Category Archives: Zalma on Insurance

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

Insured Must Reside at Dwelling

Summary Judgment Fails for Lack of Convincing Evidence See the full video at https://rumble.com/v1z0b75-insured-must-reside-at-dwelling.html and at https://youtu.be/_ff00ZPeJ6Y Plaintiff Craig Finch owns parcels of real property in Broome County, New York, the relevant ones for our purposes being one on Kennedy … Continue reading

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Only Insureds Entitled to Defense or Indemnity

Representative of Five Dead Seek to Hold Owner of Vehicle’s Insurer Responsible for Deaths and Injuries See the full video at https://rumble.com/v1yia3q-only-insureds-entitled-to-defense-or-indemnity.html and at https://youtu.be/0TqInNwGXkM In Motorists Commercial Mutual Insurance Company v. Roger Hartwell; Lynnway Auto Auction, Inc., Safety Insurance … Continue reading

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Time & Expense of Failed Bad Faith Set-Up

In Maryland if Policy Limits are Offered Before Trial There Can Be No Bad Faith See the full video at https://rumble.com/v1yb7ke-time-and-expense-of-failed-bad-faith-set-up.html and at https://youtu.be/B__sDmH4qtI When a seriously injured person is injured by a person with a policy providing minimal limits … Continue reading

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No Indemnity for Old Damage

Minnesota Statute Does not Require Insurer to Pay to Bring Church Property up to Code From Damage Predating Loss See the full video at https://rumble.com/v1y416g-no-indemnity-for-old-damage.html  and at https://youtu.be/M64VGQhH9so St. Matthews Church of God and Christ (St. Matthews) is located in … Continue reading

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Zalma’s Insurance Fraud Letter – December 1, 2022

ZIFL Volume 26, Issue 23 See the full video at https://rumble.com/v1xvyiu-zalmas-insurance-fraud-letter-december-1-2022.html and at https://youtu.be/Kt8eEl5e8Vs The December 1, 2022 issue contains articles and reports of insurance fraud convictions for every insurance claims professional, SIU investigators and everyone interested in the efforts … Continue reading

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COVID Ruined Ski Trip

INSURANCE POLICY TERMINATED BEFORE LOSSES See the full video at https://rumble.com/v1xv3cm-covid-ruined-ski-trip.html  and at https://youtu.be/7bpnwLLeb6s Plaintiffs lost the days they planned to ski at Vail in 2020. They are members of a certified class who purchased ski-pass insurance from Defendant United … Continue reading

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Zing Zing’s Owner Barbecued

No Coverage for Theft by Persons Entrusted See the full video at https://rumble.com/v1x3e74-zing-zings-owner-barbecued.html and at https://youtu.be/KQY7P3q0bCk When the plaintiff turned her restaurant over to two restaurateurs when she became ill they took out all of the equipment of the restaurant … Continue reading

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It’s Time to Subscribe to Locals or Substack

For Subscribers Only I Have Published Special Insurance Videos I published today on Locals.com Video Number 23 of the Excellence in Claims Handling program on Specific, Blanket and reporting coverages. I also published on Substack.com Video Number 9 of the … Continue reading

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Only Sue the Insurer

No Right to Sue Insurer for Fraud in Claims Handling See the full video at https://rumble.com/v1x35s2-only-sue-the-insurer.html and at https://youtu.be/vvc5g_bYFdg Impossible to Sue Insurers who are Part of the Same Group of Insurers John R. Parrish sued alleging claims for breach … Continue reading

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No Insurance Policy Covers Every Risk of Loss

Court Refuses to Strain to Find Ambiguity That Did Not Exist Go to substack at substack.com/refer/barryzalma See the full video at https://rumble.com/v1wh110-no-insurance-policy-covers-every-risk-of-loss.html  and at https://youtu.be/X8ZbOzqtAPg In ERIE INSURANCE EXCHANGE v. DRAGANA PETROVIC, No. 1-21-0628, 2022 IL App (1st) 210628-U, Court … Continue reading

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Why I am Thankful

My Thanksgiving Wishes from My Family and I to You and Yours See the full video at https://rumble.com/v1woj74-why-i-am-thankful.html and at https://youtu.be/IqeG-Nd-1Hs A Blog and Video Blog Explaining Why I am Thankful My family and I have much to be thankful … Continue reading

