Author Archives: Barry Zalma

A Video Explaining That the EUO is A Duty Owed by the Insured to the Insurer

The Examination Under Oath is a Condition Precedent to Recovery of Benefits from a Policy See the full video at https://youtu.be/m8Synuhc8Jg Every fire insurance policy issued in the U.S., like the New York Standard Fire Insurance Policy quoted in Chapter … Continue reading

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A Burglar Alarm is not a Fire Alarm

A Protective Safeguards Endorsement Establishes a Condition Precedent to Coverage Plaintiffs sued their insurance company to enforce their contractual rights. After Plaintiffs’ liquor store burned down, Defendant, the insurance company AmGuard, refused to pay the claim. In New Hamilton Liquor … Continue reading

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A video explaining the formation and interpretation of The Construction Contract

The Construction Contract See the full video at https://youtu.be/ysOd9gGLbvk When a construction contract, like every other contract, is unambiguous, the parties’ intent may be determined from the contract alone, and it is the duty of the court—not the jury—to state … Continue reading

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“Shall” is Mandatory and “May” is Permissive and they are Different

RTFP – By Reading the Full Policy Court Concluded that the Insurer Followed the Requirements of State Regulation An Illinois Regulation allows an insurer to agree to pay license fees, sales tax and title fees but does not mandate it … Continue reading

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A Video Explaining the Need to Use Construction Experts When Dealing with a Construction Defect Claim or Suit

Construction Experts See the full video at https://youtu.be/OcWFnAD0THA In construction defect cases, the standard of care and its breach must generally be shown through expert testimony. Lay testimony is sometimes sufficient where the defects are of common knowledge. In construction … Continue reading

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Theft of Salary Specifically Excluded

Not Every Employee Theft is Covered by a Fidelity Bond An Illinois appellate court was asked whether an employer can recover for an employee’s wage theft under the terms of the employer’s business insurance policy. Plaintiffs (collectively 3BC Properties, LLC, … Continue reading

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A Video Explaining the Evidence Needed to Prove Fraud

What is Evidence? See the full video at https://youtu.be/snar91UYIxY Direct Evidence Direct evidence is proof that tends to show existence of a fact in question without the intervention of the proof of any fact. It includes testimony that tends to … Continue reading

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Eighth Circuit Properly Slaps Down Insurer for Charging Premium Not Owed

Audit Including Seamen Excluded from Workers’ Compensation Policy not Appropriate LM Insurance Corporation sued Dubuque Barge and Fleeting Service Company, d/b/a Newt Marine Service (“Newt Marine”), for breach of contract alleging Newt Marine wrongfully refused to pay premiums owed under … Continue reading

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Subscribe to my NEW YouTube Channel

Barry Zalma on YouTube Zalma on Insurance  Those 54 of you who subscribed here to Zalma on Insurance as a YouTube Channel where I posted many videos has made it impossible for me post more. I have created this new … Continue reading

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A Video Explaining How a Claims Person Should Select Counsel

Retaining an Attorney See the full video at https://youtu.be/gHo76rNgvFE In instances where insurance claims may entail litigation, insurers must move quickly to engage counsel. When an attorney is retained to defend a person insured, the fact should be documented in … Continue reading

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In Mississippi Insureds Have a Mandatory Duty to Read the Policy

Failure to Read a Policy Defeats Malpractice Case Against Insurance Agent Ladner Investments Inc. (Ladner) and its sister company are in the transportation and logging business. In 2010, Michael Conway Inc. (MCI) sold Ladner an inland marine insurance policy from … Continue reading

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Barry Zalma’s Insurance Claims Books

Ethics & California’s Fair Claims & SIU Regulations 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 … Continue reading

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A Video Explaining the Use of an Independent Medical Examinations

Independent Medical Examinations See the full video at https://youtu.be/oytFzG6m2YI When a claimant claims an injury that does not agree with the facts of the incident claimed to have caused the injury, the adjuster will often seek the assistance of an … Continue reading

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Assignment of Claim to Plaintiff a Win for Defendant and its Insurers

