Category Archives: Zalma on Insurance

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

Payment of Appraisal Award Defeats Bad Faith Claim

There can be no Tort of Bad Faith if there is no Breach of Contract When a first party property insurer disagrees with its insured on the amount of loss the policy allows the dispute to be resolved by a … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Sexual Abuse of a Minor is Always an Intentional Act

Liability Insurance Policies Invariably Exclude Intentional Acts When a teacher abuses a minor student, rapes the minor student, and has constant sexual acts on a minor he or she acts intentionally to harm the minor as a matter of law. … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Torts are Different than a Coverage Issue

Severance of an Insurer from Tort Claim Not Always Required Usually a court will not allow a tort claim to be joined with an insurance coverage issue because it might prejudice the jury. When the trial court refused to sever … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Zalma’s Insurance Fraud Letter – 11-15-17

 The Essential Resource For The Insurance Fraud Professional   Barry Zalma, Inc. November 15, 2017   The Law Must be a Harsh Mistress The law demands absolute honesty, loyalty to the needs of the client over the needs of the lawyer, … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

No Subrogation Because Lease Silent and Existence of Mutual Benefit Insurance

Subrogation Remedy Limits Insurer to Rights of its Insured Subrogation is an equitable remedy available to insurers to what they paid an insured as a result of damage to property, the risk of loss of which was insured, from the … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Why Labor Must Be Depreciated to Find ACV

 Materials and Labor Depreciate to Reach Actual Cash Value The intent of a first party property insurance policy is to place the insured, after a loss, back in the same financial situation the insured was in before the loss. Insurance … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Holder of Assignment of Benefits Gets No More Rights than Insured

Eleventh Circuit Enforces Private Limitations of Action Provision of Policy The state of California is often considered to be a leader in insurance coverage litigation that is often followed by multiple states. However, as my last post proved, and as … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Failure to Sue Promptly Destroys Bad Faith Suit

Failure to Sue Within Policy’s Limitation Provision Fatal to Suit As I have said multiple times: “insurance is nothing more than a contract.” It is, also, a contract of the utmost good faith that devolves equally on the insurer and … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Attempted Insurance Fraud Is as Criminal as Actual Fraud

Insurance Fraud Happens When a Person Presents or Causes to be Presented a Fraudulent Document to an Insurer Insurance fraud is so easy and so seldom prosecuted that when a person is caught and convicted they tend to appeal to … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

No Workers’ Compensation Unless Injured on the Job

Driving to Job Site to Start Work Not in Course & Scope of Employment Workers’ compensation is designed to protect an employee injured on the job of the need to prove the negligence or intentional tort obligation of the employer. … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Proof of Mailing Sufficient to Effect Cancellation

Court Trusts the United States Postal Service For an insurance contract to exist consideration – premium – must be paid. When an insured fails to pay the premium as required by the policy the insurer had the unquestioned right to … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Insurance Policy Exclusion Must Be Enforced

Public Policy Only Applies if it Injuriously Affects a Material and Substantial Part of the Public Insurance exclusions, and all provisions of an insurance policy, must be enforced as long as they are clear and unambiguous unless the exclusion is … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Insurer Not Severed from Indemnity Action Brought Against It and Insurer

No Concern for Insurer Joined in Suit Against Additional Insured Additional insureds who seek defense from their insurer will often sue seeking declaratory relief but try to keep the case limited to the dispute with the insurer. In what has … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Fraud Scheme Fails

Performing Expensive Unnecessary Test for Insured and Not for Uninsured is Fraud Health insurance fraud is extremely profitable and seldom discovered and prosecuted. When it is successfully prosecuted the defendants, who have made millions by fraud, have sufficient funds to … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

A “Wells Notice” is a Claim

Notice of Circumstance is not a Claim The Securities and Exchange Commission (SEC) has various rights, duties and obligations. It can investigate and it can prosecute after finding sufficient facts to do so. Liability insurance only provides coverage for an … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Zalma’s Insurance Fraud Letter – September 1, 2017

The Essential Resource For The Insurance Fraud Professional What is Insurance Fraud? An intentional perversion of the truth for the purpose of inducing another in reliance upon it to part with some valuable thing belonging to him or to surrender … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Do the Crime – Do the Time – And Pay Restitution

Insurance Available to Victim of Crime Should Not Be Used to Avoid Restitution When a crime victim suffers bodily injury or property damage it the duty of the trial court to order restitution be paid by the convicted criminals to … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Are Insureds More Equal Than Insurers?

