Category Archives: Zalma on Insurance

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

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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Why Insurers Should Not Sue Each Other

Neighbors Who Hate Each Other Are Not Enough to Create a Professional Liability Claim When neighbors sue each other – especially when one neighbor was the realtor who sold the property to the neighbor under false pretenses – creates multiple … Continue reading

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Excess Insurer May Not Unilaterally Refuse Reasonable Settlement

Insured and Primary Policy May Settle When Excess Refuses to Participate Excess insurers often do not like the decisions of a primary insurer and an insured that would require payment by the excess insurer to effect a settlement. The state … Continue reading

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Insured Only Allowed One Appraisal

Insured’s Post-Appraisal Estimate Cannot Be Considered An appraisal is a contractual obligation in a first party property policy that allows the insured and insurer to resolve the amount of loss when the insured and insurer cannot agree.  When an insured … Continue reading

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Rescission by Default in Bermuda Not Binding

Comity Not Available Rescission of an insurance policy is appropriate if the policy was acquired by a misrepresentation or concealment of material fact. However, when a plaintiff is damaged by a default judgment of rescission in a foreign jurisdiction without … Continue reading

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A Court May Not Make Language of Policy Nugatory

Avoiding Making Worthless Excess Policy Language Liability insurance can be primary or excess. When multiple policies of insurance apply to a loss disputes over who owes what to the insured and in what proportion brings about litigation that resembles an … Continue reading

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City Cannot Compel Police Officers to Buy Primary Insurance

Municipality May Not Preempt State Law Police officers have a difficult and dangerous job. They should be honored for their service not punished by the citizens of the city where they live and work. In an attempt at a wild … Continue reading

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For Want of a Word In Policy Insurer Loses

Hit and Run Driver Who Forces One Vehicle into Another Allows for UM Coverage Uninsured motorist (UM) coverage covers injuries caused by a phantom vehicle that causes injury and runs from the scene – a classic hit-and-run accident. Because of … Continue reading

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Court Improperly Lets Parties to Change a Battery to Negligence

An Assault or Battery Away from Auto Does Not Arise Out of Use of Auto Automobile liability coverage requires that for coverage to apply injuries to a third party must result from the use of the automobile. Unlike broad liability … Continue reading

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Injuries Resulting from Intentional Acts Not an Occurrence

No Benefits for Deliberate Acts Resulting in Injury The USCA for the Ninth Circuit – contrary to its often stated court of reversal – wrote a clear, unambiguous, appropriate and proper decision that was even more brief than decisions from … Continue reading

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Zalma’s Insurance Fraud Letter – March 15, 2017

Zalma’s Insurance Fraud Letter Criminal Intent Proved by Circumstantial Evidence Zalma’s Insurance Fraud Letter, Volume 21, No. 6 Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have been in the business of insurance … Continue reading

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Broker is Not Agent of Insurer

Binder is Only Temporary Insurance Insurance companies issue binders to provide temporary coverage to a potential insured. They are not insurance policies but only evidence that, if certain conditions are met, a policy will be issued. Many contain conditions requiring … Continue reading

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If you Don’t Read Policy at Least Read Notice

Pretending to Be Ignorant Does Not Toll Statute of Limitations In my experience, and in the experience of the Supreme Court of Rhode Island, no one reads insurance policies. Even professionals, whether physicians or lawyers, fail to read the policy. … Continue reading

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No Coverage to Replace Defective Work

Settlement Agreement Contrary to Its Intent Eliminated Coverage As I have opined in these pages taking an assignment from a tortfeasor to get the right to sue an insurer is not a wise or profitable course of action. Although insurance … Continue reading

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FRAUD AND THE TORT OF BAD FAITH

How To Stop Fraud Insurance fraud is more often than not, successful. No one knows how much is taken by insurance fraud perpetrators from the insurance industry. It has been estimated to take as little as $80 billion to as … Continue reading

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What is Insurance?

Easy to Read & Understand Insurance policies are contracts. To form a contract an insurer must make an offer that is accepted by a potential insured who then pays consideration – premiums – for the promises made by the insurer. … Continue reading

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Private Limitation of Action Enforced in Oregon

Insurer’s Consistent Requirement that Insured Follow Policy Conditions Honored Insurance contracts – to protect against stale claims – contain a private limitation of action provision that requires filing of suit within a set period of time, usually one or two … Continue reading

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“Arises Out Of” is Unambiguous

Ninth Circuit Supports Clear and Unambiguous Exclusion Although the Ninth Circuit has been called the court of reversal it also will often write clear decisions that make logical and legal sense. Therefore, when a contractor sued its insurance company for … Continue reading

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Criminal Intent Proved by Circumstantial Evidence

36 Months in Jail For Fraudulently Taking $19.9 Million From Medicare Defrauding the United States of America has become a popular sport and profit center for those health care providers that disposed of their moral and ethical compass. It is … Continue reading

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Insured Can’t Pass Its Mistake to the Broker

Insurance Broker Sued for Doing What the Insured Asked It to Do The primary duty of an insurance agent or broker is to fulfill the orders presented to the agent or broker by the insured. If it errs in fulfilling … Continue reading

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Zalma’s Insurance Fraud Letter – March 1, 2017