Greed & Hope of Punitive Damages Results in Nothing Underlying this insurance dispute is a lawsuit between Marvin W. Durment (Durment) and several policyholders of Burlington and Endurance over alleged breaches of a joint venture agreement and an intellectual property … Continue reading

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Defenses to the Tort of Bad Faith

The Genuine Dispute Doctrine See the full video at https://youtu.be/MvTn85OWf3M Insurers in states where the tort of bad faith exists deny fraudulent insurance claims with fear and trembling. The specter of punitive damages has worked to make multi-millionaires of many … Continue reading

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Intentional Act Exclusion Applies When Resident Child Sets Fire

Setting Fire to a Blanket to Upset Her Father is an Intentional Act On August 30, 2018, the property suffered significant damage due to a fire which originated from the bedspread in Plaintiffs’ bedroom. The fire spread from the bed … 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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Claiming the Same Property Destroyed in Multiple Fires Establishes Arson for Profit

Convicted Arsonist Sentenced to 204 Months Because of Stupidity in the Presentation of a Fraudulent Claim The USA and its Department of Justice has taken a stand against arson for profit. Because it is a serious crime where people are … Continue reading

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A Video Explaining the Concurrent Cause Doctrine

Concurrent Cause Doctrine See the full video at https://www.youtube.com/watch?v=uhc5y21fNAU The concurrent cause doctrine holds that if more than one cause concurred to cause a loss, one of which is excluded and the other not, the entire loss is covered. It … Continue reading

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Arsonist Did the Crime and Must Serve the Time

Arson-for-Profit that Caused Death of Firefighter Results in 360 Months in Federal Prison As I have said many times, arson-for-profit is the most evil form of insurance fraud and one where people are injured or die. Arson-for-profit fraud is highly … Continue reading

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A Video Explaining Why Bodily Injury Caused by Mold or Fungi is Uncertain

Maybe Mold Doesn’t Cause Bodily Injury or Illness See the full video at https://youtu.be/xiyBJilePUY The Guidance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure and Moisture Indoors (Guidance) is one of the most recent … Continue reading

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Video Explanations of Insurance and Claims Topics

FREE VIDEOS EXPLAINING INSURANCE CLAIMS AND INSURANCE LAW TOPICS 15:21 A Video Explaining Why Bodily Injury Caused by Mold or Fungi is Uncertain The Guid ance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure … Continue reading

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Books for the Insurance Professionals

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 When the Notice-Prejudice Rule Does Not Apply

The Notice-Prejudice Rule Doesn’t Always Apply See the full video at https://youtu.be/ROzLqTpsa6Q Claims made and claims made and reported policies contain a date certain notice requirement. In Colorado, the Colorado Supreme Court found:­­ “The notice-prejudice rule does not apply to … Continue reading

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New York Concludes an LLC is more akin to a Partnership than a Corporation

Member of LLC May Claim Underinsured Motorist Coverage In the Matter of United Financial Casualty Company v. Alan Tekel, 2019-10964, 2020 NY Slip Op 03919, Supreme Court of The State Of New YORK Appellate Division, Second Judicial Department (July 15, … Continue reading

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Three New Books by Barry Zalma

“Zalma’s Mold & Fungi Handbook” Understanding mold, fungi, and bacteria infestations and what to do about them. This book is the latest addition to Barry Zalma’s series of books and articles that form the most thorough, up-to-date, expert-authored guides available … Continue reading

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A Video Explaining the Duties of the Public Adjuster

Public Insurance Adjusters See the full video at https://youtu.be/3xC2McFnSG8 Most policyholders do not have the in-house capability to investigate, evaluate, and negotiate significant property insurance losses. While some losses, such as a small fire loss requiring only minor repairs, may … Continue reading

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Louisiana Anti-Indemnity Statute Defeats Additional Insured Endorsement

Government Owned Sewerage Department’s Construction Contract Additional Insured Requirements Declared Void Anti-Indemnity Statute Refuses Coverage of Sole Negligence of Additional Insured The Consolidated Sewerage District No. 1 of the Parish of Jefferson (hereinafter “the Parish”) and American Alternative Insurance Company … Continue reading