Montana’s Insurance Exception to the American Rule Re Attorneys’ Fees The “American Rule” requires both parties to a tort action to pay their own attorneys. There is no right for a litigant to collect attorneys fees from the defendant. However, … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Punitive Damages and Taxes

The IRS Takes the Joy Out of a Punitive Damages Award   The stated purpose of punitive damages is to punish a wrongdoer civilly to deter the wrongdoer and others from acting wrongfully. Insurance Bad Faith litigants dream of large … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Request for a Quote Is Not Insurance

The Most Believable Witness Carries Day When a person asks an insurance agent or broker to obtain insurance he is merely asking the agent to obtain an offer of insurance from an insurer. No insurance exists until the insurer makes … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Failure to Disclose Driver Can Be Expensive to Trucker

Unreported Driver Coverage Limited to State Minimum Motor Truck Liability Insurance is controlled by both state and federal law. Insurers, to protect themselves from excessive liability desire to vet every driver operating a large vehicle by requiring the insured to … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Don’t Plead Guilty If You Don’t Mean It

Crooked Chiro Pleads Guilty to Insurance Fraud and Then Tries to Take it Back After Chiropractor John Fortuna admitted that he and his co-defendants knowingly and willfully executed a scheme to defraud the insurers’ health care benefit programs, he pleaded … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Intentional Manslaughter Not Fortuitous

No Coverage for Intentional Killing Insurance, by definition a contract whereby one undertakes to indemnify another against loss, damage, or liability arising from a contingent or unknown event. Therefore, no one can buy insurance against his or her intentional acts. … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Duty to Defend Is Not Absolute

Do Not Refuse to Accept an Offer of Defense Without Reservation Unless You Have Evidence of Conflict It is axiomatic that the duty to defend is broad and that a liability insurer must defend its insured if there is a … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Don’t Change Your Mind After Accident

Waiver of Stacking UM/UIM Cover Upheld Insurance is a contract. An insured saves money by agreeing to limit the coverage available because the insured does not believe it would be needed. Only after an accident does an insured reconsider the … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Workers’ Compensation Policy Does Not Cover Defense of Third Parties

No Cover for Liability Assumed by Contract Workers’ Compensation is required by statute to provide coverage to employees who are injured in the course of employment without a need to prove liability, negligence or any other tort. Workers’ Compensation policies … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

When is an Appraiser Disinterested?

What is “Competent and Disinterested”? California Insurance Code, at § 2071 provides a method by which an insured and insurer may quickly, and informally, resolve disputes concerning the amount of loss. Although called “appraisal” it is really a contractual arbitration … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

No Good Deed Goes Unpunished

Pay the Premium or Lose Coverage States across the U.S. have passed statutes regulating the cancellation of insurance policies. The statutes impose strict notice to the insured and how cancellation for failure to pay premium can be cured. In Anthony … Continue reading

Share
Posted in Zalma on Insurance | Leave a comment

Insurance Claims In a Catastrophe

Insurance Claims In a Catastrophe If your house was damaged or destroyed by a wildfire, accidental fire, windstorm, flood, hurricane or earthquake, as a result of state declared catastrophes and you had a fire, homeowners, flood insurance, tenant’s homeowners or … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Insurance Claims In a Catastrophe