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False Invoices Defeat Claim

IT DOESN’T PAY TO TRY TO CHEAT YOUR INSURANCE COMPANY See the full video at https://rumble.com/v1w8f2o-false-invoices-defeat-claim.html and at https://youtu.be/hzt8zH-qPvg Legitimate Claim Destroyed by Creating Fake Invoices Sigismondi Foreign Car Specialists, Inc. appealed the U. S. District Court’s summary judgment in … Continue reading

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RUST IS AN ACT OF NATURE

CAST IRON PIPES RUST & LEAK Acts of Nature are Excluded See the full video at https://rumble.com/v1vgvey-rust-is-an-act-of-nature.html  and at https://youtu.be/le_2YZLhx40 Marisol Rosa (“Rosa”) appealed a final summary judgment entered in favor of Safepoint Insurance Company (“Safepoint”). In Marisol Rosa v. … Continue reading

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Arson is not Evidence of Love

Arson is not Evidence of Love See the full video at https://rumble.com/v1v7p1c-arson-is-not-evidence-of-love.html and at https://youtu.be/C2HyIpWTxT0 Following a fifteen-day trial, a jury agreed with the State’s claims that defendant Terrence L. Strothers’ year-long dispute over a woman with another man, Shane … Continue reading

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For Subscribers Only

The Examination Under Oath A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud I have created an hour long presentation about the examination under oath which will be added to my locals community and my … Continue reading

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Claims Commandments

Claims Commandment XI See the full video at https://rumble.com/v1uyjy4-claims-commandments.html and at https://youtu.be/B5SCwxgicU4 Thou Shall Empathize With the Claimant Everyone in a claim situation is unhappy, disturbed, shocked, injured either in body or emotionally and needs help. The adjuster must recognize … Continue reading

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LIARS NEVER PROSPER

MATERIAL MISREPRESENTATION RESCINDS POLICY Never Lie on an Application for Insurance See the full video at https://rumble.com/v1uxyrm-liars-never-prosper.html  and at https://youtu.be/40aAMVO04TM Plaintiff Security National Insurance Company’s moved for Summary Judgment on its suit for declaratory relief that the insured Salient Landscaping, … Continue reading

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Claims Commandments

Claims Commandment X Thou Shall Not Pretend to be a Lawyer See the full video at https://rumble.com/v1unu1m-claims-commandments.html and at https://youtu.be/dDARmaIdJ58 Some experienced and professional claims people know the law in their area of expertise better than most lawyers. Most claims … Continue reading

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Sleep With Dogs You’ll Wake With Fleas

No PIP Benefits for Staged Collision See the full video at https://rumble.com/v1uq6gi-sleep-with-dogs-youll-wake-with-fleas.html  and at https://youtu.be/41qiTwhbKbQ An insurer proved that it was faced with claims for injuries from staged accidents. The medical care providers of the fraud perpetrators who claimed to … Continue reading

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Zalma’s Insurance Fraud Letter – November 15, 2022

ZIFL – Volume 26, Issue 22 See the full video at https://rumble.com/v1ugehy-zalmas-insurance-fraud-letter-november-15-2022.html   and at https://youtu.be/2LLr4abAY2g and the full pdf of the issue at http://zalma.com/blog/wp-content/uploads/2022/11/ZIFL-11-15-2022.pdf In this the twenty sixth year of publication of Zalma’s Insurance Fraud Letter, Issue Number … Continue reading

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Claims Commandments

Claims Commandment IX Thou Shall Document the Claim File See the full video at https://rumble.com/v1twipc-claims-commandments.html and at https://youtu.be/wjXvbSYAwAY Insurance claims handling is a person to person business where the claims handler, the insured and the claimant (if there is one) … Continue reading

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Appraisers Can’t Determine Causation

Appraisal Limited to Quantum of Crop Loss See the full video at https://rumble.com/v1tm7oo-appraisers-cant-determine-causation.html and at https://youtu.be/UQ1vL6b-jzs In Agrisompo North America, Inc. v. Coldwater Planting Company, M&W Farms, LLC, Brazil Planting Company, Pushen & Pullen Farms, and Webb Farms, No. 3:22cv51-MPM-RP, … Continue reading

