Category Archives: Zalma on Insurance

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

A Video Explaining the Latent Defect and Inherent Vice Exclusions

Latent Defect See the full video at https://youtu.be/fFhppjrhVMU Cases that provide coverage despite an exclusion for latent defects fall generally within two categories. The court determines either that: the defect could have been discovered through appropriate testing and it is … Continue reading

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Claim Must be Made Against Insured During Policy Period to Recover on a Claims Made Policy

No Cover for Defense of Criminal Charges Made Years After Claim Made by Prosecutors Appellant Denis M. Field challenged a final summary judgment in favor of dozens of insurers (appellees) in his suit to recover defense costs he incurred in … Continue reading

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A Video Explaining the Duties of the Public Insurance Adjuster

Duties of the Public Adjuster See the full video at https://youtu.be/AoJnf_MhiQI Most policyholders do not have the in-house capability to investigate, evaluate, and negotiate significant property insurance losses. While some losses, such as a small fire loss requiring only minor … Continue reading

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It is not Nice to Seek Predated Insurance After an Accident

Insured May not Assume Coverage Exists if the Insured Fails to Order Collision Coverage Walter Alvarez appealed the trial court’s entry of summary judgment in favor of Pinnacle Insurance Group of Indiana, Inc. (“Pinnacle”) and Joyce Helsel (“Helsel,” and together … Continue reading

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A Video Explaining the Trigger of Coverage Concerning Property Damage

Trigger of Coverage The term “trigger of coverage” means “what event must occur for potential coverage to commence under the terms of the insurance policy” and “what must take place within the policy’s effective dates for the potential of coverage … Continue reading

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Multiple Theft Losses of Amounts Less than the Deductible Defeats Claim

Common Meaning of “Occurrence” Applied Since Policy Did not Define Term In Port Consolidated, Inc. v. International Insurance Company Of Hannover, PLC, No. 19-13544, United States Court Of Appeals For The Eleventh Circuit (September 8, 2020) Port Consolidated, Inc. (“Port”), … Continue reading

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A Video Explaining Casualty Insurance

Casualty Insurance See the full video at https://youtu.be/zXxftSYktgg Many people use the terms “casualty” and “liability” as if they were synonymous. However, casualty insurance includes insurance that does not fall within the definition of liability insurance. “Casualty insurance” is defined … Continue reading

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Insurance Fraud is a Crime of Moral Turpitude

Illegal Alien Deported Because of Conviction of Insurance Fraud Anahi Jaquez-Estrada sought review of a decision of the Bureau of Immigration Appeals (BIA) affirming a decision of an Immigration Judge which found her removable to Mexico. In Anahi Jaquez-Estrada, v. … Continue reading

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Zalma’s Insurance Fraud Letter – September 15, 2020

The Essential Resource for The Insurance Fraud Professional See the full video at https://youtu.be/hCEYIFMxAgk Florida High Court Rejects Attorney Strems Bid to Dissolve Suspension; Contempt Petition Filed Scott Strems, about whom ZIFL has reported earlier, a Florida attorney accused of … Continue reading

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A Video Explaining The California Fair Claims Settlement Practices Regulations 2020

The Reasons Why the California Department of Insurance Imposed the California Fair Claims Settlement Practices Regulations on All Insurers Doing Business in California See the full video at https://youtu.be/AHuIuZile3I In 1993, after waiting five years after receiving direction from the … Continue reading

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A Loss Caused by Wear and Tear is not Fortuitous

First Party Property Insurance only Provides Coverage for a Fortuitous Loss This insurance coverage dispute concerns damage to a building that resulted from rainwater ponding on the roof and eventually finding its way inside. The issue on appeal is whether … Continue reading

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Newest Book from Barry Zalma on the Fair Claims Settlement Practices Regulations

The California Fair Claims Settlement Practices Regulations 2020 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 … Continue reading

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A Video Explaining Why Rescission Is a Remedy That Must be Used with Care

Rescission Is a Remedy That Must be Used Cautiously See the full video at https://youtu.be/tQB3yB4geoA Insurers must use the rescission remedy with care. Insurers should never assume that the promise to pay indemnity to the insured under a policy of … Continue reading

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USDC in New Jersey Bends Over Backwards to Help a Pro Se Plaintiff

To Sustain a Suit Against an Insurer it is Necessary to Allege Adequate Facts No one likes to have an insurance claim denied. However, many times the insurance company made the correct decision. When an insured finds it difficult or … Continue reading

