Category Archives: Zalma on Insurance

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

No Excuse for Not Reporting Loss as Soon as Practicable

Waiting Until You Lose a Suit to Report the Loss to the Insurer Breaches Material Condition Claims made and reported policies require prompt reporting within the policy period. When an insured is sued, the prudent insurer will immediately report the … Continue reading

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No Good Service From Agent Goes Unpunished

Agent Fulfilled Duty to Advise Insured of Changes in New Policy When an insured seeks coverage from an insurance agent or broker it is obligated to answer all application questions accurately. When a trucking firm advised its agent of product … Continue reading

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Love In The Air – Wife Shoots Husband

When Your Estranged Wife Shoots You, Don’t Expect Coverage As June approaches and love is in the air courts are faced with interesting cases arising from love and marriage proving they don’t always go together like a horse and carriage. … Continue reading

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The Reason for the Examination Under Oath

An Important Tool to Resolve Insurance Claims Courts that construe submission to an EUO as a condition precedent to recovery generally do not require the insurer to prove that it suffered actual prejudice from an insured’s unexcused refusal to submit … Continue reading

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Ethics for the Insurance Professional

The Covenant of Good Faith Is a Force for Ethical Behavior People who are insured are obligated to treat their insurer equally and in good faith. It is no answer for a person insured to say that the error or … Continue reading

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A Policy In Evidence is Needed to Prove Coverage

How to Lose a Declaratory Relief Action by Not Trying When a person seeks insurance coverage he or she is required to prove that a policy of insurance exists and that there is evidence that allows a finding that the … Continue reading

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Lover Scorned Admits to Aiding Insurance Fraud

Conviction for Aiding Insurance Fraud Affirmed Although love remains a many splendored thing when love dissolves and vengeance is attempted it can be a doubled edged sword.  Joseph Anthony Mauro was convicted by a jury finding him guilty of insurance … Continue reading

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An Insurer Cannot Safely Refuse Defense and Indemnity in Illinois

Illinois Finds Failure to File a Declaratory Relief Action Vexatious The Valuable Dead Dog Country Mutual Insurance Company appealed the trial court’s grant of summary judgment to plaintiff, Sabas Soto, finding defendant acted vexatiously and unreasonably and awarding plaintiff attorney … Continue reading

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Misrepresentation of Material Facts on Application Requires Rescission

Dr. Lies on Application & Policy Rescinded As I have reported multiple times in this blog that the covenant of good faith and fair dealing applies equally to the person insured as the insurer. When a doctor applies for insurance … Continue reading

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Zalma’s Insurance Fraud Letter – May 15, 2017

Insurance Fraud & Politics   Zalma’s Insurance Fraud Letter, Volume 21, No. 10      Every Insurance Adjuster Must Be Trained About Fraud Certified Expert in Corporate Property Insurance Program Now available from Illumeo and Barry Zalma: A comprehensive program enabling … Continue reading

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Lawyer Fails Trying to Make an Application an Insurance Policy

Read Your Policy or Else An insurance application is nothing more than a request presented to an insurer seeking an offer of insurance. It is not a contract. It is not even an offer. It is a request for an … Continue reading

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Agent Should Explain Effect of Coinsurance

Promise of Coverage Without Explanation of Coinsurance Can Be Fatal To Insurance Agent No one seems willing to read the insurance policy they purchased. When they have a loss an the failure to read the policy costs the insured money … Continue reading

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Various Types Of Insurance Fraud Found by FBI

The FBI lists the following common insurance fraud schemes in its Insurance Fraud Report at https://www.fbi.gov/stats-services/publications/insurance-fraud: Premium Diversion Premium diversion is the embezzlement of insurance premiums. It is the most common type of insurance fraud. Generally, an insurance agent fails … Continue reading

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Appropriate to Effect “Force Placed Insurance”

Pay Your Mortgage & Keep Insurance or Lose Many people have – especially in the last ten years – difficulty paying their mortgage and keeping the property insured as required by the mortgage documents. When the lender exercises its rights … Continue reading

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Heads I Win, Tails You Lose

Insurance Fraud by Divine Right The story that follows is based on fact. It is, however, a work of fiction. The names, places and descriptions have been changed to protect the guilty. Any resemblance to real people is purely coincidental. … Continue reading

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“Doc-in-the-Box” Scheme Defeated

Chiropractors Cannot Own & Control Medical Practice Insurance fraud appears in many different schemes. When a chiropractor wishes to increase his practice and the fees charged in order to defraud insurers who compensate people injured in accidents, creates a “Doc-in-the-Box” … Continue reading

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Eleventh Circuit Refuses to Create Ambiguity When None Exists

Clear Exclusion Enforced Although appellate decisions concerning insurance issues are seldom noted for their brevity sometimes an issue is so clear that the appellate court needs only state the obvious and logical decision.  When a lawyer does not read the … Continue reading

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Arson-for-Profit Fails – Life In Prison Without Parole

Stupid & Vicious Attempt at Insurance Fraud Fails I have reported often that arson-for-profit is the most dangerous, deadly, and stupid way to steal money from insurance companies because there is always evidence left after the fire and people are … Continue reading

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Insurer Victims Must Be Provided Restitution From Criminal

Insurers That Pay A Theft Claim Are Victims States like Ohio believe that a person who is smart enough to insure against theft and other criminal acts suffer no loss if insurance exists to pay for the loss. Acting on … Continue reading

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Zalma’s Insurance Fraud Letter – May 1, 2017

 Happy Law Day From The Essential Resource For The Insurance Fraud Professional   Innocent Young Lawyer Falls Into Fraud Trap Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have been in the business of … Continue reading

