Category Archives: Zalma on Insurance

insurance, insurance coverage, insurance claims, insurance bad faith, claims, investigation, fraud.

Ethics for the Insurance Professional

Methods for Insurers and their Personnel to Act with the Utmost Good Faith Ethics is a process of systematically applying, using, defending and recommending concepts of right and wrong behavior. Ethical behavior is required of both parties to a contract … Continue reading

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The Importance of Careful Policy Drafting

Collapse Requires Actual Abrupt Falling Down Homeowners learn the hard fact that concrete is not impervious. Chemicals in soil can react with the concrete and cause it to deteriorate, crack and if not repaired break and fall in. Insurance policies … Continue reading

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The Compact Book of Adjusting Property Insurance Claims

A Manual for the First Party Property Insurance Adjuster The insurance adjuster is not mentioned in a policy of insurance. The obligation to investigate and prove a claim falls on the insured. Standard first party property insurance policies, based upon … Continue reading

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Known Loss Provision Prevents Coverage

Knowledge of Ongoing Property Damage Defeats Coverage People who are accused of tortious conduct are loathe to report the accusation to their insurer. Even though they know someone incurred property damage, and would continue to incur property damage, are obligated … Continue reading

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Barry Zalma Releases Insurance Education Books on Amazon.com

Insurance Education Books on Amazon Publications by 50+ Years Insurance Expert Inform Industry Professionals on Insurance Fraud Culver City, CA – After practicing insurance law for over five decades, Barry Zalma, Esq., CFE, an internationally recognized and award-winning insurance expert … Continue reading

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Adjuster’s Statement Concerning a Flood Insurance Claim That is Contrary to Policy Wording is Unenforceable

Flood Insurance Statutes Preempt State Law Claims Flood catastrophes almost invariably result in disputes over insurance proceeds, insurance, and repairs. The National Flood Insurance Program created flood insurance benefits paid from the Treasury of the United States. As a result … Continue reading

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“The Compact Book on Adjusting Liability Claims”

 “A Handbook for the Liability Claims Adjuster” This Compact Book of Adjusting Liability Claims is designed to provide the new adjuster with a basic grounding in what is needed to become a competent and effective insurance adjuster. It is also … Continue reading

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Unwise to Waive Viable Coverage Argument

Never Try a Totally New Argument On Appeal Lawyers and litigants select a theory on which to try a serious case. They present all the evidence and make all the arguments on that theory. If they lose at trial the … Continue reading

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For Want of a Contract Lawyers Get No Fees

Contingent Fees Only Available to Lawyer from Client Contingent fee lawyers obtain a fee from their client when they recover funds to indemnify the client for a loss. A tort lawyer’s work also provides contingent assistance and funds to the … Continue reading

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Excess Can’t Deny Claim if Notice is Prompt

Notice to Excess Not Required Until Insured Knows the Claim Will Exhaust the Primary Insurance Liberty Mutual Fire Insurance Company,  as subrogee of Edison Properties, LLC, et al. v. Navigators Insurance Company, 2018 NY Slip Op 00631, 5602 653341/13, Appellate … Continue reading

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Passover is Coming – Be Prepared

Passover Seder for Americans: An All English – Easy to Perform – Passover Seder Paperback Passover is one of the many holidays Jewish people celebrate to help them remember the importance of G_d in their lives. We see the animals, … Continue reading

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Three Books Showing How Insurance Fraud Was Defeated

Murder & Old Lace: Solving Murders Performed for Insurance Money   When the women first met – 20 years ago at a Santa Monica health spa – Magogassasanian appeared taken with Gogolivesky. The women moved Alvarado into an apartment, then … Continue reading

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Life Insurer Must Pay What It Owes – Promptly

No Reasonable Excuse to Refuse to Pay Beneficiary Once a life insurer receives proof of the insured’s death and a claim from the beneficiary it must pay the limits immediately but not later than 30 days. When the insurer delays … Continue reading