Convicted Insurance Fraud Perpetrator Sues Insurer for Reporting Him

“Chutzpah” by Fraud Perpetrator Fails “Chutzpah” is a Yiddish term meaning unmitigated gall. The best definition I have heard is when a man is convicted of murdering his parents and pleads for mercy because he is an orphan. In David … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Convicted Insurance Fraud Perpetrator Sues Insurer for Reporting Him

Zalma’s Insurance Fraud Letter – October 15, 2017

Zalma’s Insurance Fraud Letter The Essential Resource For The Insurance Fraud Professional Barry Zalma, Inc.  October 15, 2017   Any Medical Provider Convicted of Fraud in California Will Be Suspended The liens of a physician, practitioner or provider and the … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Zalma’s Insurance Fraud Letter – October 15, 2017

Trademark Infringement Claim Places Insured at Land’s End

Advertising Injury Coverage & Exclusion Clarified Trademark infringement lawsuits are often complex and difficult for insurers to deal with. Some provide coverage without dispute while others rely on exclusions written to limit the coverages provided. Since insurance coverage grants are … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Trademark Infringement Claim Places Insured at Land’s End

Oklahoma Statute Deprives UM/UIM Insurer of the Equitable Remedy of Subrogation

Oklahoma Statute Takes Away Insurer’s Right of Subrogation Against UM/UIM Insurer Subrogation is an equitable remedy that allows an insurer who pays a claim to an insured due to the actions of a tortfeasor to sue the tortfeasor as if … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Oklahoma Statute Deprives UM/UIM Insurer of the Equitable Remedy of Subrogation

I’m Dead – Really I Am!

Life Insurance Fraud Fails Nigeria seems to be the birthplace of different types of fraud. Everyone in the U.S. has received a letter, e-mail or fax offering millions from some Nigerian prince or government official if only the recipient gives … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on I’m Dead – Really I Am!

Incorrect Statement of Values Allows Rescission

Innocent Material Misrepresentation Sufficient to Allow Rescission Insurance, as I have said over and over again, is a business of the utmost good faith that requires both parties to do nothing that will deprive the other of the benefits of … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Incorrect Statement of Values Allows Rescission

The Duty to Select Type and Amount of Insurance Belongs to the Insured

Insurance Agent Only Required to Provide Insurance Ordered Unless they take on a fiduciary obligation an insurance agent or broker is only required to provide the insurance it was asked to acquire. The agent or broker need not – unless … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on The Duty to Select Type and Amount of Insurance Belongs to the Insured

No Occurrence – No Fortuity – No Coverage for Defense or Indemnity

Lack of the Potential for a Covered Claim Defeats Bad Faith Suit The ability to allege and prove a right to a defense under a liability insurance policy is usually fairly simple. All that is required of the insured is … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on No Occurrence – No Fortuity – No Coverage for Defense or Indemnity

Restoration of Ill Gotten Gains Not Insurable – Fraud Doesn’t Pay

Neither an Intentional Nor a Criminal Act is Fortuitous From the first insurance coverage issued on a clay tablet in ancient Sumeria every insurance claim required a fortuitous loss – one that is either contingent or unknown at the time … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Restoration of Ill Gotten Gains Not Insurable – Fraud Doesn’t Pay

Who Pays Black Lung Victim When His Employer and Its Insurer are Insolvent?

Guaranty Fund Is More Responsible than the Federal Black Lung Trust Fund Island Fork Construction v. Jimmy Bowling; Director, Office Of Workers’ Compensation Programs, No. 16-4319, United States Court Of Appeals For The Sixth Circuit (September 29, 2017) Jimmy Bowling … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Who Pays Black Lung Victim When His Employer and Its Insurer are Insolvent?

Why Pennsylvania Made it Easier to Prove Insurer Bad Faith

No Need to Prove Ill-Will or Self-Interest to Prove Bad Faith Since its creation as a tort in the 1950’s and 1960’s the tort of bad faith required proof the the insurer will do nothing which will injure the right … Continue reading

Share
Posted in Zalma on Insurance | Comments Off on Why Pennsylvania Made it Easier to Prove Insurer Bad Faith