Category Archives: Zalma on Insurance

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

Needed by the Insurance Claims Professional

Construction Defects and Insurance, Mold Claims and its Time to Rescind the Tort of Bad Faith Over the last 51 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has … Continue reading

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Faulty Workmanship Not an “Occurrence”

CGL Provides No Coverage for Damage to the Insured’s Work Construction contracts are risk transfer devices. The owner shifts the risk of loss to the general contractor who shifts the risk of loss to subcontractors and all shift the risks … Continue reading

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Do You Want to be an Insurance Professional? Here’s How!

The Homeowners Insurance Policy and ten volumes of Zalma on Insurance Claims For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) the ability to perform their duties appropriately and … Continue reading

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Insurer may Subrogate Against Insurer’s Policy Aquired under MSA

Right to Subrogation Under Master Service Agreement Master Service Agreements usually transfer the risk of losses from one party to the other and from one party’s insurer – adding the other as an additional insured – to the benefit of … Continue reading

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Insurance Claims and Insurance Law Books from Barry Zalma

Everything Needed by Anyone Interested in Insurance For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) the ability to perform their duties appropriately and in good faith is absolutely … Continue reading

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Insurance Fraud Becomes Inconsequential Because of Murder

Chutzpah – After a Vicious Murder the Defendant Adds Insurance Fraud It takes a great deal of chutzpah to set a fire to cover a murder and then try to profit from the fire by making a claim under a … Continue reading

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Fun for the Insurance Professional – True Crime Stories of Insurance Fraud

How Insurance Fraud Sometimes Fails and Sometimes Succeed For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) the ability to perform their duties appropriately and in good faith is … Continue reading

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You Can’t Change the Terms of a Contract by Argument on Appeal

Specific Requirements for Waiver of Subrogation Don’t Cover Every Possible Insurance Policy People write contracts containing insurance provisions without sufficient knowledge of insurance. As a result they attempt to have a court enforce the contract they should have created rather … Continue reading

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It is Time to Improve the Skills of Insurance Claims Personnel

Fair Claims Settlement & SIU Regulations, Ethics, Rescission, The EUO, & Random Thoughts on Insurance For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) the ability to perform their … Continue reading

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Workers’ Comp is Always an Exclusive Remedy

UM/UIM Coverage Purchased by Employer Doesn’t Work When Workers’ Comp is Available The State of Delaware Insurance Coverage Office moved the court for Summary Judgment against a claim by an injured employee for UM benefits in addition to his workers’ … Continue reading

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How to Serve Insurers and Policyholders With Skill & Professionalism

Insurance Fraud & Weapons to Defeat Fraud & Compact Books of Adjusting Property & Liability Claims For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) the ability to perform … Continue reading

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Zalma’s Insurance Fraud Letter – March 15, 2019

Independent Counsel and the Law of Unintended Consequences The standard provision in a liability insurance policy that provides an insurance policy requiring the insured to permit the insurer’s lawyer to defend claims against the insured amounts to an advance consent … Continue reading

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Knowledge Makes a Claims Person Able to Deal in Good Faith With any Claim

Construction Defect, Mold and Bad Faith Claims For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) the ability to perform their duties appropriately and in good faith is absolutely … Continue reading

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Policyholder’s Dream Case Turned Into a Nightmare

Certificate of Insurance is not Evidence of Insurance Sufficient to Gain Default Judgment It is axiomatic that when suing an insurer seeking the benefits of an insurance policy the plaintiff must prove the existence of an insurance policy by admitting … Continue reading

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Knowledge of Insurance Claims Law Needed by Everyone

How to Become an Insurance Claims Professional For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) the ability to perform their duties appropriately and in good faith is absolutely … Continue reading

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Decision of ERISA Benefits Plan Director Upheld

You Can’t Always get What You Want from an ERISA Plan Conflicts about applicability of ERISA plans must be resolved by federal courts. In Alexandra H. v. Oxford Health Insurance, Inc., No. 18-11105, D.C. Docket No. 1:11-cv-23948-FAM United States Court … Continue reading

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A Passover Seder for Americans

Passover Seder for Americans: An All English – Easy to Perform – Passover Seder by Barry and Thea Zalma. Passover is one of the many holidays Jewish people celebrate to help them remember the importance of G_d in their lives. … Continue reading

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Lawyers Should Never Lie to Their Insurers

When a Lawyer Admits Fault to a Court the Lawyer Should Anticipate a Malpractice Lawsuit Rescission is, as I have often reported, including a report on an earlier review of this case, a remedy available to an insurer whose insured … Continue reading

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Do You Want to be an Insurance Claims Professional?