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“Murder And Insurance Fraud Don’t Mix”

A Professional Claims Investigator Stops a Murderer My name is Marion Orpheus Montague. My friends, and some enemies, call me “MOM.” It is not a designation of my ability to nurture my clients. I have never been, nor will I … Continue reading

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Zalma’s Insurance Fraud Letter – February 15, 2018

The Essential Resource For The Insurance Fraud Professional Arson and Fraud Conviction Upheld Samuel F. Crawford appealed from a judgment convicting him upon a jury verdict of arson in the third degree, attempted insurance fraud in the fifth degree, conspiracy … Continue reading

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“Candy and Abel”

“Murder for Insurance Money” How a young lawyer and wise old investigator defeated an attempt at life insurance fraud. Available as a Kindle Book. Available as a paperback.       © 2018 – Barry Zalma This article, and all … Continue reading

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The Case of the Art Flambé

Arson-for-Profit and Rembrandt The following is one of the more than 80 fictionalized real-life insurance fraud stories from my book, “Heads I Win, Tails You Lose” available on Amazon.com. Available as a Kindle Book. and Available as a paperback. FROM MODEL … Continue reading

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“Random Thoughts on Insurance Volume V”

 Digests from Barry Zalma’s Blog: ‘Zalma on Insurance’ After more than 50 years acting as a claims person and insurance coverage lawyer I enjoy reading court decisions concerning insurance. The idea of this blog is to find new cases that … Continue reading

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Jail House Lawyer Fails to Get Parole Terms He Wanted

Demand for Kind Parole Terms Fails Insurance fraud is a serious crime. When you plead to the crime you will serve time in jail. When you are capable of Parole you are released to the public but you are not … Continue reading

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“HEADS I WIN, TAILS YOU LOSE”

Stories of How Insurance Fraud is Defeated & How it Succeeds A collection of columns originally published in the magazines “Insurance Journal,” “Insurance Week,” and “The John Cooke Insurance Fraud Report” insurance trade publications serving the insurance community in the … Continue reading

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Arson and Fraud Conviction Upheld

Chutzpah: Appeal of Conviction After Videotaped Confession As I have said before “Chutzpah” is a Yiddish word for utmost unmitigated gall. The best definition is the person who murders his parents and then pleads for mercy because he is an … Continue reading

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“The Insurance Examination Under Oath”

The Best Weapon Against Insurance Fraud Now Available at Amazon.com as a Kindle book or a paperback. The insurance Examination Under Oath (“EUO”) is a formal type of interview authorized by an insurance contract. It is taken under the authority … Continue reading

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Lawyer Accused of Insurance Fraud Scheme Entitled to Defense

Accusation that Lawyer Took Kickbacks from Auto Liability Claims Not Enough to Defeat Claim For Defense Insurance companies, chafing from multiple millions paid out in insurance fraud schemes are fighting back by suing the lawyers – among others – involved … Continue reading

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Rescission of Insurance

The Equitable Remedy that Protects Insurers from Fraud 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 … Continue reading

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No Way a Bicycle is a Covered Automobile

A Professional Service Corporation is a Distinct Entity Darryl Isaacs, a Kentucky lawyer did business as a professional service corporation (PSC). He was seriously injured when riding a bicycle he was hit by a car that was severely underinsured. He … Continue reading

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Ethical Behavior is the Basis of Every Insurance Transaction

Ethics for the Insurance Professional Methods for Insurers and their Personnel to Act with the Utmost Good Faith Ethics is a process of systematically applying, using, defending and recommending concepts of right and wrong behavior. Ethical behavior is required of … Continue reading

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No Reformation When Insured Accepts Offer for Less than Requested

The Burden of Proof is on he who Seeks Reformation Insurance agents and brokers obtain the insurance ordered by the insured. It is the obligation of the person insured to be certain the insurance acquired is the insurance wanted. When … Continue reading