Some Interesting and Important Words Zalma’s Insurance Fraud Letter, Volume 21, No. 5  The Current Issue Contains the Following heck in every day for a case summary at http://zalma.com/blog Some Interesting and Important Words Illumeo Continuing Education California SIU Regulations … Continue reading

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Prima Facie Evidence of Insurance Needed

Insurer Must Prove Adverse Vehicle is Insured to Avoid UM Arbitration I often praise the New York Appellate Courts for their ability to resolve a dispute in concise, clear and brief opinions. Fiduciary Ins. Co. of America v. Greenidge, Supreme … Continue reading

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Six Years Successfully Stealing from Medicare

Convicted after Stealing Almost $20 Million From Medicare One of the greatest thefts of all time is that by health care providers against Medicare and Medicaid. For six years defendant Michael J. Galatis stole from the U.S. Government with impunity. … Continue reading

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Utah Eliminates Tort Defense by Statute

Statute Requires Insurer to Pay for Injuries Incurred Without Fault of Driver For a person to be responsible for injuries resulting from the operation of an automobile the persons injured must prove that the driver had a duty to operate … Continue reading

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To Find Actual Cash Value Labor as well as Components Must be Depreciated

No Component of a Property Exists Without the Labor to Make It The definition of the term “Actual Cash Value” (ACV) has been difficult for insurers over the last few decades. States and insurers define it differently. Some insurers, attempting … Continue reading

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No Premium No Policy

Insurer Cancels Policy for Non Payment of Premium Many people across the U.S. use debit cards, credit cards and access to checking account to pay ongoing debts automatically. For such a system to work the checking account must have sufficient … Continue reading

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Failure to Prove Lack of Insurance Fatal to UM Claim

Incompetent Trial Evidence Loses UM Coverage When an insured sues its Uninsured/Underinsured (UM) Motorist insurer the insured need only prove that the motorist who damaged the insured in an auto accident it need only prove that the person responsible for … Continue reading

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No Proof of Loss No Flood Coverage

Flood Insurance Conditions Must Be Strictly Construed Catastrophes cause as many legal problems as they cause damage to property. Super Storm Sandy is a catastrophe that seems to prove the proposition. People who acquire a flood insurance policy based upon, … Continue reading

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When a Policy Is Not Illusory

A Crane On a Skyscraper Is an Excluded Tool No insurance policy covers every eventuality that can damage property. All insurance policies contain exclusions advising the insured of those certain risks of loss the insurer is unwilling to accept. People … Continue reading

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Contempt Sanctions Not Insurable Damages

Lawyers Held In Contempt Cannot Receive Defense or Indemnity From E&O Insurer Lawyers acting badly can cause problems for others. When a group of lawyers violated a court order and caused a company to be sued who would never have … Continue reading

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Zalma’s Insurance Fraud Letter — February 15, 2017

Lie on Health Insurance Application Is Criminal   Zalma’s Insurance Fraud Letter, Volume 21, No. 3 Zalma’s Insurance Fraud Letter, Volume 21, No. 4 Every Insurance Adjuster Must Be Trained About Fraud In the last 49 years that I have … Continue reading

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Claim of Estoppel Does Not Create Coverage

Coverage by Estoppel Requires Evidence of Prejudice Emulating their brother jurists in New York the District Court of Appeal of Florida wrote a succinct, brief and easy to understand an insurance coverage dispute. In Progressive Express Insurance Company v. Anzualda … Continue reading

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Sovereign Immunity Statute Causes Coverage Issue

Governmental Insurers and Insured’s Litigate Because of Failure to Deal With State Statutes A Florida county bought an excess insurance policy from Star Insurance Company with a self insured retention of $350,000 at the same time a state statute waived … Continue reading

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Breach of Lease Forfeits Right to Sue Lessor

Lessee Who Does Not Buy Required Liability Insurance for Lessor Loses Commercial leases, as a matter of course, require the lessee to obtain liability insurance in favor of the lessor. The insurance condition is usually a condition precedent and failure … Continue reading

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Emotional Decision of Jury Overturned

Two Juries Give Verdict to Church and Ignores Law Juries are made of humans who wish to provide justice. On a rare occasion a jury will ignore the law to help a plaintiff they feel is more righteous than the … Continue reading

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Excellence in Claims Handling

It is Time For Insurers to Require Excellence from Their Claims Staff In search of profit, insurers have decimated their professional claims staff. They laid off experienced personnel and replaced them with young, untrained, unprepared people. A virtual clerk replaced … Continue reading

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Failure to Conduct Real Investigation Supports Bad Faith Judgment

Hiring Counsel Not Investigation In the last few decades insurance companies, recognizing that their failure to train their new claims staff, failure to keep experienced claims staff, and failure to require a staff that can provide excellence in claims handling, … Continue reading

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Pollution Exclusion Unambiguous

After Insurer Proves Exclusion Applies Burden Shifts to Insured to Prove Otherwise Pollution exclusions have been rewritten over the last few decades until courts now agree that the absolute pollution exclusion is not ambiguous. In Hiland Partners GP Holdings, LLC … Continue reading

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New Jersey Eliminates Stink Over Assignments of Claims

Non-Assignment Clauses Only Prevent Assignment of Policy Not a Perfected Loss and Claim Every third party liability insurance policy contains an anti-assignment condition that prevents an insured from assigning the policy to a third party without the permission of the … Continue reading

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