Books Needed by Everyone Interested in Insurance Claims
Over the last 53 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 it for insurers and their claims staff to become insurance claims professionals.
The State of California Imposes Control on the Investigation of Insurance Fraud Effective October 1, 2020 – New Regulations to Enforce Statutes Requiring Insurers to Maintain a Special Investigative Unit
California SIU Regulations 2020 is designed to assist California insurance claims personnel, claims professionals, independent insurance adjusters, special fraud investigators, private investigators who work for the insurance industry, the management in the industry, the attorneys who serve the industry, and all integral anti-fraud personnel working with California admitted insurers who must comply with the requirements of California SIU Claims Regulations that were rewritten and made operative October 1, 2020.
The state of California, by statute, requires all admitted insurers to maintain a Special Investigative Unit (an “SIU”) that complies with the requirements set forth in the Special Investigative Unit Regulations (the “SIU Regulations”) and train all integral anti-fraud personnel to recognize indicators of insurance fraud. It is necessary, therefore, that insurance personnel who are engaged in any way in the presentation, processing, or negotiation of insurance claims in California to be familiar with the SIU Regulations.
The state has imposed on all claims personnel duties to deal with insurance fraud if the insurers are doing business in the state. California licensed insurers are required by California Insurance Code Sections 1875.20-24 and California Code of Regulations, Title 10, Sections 2698.30 -.41 to establish and maintain Special Investigative Units that identify and refer suspected insurance fraud to the California Department of Insurance (CDI) and directly to the local California County District Attorney’s Office for workers’ compensation only. The regulations also require each insurer to submit an SIU Annual Report to CDI which provides important information regarding the insurer’s SIU anti-fraud operations, procedures, and training material. The SIU Compliance Review Program evaluates the accuracy, completeness, and timeliness of the report. The reports are used to conduct a risk assessment to help determine which insurers are selected for SIU compliance review. R
The Appendices include outlines to be used by a staff member of the insurance company SIU, its trainers, educators, or lawyers to present a training class for all of the “integral anti-fraud personnel” of the insurers as defined by the SIU Regulations. Insurers must understand that every claims employee must be trained in accordance with the requirements of the SIU Regulations no later than 30 days after the person is hired and annually thereafter. As it is not economically reasonable to train one new employee California SIU Regulations 2020 cam provide the needed training without the additional expense of a training class for one or two persons.California SIU Regulations 2020, and its appendices, will provide the insurer and its staff with the information needed to comply with the SIU Regulations and will provide the training required for what the SIU Regulations describe as an insurer’s “integral anti-fraud personnel.”
The Reasons Why the California Department of Insurance Imposed the Regulations
In 1993, after waiting five years after receiving direction from the California Supreme Court, the state of California determined that the insurance industry needed to be regulated to stop insurers from treating the people insured badly and without good faith. It created a set of Regulations called the “California Fair Claims Settlement Practices Regulations” (the “Regulations) that were designed to enforce the mandate created by the California Fair Claims Settlement Practices statute, California Insurance Code Section 790.03 (h). in response to the direction of the California Supreme Court in its decision, Moradi-Shalal v. Fireman’s Fund Ins. Companies, 46 Cal. 3d 287 (1988).
In so doing the California Department of Insurance (CDOI) issued rules that were designed to micro manage the business of insurance claims and create a method to punish those insurers who failed to comply with the Regulations. Some of the Regulations recited what had always been recognized by the insurance industry as good faith and proper claims handling. Others imposed draconian mandates on what and when to do everything in the claims process.
The Regulations also provided a guide to insureds, public insurance adjusters and policyholders’ lawyers to assert any violation of the Regulations to be evidence of an insurer’s breach of the implied covenant of good faith and fair dealing.
The Reason for This Book
This book was designed to assist insurance personnel who do business in the state of California.
It will provide advice to:
•all insurance claims personnel,
•independent insurance adjusters,
•special fraud investigators,
•private investigators who work for the insurance industry,
•the management in the industry,
•the attorneys who serve the industry,
•public insurance adjusters,
•counsel for policyholders working with insurers doing business in California
the information needed to properly, efficiently, and fairly resolve insurance claims.
All insurers doing business in California must comply with the requirements of the Regulations or face the ire of, and attempts at financial punishment from, the CDOI. That punishment was found to be questionable and limited because of one courageous insurer who fought the CDOI and succeeded before an administrative law judge who limited the right to punish. That success, as far as I have been able to determine, has not been emulated.
Regardless of difficulties in assessing punishment the state of California requires all who are involved in the claims process — even if only tangentially — to be trained with regard claims handling in compliance with the Regulations and attest to completion of such training under oath. To avoid the required annual training the claims person can submit a sworn document to the insurer or insurers for whom the claims person works that avers that he or she has read and understood the Regulations.
Reviewing this book, the Regulations and commentary set forth below should be sufficient to comply with the training requirements of the Regulations.
It is necessary that insurance personnel who are engaged in any way in the presentation, processing, or negotiation of insurance claims in California be familiar with the Regulations. Counsel for insurers and policyholders should also be familiar with the Regulations since they establish a minimum standard for claims handling in the state.
There is also an outline for a training course in the appendix.
“Zalma’s Mold & Fungi Handbook”
Understanding mold, fungi, and bacteria infestations and what to do about them.
This book is the latest addition to Barry Zalma’s series of books and articles that form the most thorough, up-to-date, expert-authored guides available today about damage to structures and injuries to people by mold, fungi, bacteria or viral infections.
Zalma’s Mold and Fungi Handbook deals specifically with the issues relating to mold, fungi, and bacterial infestations and provides a detailed examination of the substances, their potential for property damage and bodily injury.
Written by nationally-renowned insurance coverage and insurance claims expert, Barry Zalma, a semi-retired insurance coverage attorney, insurance claims consultant, insurance claims expert witness, author, videoblogger and blogger. Zalma’s Mold and Fungi Handbook provides in-depth explanations, analysis, examples, and detailed discussion of:
•Mold, fungi and bacteria insurance claims; and
•Mold, Fungi, and Bacteria litigation.
Thorough, yet practical, this book forms the ideal guide for any property owner, professional who works in or frequently interacts with the repair or remediation of mold, fungi or bacteria infested property. It is also of use to every insurance underwriting, sales or claims professional and any lawyer involved in the construction industry or who is involved in construction defect litigation dealing with mold, fungi or bacterial infestations. Business owners, whether they own or rent property, will benefit greatly from the The Mold and Fungi Handbook. It is the perfect resource for insurance educators, trainers, and students whose role requires an understanding of mold, fungi and bacterial infestations.
The author has provided checklists, and information and references to statutes involved with mold, fungi or bacteria.
This, Zalma’s Mold & Fungi Handbook was written to help anyone faced with property damage or bodily injury as a result of exposure to mold, fungi or bacterial infestations. It was also written to assist in the presentation of claims to tortfeasors and insurers for the damages to property or persons.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and email@example.com.
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
Over the last 52 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 it possible for insurers and their claims staff to become insurance claims professionals.
Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts
Listen to Barry Zalma’s Podcast: Zalma on Insurance