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Trigger of Coverage

A Video Explaining the Term “Trigger of Coverage for Property Damage The term “trigger of coverage” means “what event must occur for potential coverage to commence under the terms of the insurance policy” and “what must take place within the … Continue reading

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Obamacare Results in Litigation About Lactation Services

Dismissal of Class Action for Lack of Private Right of Action in ACA The Patient Protection and Affordable Care Act (“the ACA”) includes a mandate that group health plans and health insurers “provide coverage” and “not impose any cost sharing … Continue reading

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Construction Defects and Insurance

Construction Defects and Insurance Barry Zalma has updated and re-edited his seminal work Construction Defects Coverage Guide into is the latest addition to Barry Zalma’s insurance claims series of books and articles that will form the most thorough, up-to-date, expert-authored insurance claims … Continue reading

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Claims Personnel

The People Who Keep the Promises Made by the Insurance Policy Watch the full video at https://youtu.be/zfob5rQwBWY The Claims Adjuster The claims adjuster is the contact between the insured and the insurer. He or she can be an employee of … Continue reading

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Failure to Identify Relative as a Resident of Household Limits Available UM Coverage

Uninsured Motorist Coverage Limited to Minimum Statutory Limits Tiffany Chow appealed the district court judgment in favor of IDS Property Casualty Insurance Company in this insurance coverage dispute. In IDS Property Casualty Insurance Company v. Tiffany Chow, No. 19-55837, United … Continue reading

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Zalma’s Insurance Fraud Letter – July 15, 2020

Zalma’s Insurance Fraud Letter Insurance Fraud Is Often A Violent Crime See the video about  Zalma’s Insurance Fraud Letter, July 15, 2020 at https://youtu.be/xtExcV6fPuQ and read the full text of ZIFL at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-barry-zalma-esq-cfe-10c and at https://zalma.com/zalmas-insurance-fraud-letter-2/ Articles, including: Insurance Fraud … Continue reading

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A Video Explaining How the Law of Unintended Consequences Destroyed the Need for the Tort of Bad Faith

The Law of Unintended Consequences and the Tort of Bad Faith See the full video at https://youtu.be/s7cnXrrJqTs The concept of unintended consequences is one of the building blocks of economics. Adam Smith’s “invisible hand,” the most famous metaphor in social … Continue reading

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Private Limitation of Action Provision Defeats Law Suit Against Insurer

Good Deeds by Insurer Still Punished by Late Filed Lawsuit Insurance policies, to protect the insurer from stale claims and lawsuits where available evidence is difficult to obtain, contain private limitations of action provisions usually one or two years. In … Continue reading

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A Video Explaining the Claims Made CGL

The Claims Made Form See the full video here: https://youtu.be/WoQzgOK375g The insurance industry spent 10 years trying to restrict their liability for long tail losses. They tried wording that would prohibit stacking, as well as wording that would only allow … Continue reading

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Insurance Created by Government Needs Nine Years of Court Decisions to Make Sense

The Little Sisters of The Poor Establish Why Government Should Not Be Involved in Insurance The Patient Protection and Affordable Care Act of 2010 (Obama Care or the ACA), an attempt to legislate health insurance brought about more than nine … Continue reading

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A Video Explaining the Fair Claims Settlement Practices Regulations

The Reasons Behind the California Fair Claims Settlement Practices Regulations See the full video here https://youtu.be/7ELoCEAIldA In 1993 the state of California determined that the insurance industry needed to be regulated to stop insurers from treating the people insured badly … Continue reading

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Long Time in Jail for Pill Mill Doc & Fraudster

90 to 180 Months for Pill Mill Doc’s Fraud & Death of Victim to Whom She Provided Narcotic Drugs In Commonwealth Of Pennsylvania v. Stephanie Tarapchak, J-S17021-20, No. 281 MDA 2018, Superior Court Of Pennsylvania (JUNE 23, 2020) Stephanie Tarapchak … Continue reading

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