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Everything Needed by the Ethical Insurance Claims Professional from Barry Zalma

Ethics for the Insurance Professional – Second Edition How the Covenant of Good Faith and Fair Dealing Requires Ethical Insurance Representatives Insurance is, by definition, a business of the utmost good faith. This means that both parties to the contract … Continue reading

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A Video Describing Insurance Fraud by Insurers and Agents

Insurer and Insurance Agents Jailed for Fraud See the whole video at https://youtu.be/bHlu5qI8R_E Maryland Insurance Executive Guilty of Wire Fraud Jeffrey Brian Cohen, 39, of Reisterstown, Md., after four days of trial, pled guilty on June 5, 2015 to wire … Continue reading

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Settlement Agreement of Insurance Litigation is not an Insurance Policy

Settlement of a Lengthy Lawsuit Changed the Meaning of a Long Term Care Policy More than ten years ago policyholders sued Continental Casualty Company (CNA) over its interpretation of certain long-term care policies. A settlement resulted in CNA agreeing to, … Continue reading

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Everything Needed to Become an Insurance Claims Professional

The Importance of Insurance Claims Professionals The Compact Book of Adjusting Property Insurance Claims – Second Edition A Manual for the First Party Property Insurance Adjuster The insurance adjuster is not mentioned in a policy of insurance. The obligation to … Continue reading

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A Video Explaining How a Bad Faith Suit Created a Flood of Mold Claims and Suits

The Ballard Allison Case See the full video at https://youtu.be/p5uTc4ynvyk The fear of mold claims was engendered in the insurance industry by the trial court decision in Ballard v. Fire Insurance Exchange, No. 99-05232 (Texas District Court, Travis County, June … Continue reading

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Prompt Notice of Uninsured Motorist Claim Required by Condition Precedent

Failure to Give Notice of UM Claim Until Two Years After Accident is Fatal to Claim In Hyde v. State Farm Mutual Automobile Insurance Company, A20A1221, Court of Appeals of Georgia (September 2, 2020) Elizabeth M. Hyde appealed the trial … Continue reading

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A Video Explaining the Problem Created by the “Manufactured” Lawsuit

Manufactured Litigation & The Bad Faith “Set Up” See the entire video at https://youtu.be/p5uTc4ynvyk Some courts recognize “set-up” or manufactured bad faith situations where claimants make settlement demands with unrealistic time limitations or otherwise force the insurance company to make … Continue reading

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Reliance Required for Agent’s Alleged False Representations of Coverage

Agent Only Required to Obtain the Policy Ordered The North Carolina Court of Appeal was asked whether a claim for unfair and deceptive trade practices against an insurance agent, based on the agent’s misrepresentation to a third party of the … Continue reading

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A Video Explaining the Need to Train Claims Personnel to Recognize Insurance Fraud

Training Claims Personnel To Recognize Insurance Fraud See the full video at https://youtu.be/hPoAHifvCIw The introduction of the tort of bad faith resulted in the insurance industry running scared for many years from investigating fraud. Insurers avoided denying claims fearful that … Continue reading

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Eleventh Circuit Stretches Policy Wording to Find a Duty to Defend

Georgia’s Four Corners Rule Requires a Defense Even When Rape is Alleged Annalee Hunter sued Five Paces Inn, an Atlanta bar after being drugged, assaulted and raped by an employee of Five Paces. Five Paces’s insurers brought a declaratory judgment … Continue reading

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A Video Explaining How to Read Your Homeowners Insurance Policy

Read Your Homeowners Insurance Policy See the full video at https://youtu.be/e_LdYs0xfVQ Your home is likely your most valuable asset, and a homeowners insurance policy is an important part of protecting your home and your belongings. If you have a mortgage … Continue reading

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Waiting 21 Months After Incident to Report Claim to Insurer Defeats Liability Coverage

Rape on Premises Known to Insured Must Be Promptly Reported to Insurer While Paris Evans was checking to make sure a ground-level door located off the parking deck was closed she was sexually assaulted by an unidentified man who threatened … Continue reading

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A Video Explaining how to Apply Ethics to the Work of the Insurance Professional

The Ethical Insurance Professional See the full video at https://youtu.be/ycolZsA8tU0 When the insurance professional has a well-developed ethical compass he or she can always apply that ethical compass to his or her work and will almost always treat the insureds … Continue reading