How to Be an Insurance Claims Professional New Books from Full Court Press Full Court Press continues to publish expert secondary content. This time it’s a new collection of insurance law treatises from consultant, expert witness, arbitrator, and mediator Barry … Continue reading

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Liability Policies Can’t Be Stacked in Montana

Clear & Unambiguous Anti-Stacking Language Allowed by Statute When a person insured carries modest limits of liability on an auto liability policy but the insured causes severe injuries too small to cover the losses the insured and the injured persons … Continue reading

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True Crime Stories of Insurance Fraud

Fictionalized True Insurance Crime Books Over the last 51 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 … Continue reading

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She who Sits on Her Rights Loses Them

Arbitration Award by Default Upheld Against Tardy Appeal People like to sue insurance companies. They believe, often correctly, that it is easy because jurors dislike insurance companies and even if the case has no merit they will enter a judgment … Continue reading

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Be an Insurance Professional!

How to Become an Insurance Claims Professional The insurance claim professional must be able to recognize and defeat attempts at insurance fraud while dealing ethically and in good faith with all insureds and claimants with whom the insurance professional comes … Continue reading

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Clear and Unambiguous Policy Language Must be Applied

Every Insured Must Read and Understand the Policy before Buying I have argued for the last 51 years that insurance disputes can be avoided by the people insured actually reading and understanding the policy before buying it. Very few people … Continue reading

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Do You Want to Be an Insurance Professional? Here’s How.

A Method to Create Insurance Claims Professionals The insurance claim professional must be able to recognize and defeat attempts at insurance fraud while dealing ethically and in good faith with all insureds and claimants with whom the insurance professional comes … Continue reading

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The Four Corners Rule Strikes Again

Duty to Defend Exists if there is a Potential for Coverage of one Allegation The duty to defend is always broader than the duty to indemnify. In states like Wisconsin the law requires the court to consider only the allegations … Continue reading

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The Need for Truly Professional Insurance People

A Method to Create Insurance Claims Professionals For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) perform their duties appropriately it is absolutely necessary that they maintain insurance professionalism. … Continue reading

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If you don’t Like the Contract Terms – Don’t Sign It

Farmers Agents Must Fulfill Their Contracts with the Insurer Insurance contracts are adhesive. You take the terms offered. The Farmers Group of insurance companies use captive agents who are required to sign an adhesive agency agreement to have the right … Continue reading

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Make Your Claims Staff Professional

The Need for Truly Professional Insurance Claims People For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) perform their duties appropriately it is absolutely necessary that they maintain insurance … Continue reading

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Insurance Policies Must Be Read as they are Written

“Arise out of ” or “Relate in Any Way” People who write contracts with conditions requiring that one party provides insurance protection for another must be able to read and understand all of the terms, conditions and limitations of a … Continue reading

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How to Make Your Claims Staff Professional

The Need for Truly Professional Insurance Claims People For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) perform their duties appropriately it is absolutely necessary that they maintain insurance … Continue reading

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Zalma’s Insurance Fraud Letter – March 1, 2019

Beware! California Wants to Add to SIU Regulations If You Write Insurance in California You Need to Present Arguments to California DOI The California Department of Insurance (CDOI) has organized a discussion on proposed changes to the SIU Regulations that … Continue reading

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Do You Find it Difficult to Find or Maintain a Staff of Insurance Claims Professionals?

Train the New Ones and Maintain the Experienced Insurance Claims Professionals For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) perform their duties appropriately it is absolutely necessary that … Continue reading

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Ignoring an Administrative Order is Expensive

1011 Fake Claims Results in more than $500,000 Penalty When a chiropractor is caught billing insurers for services not performed he should never fail to appear to defend himself at an administrative hearing. Of course, if he or she has … Continue reading

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Beware! California Wants to Add to SIU Regulations

If You Write Insurance in California You Need to Present Arguments to California DOI The California Department of Insurance (CDOI) has organized a discussion on proposed changes to the SIU Regulations that must be followed and complied with by almost … Continue reading

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Do You Find it Difficult to Find or Maintain a Staff of Insurance Claims Professionals?

Train the New Ones and Maintain the Experienced Insurance Claims Professionals For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) to survive and perform their duties appropriately it is … Continue reading

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Arbitration Awards Need Abuse to be Overturned

Abitrators have Substantial Discretion to Determine the Scope of Their Contractual Authority to Fashion Remedies Arbitration is controlled by strong public policies favoring arbitration as a speedy and relatively inexpensive means of dispute resolution. For that reason arbitration awards are … Continue reading

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Experienced People are Unavailable – Train Up a Staff of Insurance Professionals

Information Needed by Every Insurance Lawyer, Claims Person or Claims Management Personnel For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) to survive and perform their duties appropriately it … Continue reading

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Joint Ventures Change Risk and Must Be Disclosed to the Insurer for Coverage to Exist

Failure to Disclose Joint Venture Avoids Coverage Many construction contracts are completed by multiple construction specialties entering into a joint venture. A Joint Venture is a cooperative enterprise entered into by two or more business entities for the purpose of … Continue reading

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Having Trouble Staffing Your Insurance Claims Staff – Train Them!

Information Needed by Every Insurance Lawyer, Claims Person or Claims Management Personnel For those who serve the insurance industry and its policyholders (whether as lawyers, adjusters, claims management, or public insurance adjusters) to survive and perform their duties appropriately it … Continue reading

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