for Physical as Mental Problems the Limitations are Enforceable Plaintiff Suzanne Stone had an employer-provided health care plan (the “Plan”) governed by the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. … Continue reading

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A Video Explaining What Liability Insurance is and How to Acquire It

What Is Liability Insurance? See the full video at https://youtu.be/8BAPjTJzJ7Q Insurance, by definition, is a contract where the insurer, for consideration (premium) agrees to indemnify another against a contingent or unknown risk of loss. It is used as a method … Continue reading

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Protective Safeguard Endorsement Creates a Mandatory Condition Precedent

Failure to Fulfill a Condition Precedent Defeats Fire Claim Plaintiffs sued their insurance company to enforce their contractual rights to their insurance coverage. After Plaintiffs’ liquor store burned down, Defendant, the insurance company, AmGuard, refused to pay the claim. It … Continue reading

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A Video Explaining What Mold Inspections Cannot Do

Dealing with Mold Emergency Services See the full video at https://youtu.be/KTTrF-VZ2G8 When dealing with emergency services (loss-mitigation), restoration, construction, or mold containment, the vendors of such services should understand that the industries they serve are in a business to provide … Continue reading

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The Concurrent Cause Doctrine Strikes in North Dakota

When there Exist Two or More Causes of a Loss and One is Excluded and the Other Not Coverage Exists to Defend and Indemnify North Star Mutual Insurance appealed from a declaratory judgment holding that a commercial general liability policy … Continue reading

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A Video Explaining Insurance Contract Construction and Interpretation

A Video Explaining Insurance Contract Construction and Interpretation The first thing every person representing an insurer with regard to a potential fraudulent claim must understand that the insurance policy is the basis for every insurance fraud investigation.  Without an insurance … Continue reading

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West Virginia Prohibits Subrogation Against Political Subdivisions

Creative Pleadings Cannot Change a Subrogation Claim Into Something Else Subrogation is an equitable remedy allowing a person who pays to indemnify another who was injured by a negligent tortfeasor to step into the shoes of the other to seek … Continue reading

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A Video Just for Fun – A “Heads I Win, Tails You Lose” Story

The Tiffany Kid The following is a story from my book, Heads I Win, Tails You Lose, a collection of stories from my experience as an insurance coverage lawyer. The book is available from amazon.com as both a paperback and … Continue reading

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A Video Explaining What is Needed to Make the Decision to Defend Under a CGL Policy

Making the Decision to Defend See the full video at https://youtu.be/Iha8TzYaRSQ Insurance is considered a quasi-public utility, since modern industry and business could not effectively operate without it. The courts recognize the importance of insurers to the community as a … Continue reading

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No Liability Policy Should Insure Against Insured’s Breach of Contract or Intentional Acts

Agent Without a Special Relationship Not Responsible to Explain to Insured Coverage Requested is not Available Insurance agents and brokers are required to obtain the insurance requested by the insured if that insurance is available in the marketplace. They are … Continue reading

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A Video Explaining the Underwriting Concerns About Unacceptable Risks

The Morale Hazard and Unacceptable Risks See the full video at https://youtu.be/I9FXFTkc_KA The property owner must understand that some risks are unacceptable under any circumstances to most major insurers. For example: Vacant property represents an unacceptable risk to many insurers. … Continue reading

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