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Pill Mill Doc Stays In Jail

Doc’s Appeals Fail After Jury Conviction Some doctors, who take an oath to “first do no harm” have decided that profit is more important than keeping their oath. The profits of giving out hundreds of prescriptions for high powered pain … Continue reading

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A Book for Every SIU Investigator, Claims Person or Claims Lawyer

Insurance Fraud and Weapons to Defeat Fraud My new book, Insurance Fraud and Weapons to Defeat Fraud, is now available  with Volume One as a paperback and a Kindle book.   Volume Two is available as a Kindle book or a … Continue reading

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Two Books Needed by Every Claims Person

“The Compact Book on Adjusting Liability Claims: A Handbook for the Liability Claims Adjuster” This Compact Book of Adjusting Liability Claims is designed to provide the new adjuster with a basic grounding in what is needed to become a competent … Continue reading

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Diminution in Value Not Physical Damage

 Coverage Requires Physical Damage to Property Insurance is a contract of indemnity. The terms and conditions of the policy contract are often in dispute and need a court’s interpretation to clarify its meaning. In Decker Plastics Corp. v. West Bend … Continue reading

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“Candy and Abel: Murder for Insurance Money”

Life Insurance Fraud Defeated As a famous Old Bailey Judge once said to a man in the dock who tried the same ploy by saying “as God is my judge, I’m not guilty” the judge replied: “He isn’t, I am, … Continue reading

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Flood Insurance Policy Must Be Strictly Construed

Filing Suit on Flood Policy Admits That Claim Was Denied The National Flood Insurance Program (NFIP) is not the same as commercial insurance. Every claim is paid, eventually, by the U.S. Treasury. Therefore, federal courts are obligated to strictly construe … Continue reading

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Murder & Insurance Fraud Don’t Mix

How a Jeweler Tried to Get Rich by Faking a Robbery On January 16, just after completing the year-end-physical inventory, Gagik “George” Sassonian the owner of Yerevan Jewelry Manufacturing, was concerned about his finances. The Christmas selling season was bad. … Continue reading

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Zalma’s Insurance Fraud Letter – February 1, 2018

Zalma’s Insurance Fraud Letter February 1, 2018 The Essential Resource For The Insurance Fraud Professional “Chutzpah” or how a Guilty Plea to Insurance Fraud Defeats Claim Chutzpah” is a Yiddish word meaning “unmitigated gall” where, for an example, a person … Continue reading

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Arson for Profit

How an Attempt to use Arson & Fraud to Fund Terrorism Failed This story is based on a real case involving a member of Russian/Armenian organized crime, real insurers, investigators, lawyers, fire fighters, and insurance brokers. The names, descriptions, and … Continue reading

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Insured May Cancel a Policy at any Time

Insurer Owes No Obligation to Beneficiary After Policy was Cancelled Members of the public and most lawyers dislike insurance companies. They believe that, regardless of the preponderance of evidence that a life or accidental death policy was cancelled by the … Continue reading

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Random Thoughts on Insurance, Volume V

Digests from Barry Zalma’s Blog Zalma on Insurance After more than 50 years acting as a claims person and insurance coverage lawyer I enjoy reading court decisions concerning insurance. The idea of this blog is to find new cases that … Continue reading

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Conflict Must be Significant, not Merely Theoretical, to Allow Independent Counsel

Coverage Issue That Has Nothing to do With Underlying Action Insufficient to Allow Independent Counsel Most commercial insureds want to retain counsel of their choice to defend them when a tort action is brought against them and want their insurance … Continue reading

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The “Compact Book of Adjusting Liability Claims”

How to Adjust a Third-Party-Liability Claim Adapted from Barry Zalma’s new book on Amazon.com. Click the links where you will fin it Available as a Kindle book & Available as a paperback. This Compact Book of Adjusting Liability Claims is designed … Continue reading

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