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The Plaintiff Who Represents Himself Has a Fool for a Client

Pro Se Appeal Fails for Lack of Facts or Evidence When dealing with a court it should be axiomatic that the party seeking relief have sufficient skills with the presentation of evidence and recitation of legal precedent if he or … Continue reading

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A Video Recitation of Guebara v. Allstate Insurance Co., 237 F.3d 987 (9th Cir. 01/12/2001)

A Recitation of the Establishment of the Genuine Dispute Doctrine See the full video at https://youtu.be/uXORQsD3vzw The full text of Guebara v. Allstate Insurance Co., 237 F.3d 987 (9th Cir. 01/12/2001), follows. It established that testimony at an EUO can … Continue reading

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Expert Testimony Does not Establish Existence of Direct Physical Loss

Failure to Prove Direct Physical Loss to the Property Defeats Claim In Mama Jo’s Inc., d.b.a. Berries v. Sparta Insurance Company, No. 18-12887, United States Court Of Appeals For The Eleventh Circuit (August 18, 2020) the Eleventh Circuit was asked … Continue reading

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A Video Explaining The Law of Unintended Consequences and its Effect on the Tort of Bad Faith

Why the Tort of Bad Faith has Outlived its Purpose The Fourteenth Amendment to the U.S. Constitution https://youtu.be/H0-YmDB40sw Insurance companies are understood to be persons who operate in the United States and are entitled to all the rights, benefits and … Continue reading

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Zalma’s Insurance Fraud Letter — September 1, 2020

ZIFL – Volume 24 Issue 17 In this issue of Zalma’s Insurance Fraud Letter speaks to: A Primer on Rescission of Insurance The Fifth Amendment Is No Use to A Plaintiff – A Video Explaining Why the Fifth Amendment Is … Continue reading

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A Video Explaining Interpretation Of Coverage For “Collapse”

What is “Collapse” and is it Covered? See the full video at https://youtu.be/kUT9FigPiJ0 A collapse is a sudden or relatively abrupt occurrence causing serious structural damage, and not a gradual occurrence over a period of time: [A] homeowners insurance policy … Continue reading

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Shooting a Man to Death in a Tavern is an Excluded Battery

Insurers are Loathe to Insure Bars for Assault or Battery Insurance is a risk transfer device. However, insurers are not necessarily willing to take on all risks faced by an insured. Because bars are often faced with unruly patrons who … Continue reading

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A Video Explaining the False Swearing Defense

FALSE SWEARING See the full video at https://youtu.be/hBKdHT0W4pE In common language the “false swearing” provision of an insurance policy merely means that if the insured lies under oath the policy is void whether the lie is in a proof of … Continue reading

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A Minimal Potential for Coverage Requires an Insurer to Defend

Additional Insured’s Must be Defended by Insurer that Made them Additional Insureds Insurance is a risk spreading contract. Construction contracts that require subcontractors make the general contractor and the owner an additional insured of the subcontractors’ policy are also risk … Continue reading

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A Video Explaining Insurance Fraud by Insurers and Those Involved in the Business of Insurance

Insurance Fraud by Insurers See the full video at https://youtu.be/sI8DLTvp9ZA Insurance fraud is not limited to fraud by insureds against their insurers. Much to the shame of the insurance industry, the reverse also happens. The poster child of fraud by … Continue reading

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Ninth Circuit Finds Exclusion to be Clear and Unambiguous

E&O Policy Exclusion for Appraisals of Multi-Family Units Applies to Appraisal of land for High Rise Condo An appraiser acquired an errors and omissions policy from Liberty but it limited to coverage for appraisals involving multi-unit dwellings of 1o or … Continue reading

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A Video Explaining Why Rescission is Optional to the Party Deceived

Rescission is Optional at the Request of the Person Deceived See the full video at https://youtu.be/gt1sQ6celh4 In Williamson & Vollmer Engineering Inc. v. Sequoia Insurance Co., 64 Cal. App. 3d 261, 134 Cal. Rptr. 427 (Cal.App.Dist.1 10/28/1976) the California Court … Continue reading

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Rescission of a Life Policy Can be Tricky in Kentucky

State Statutes and Regulations Limit Life Insurer’s Right to Rescind Chad Jude replaced a $500,000 life insurance policy with a $1.5 Million policy but misrepresented material facts to the insurer that allowed them to effectively rescind the $1.5 million policy.  … Continue reading

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