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The Temptation of Fraud

Innocent Young Lawyer Falls Into Fraud Trap In California a person can pass the Bar Exam and practice law even if he or she does not attend law school or attends an non ABA accredited law school. Finding employment with … Continue reading

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Fraud Investigation & Punitive Damages

Tort Damages for Failed Fraud Investigation Insurance fraud investigations by Special Investigation Unit (SIU) have saved the insurance industry millions of dollars that would have been paid to fraud perpetrators without the SIU investigation. Even though states require the existence … Continue reading

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Insured Must Prove Whether Insurance Conditions Were Satisfied

Even a Stopped Watch Is Correct Twice a Day The often reversed Ninth Circuit Court of Appeal gets things right once in a while. In this brief and clear opinion the Ninth Circuit granted an insurer declaratory relief because the … Continue reading

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Travelers Avoids $36 Million Verdict

“Arising Out Of” Not Ambiguous In Pennsylvania Decades of litigation over the effects of pervasive asbestos use have yielded a financial burden borne across an array of industries. A historical manufacturer of asbestos-containing products and its insurer disputed the rightful … Continue reading

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Assault & Battery Exclusion Unambiguous

 An Insurance Company May Limit Coverage in any Manner Alcoholic beverages tend to have an effect on the ability of those who consume it to lose their ability to control their tempers. People who work in bars to protect the … Continue reading

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Insurance is an Important Part of Every Commercial Lease

Two Cases Confirm the Importance of Insurance I admire New York appellate courts because they write opinions that are truly brief, concise, and state the law without fluff or attempts to look wise when a simple paragraph will do. The … Continue reading

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When Joint Venture Is Insured Joint Venturer is Insured

To Prove Bad Faith Plaintiff Must Prove Malice, Oppression, Wilfulness or Reckless Indifference Insurers, like every business, will often err, be lazy, or just fail to treat their insured properly. When that happens the insured will invariably sue or cross-claim … Continue reading

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Zalma’s Insurance Fraud Letter – April 15, 2017

Zalma’s Insurance Fraud Letter The Essential Resource For The Insurance Fraud Professional    Zalma’s Insurance Fraud Letter, Volume 21, No. 8 Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have been in the business … Continue reading

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Broker Responsible to Assure Policy Provides Coverage Ordered

Broker May Not Rely on Representation of Underwriter About Coverage Provided It is axiomatic that an insurance broker is responsible to obtain the coverage required by the insured. As an insurance professional the broker is required to read the policy … Continue reading

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Washington State Turns TPA Into a Virtual Insurer

Washington State Court Finds TPA Subject to Bad Faith Law I has been axiomatic across the country that only an insurer may be liable for the tort of bad faith. For example, in 1973 Gruenberg v. Aetna Ins. Co. (1973) … Continue reading

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Happy Passover

Passover 2017 – In English Passover is a time when every Jewish father and mother tell their children the story of the Exodus of the Jews from slavery in Egypt. It is a story that Jewish people have told every … Continue reading

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Fraudulent Claim Voids Coverage

When Insured Admits Tax and Bankruptcy Fraud They Should Be Prosecuted Making false reports to the IRS and to Bankruptcy Courts about the value of a business or its property to avoid taxes and paying legitimate debts seems to be … Continue reading

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Punished for Not Reading Policy

Broker Can Be Negligent For Failing To Acquire Insurance Requested Insurance brokers transact insurance with but not on behalf of insurers. They act as the agent of the insured to acquire the insurance required by their client. By so doing … Continue reading

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Justice Gorsuch and Insurance

Two Insurance Cases Written by the New Supreme Court Justice Today, Justice Neil Gorsuch will be appointed to the U.S. Supreme Court. Since I and my readers are interested in insurance matters I thought it might be useful to see … Continue reading

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Police Officer Immune as a Result of Dog’s Bite

Immunity Exists for Policy Officer Unless The State Has Insurance A state government in Arkansas, and its employees, are immune from suit unless and only up to the amount of available insurance. In Jason Harris v. Norman Beth, Supreme Court … Continue reading

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Zalma At The Atlantic Claim Executive Association Spring Conference

Resources to Defeat Insurance Fraud Yesterday I was honored to speak before the Atlantic Claim Executive Association Spring Conference at the Hammock Beach Resort in Palm Coast, Florida.  The slide show is at the link below. ACA-INSURANCE FRAUD & WEAPONS … Continue reading

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Zalma’s Insurance Fraud Letter – April 1, 2016

The Essential Resource For The Insurance Fraud Professional Now Available Rescission for Fraud by Default in Bermuda Not Binding    Zalma’s Insurance Fraud Letter, Volume 21, No. 7   Every Insurance Adjuster Must Be Trained About Fraud In the last … Continue reading

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Dangerous Immature Driver Loses License

Uninsurable Driver Refused License by DOI Zachary Phillips, at age 16, drove recklessly in an accident that resulted in the death of his passenger. He claimed he was not driving but evidence established he was driving the vehicle that resulted … Continue reading

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Insured Must Treat the Insurer With Good Faith & Fair Dealing

Federal Court Will Not Recognize a Fake Attempt at Defeating Diversity When I was a young lawyer plaintiff’s bad faith lawyers wanted to avoid federal jurisdiction because California state courts were more likely to return a verdict in favor of … Continue reading

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Settlement Resolves All Disputes

It is Not Always Logical to Accept Policy Limits Policy limit demands are made in almost every serious injury case. They usually result in a settlement. However, when there is underinsured motorist (UIM) coverage available the plaintiff and counsel must … Continue reading

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