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Failure to Timely Sue Defeats Claim

Private Limitation of Action Provision Enforceable See the full video at https://rumble.com/v1tckaa-failure-to-timely-sue-defeats-claim.html and at https://youtu.be/gbA7CzgFXLc The Hanover Insurance Company, Inc. (“Hanover”) and Sportsinsurance.com, Inc. (“Sportsinsurance”) each appealed from the District Court’s order granting in part and denying in part Hanover’s … Continue reading

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Mandamus Required

Proof Required of Liability and Underinsured Nature of Defendant Before Suit Against Insurer See the full video at https://rumble.com/v1rzphc-no-need-for-fiduciary-relationship-between-agent-and-insured.html and at https://youtu.be/upNV1bmfWcM In the case In Re United Financial Casualty Company, Relator, No. 14-22-00502-CV the Court of Appeals of Texas, … Continue reading

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CLAIMS COMMANDMENTS

Claims Commandment VIII – Thou Shall Not Suffer Fraud to Succeed See the full video at https://rumble.com/v1rzynm-claims-commandments.html  and at https://youtu.be/5ukWs_Y2jQU Insurance fraud in the U.S. is epidemic. Insurance fraud continually takes more money each year than it did the last … Continue reading

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CLAIMS COMMANDMENTS

Claims Commandment VII – Thou Shall Never Lie to an Insured See the full video at https://rumble.com/v1s815y-claims-commandments.html and at https://youtu.be/ob_TI6UqP-s Insurance is, and has been since the first policy was carved into a clay tablet, considered a business of the … Continue reading

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No Need for Fiduciary Relationship Between Agent and Insured

Insurance Agent Must Fulfill Requests Made by Insured See the full video at https://rumble.com/v1rzphc-no-need-for-fiduciary-relationship-between-agent-and-insured.html and at https://youtu.be/Tgl1c14K66o Donald Isken (“Mr. Isken”), sued Rick Galster III Insurance Agency, Inc. (“Galster Insurance”) seeking monetary damages for negligence, fraudulent inducement, and fraudulent misrepresentation. … Continue reading

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Claims Commandments

Claims Commandment VI Thou Shall Document The Claims File See the full video at https://rumble.com/v1raut0-claims-commandments.html and at https://youtu.be/oOdyMfoNnH8https://www.youtube.com/watch?v=yTbQ3OdGaKw  Most insurance regulators, by Fair Claims Settlement Practices statutes and Regulations, require that every insurer maintain claim files that are subject to … Continue reading

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Double Jeopardy Eliminates Three of Four Convictions

Single Insurance Fraud Conviction Remains See the full video at https://rumble.com/v1raigk-double-jeopardy-eliminates-three-of-four-convictions.html  and at https://youtu.be/Vo6bEJ3yaiY In The People of the State of Colorado v. Natasha Earnce Robinson, No. 19CA1768, 2022 COA 124, Court of Appeals of Colorado, Third Division (October 27, … Continue reading

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Claims Commandments

Claims Commandment Number V See the full video at https://rumble.com/v1r3q4q-claims-commandments.html and at https://www.youtube.com/watch?v=UoQ4qKpJnnc In this the fifth of Fifteen Claims Commandments we deal with the need for every insurance claims professional to work with the first party property insured. Thou … Continue reading

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MRI Machine Explodes

No Coverage if Injuries not Related to Use of MRI See the full video at https://rumble.com/v1r49h4-mri-machine-explodes.html and at https://youtu.be/pCR8R9o29RY In John Fitzpatrick and Colleen Fitzpatrick v. Oradell Animal Hospital, Inc., et. al, No. A-3442-20, Superior Court of New Jersey, Appellate … Continue reading

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Claims Commandments

Claims Commandment Number IV Thou Shall Understand The Policy See the full video at https://rumble.com/v1r36zk-claims-commandments.html  and at https://www.youtube.com/watch?v=mYV1yv2TnAo In this the fourth of Fifteen Claims Commandments we deal with the need for every insurance claims professional to read and understand … Continue reading

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Don’t Hide Issue Until Trial

Insurer Entitled to Notice of Reformation Claim Before Trial See the full video at https://rumble.com/v1qy7gs-dont-hide-issue-until-trial.html and at https://youtu.be/joEeZetLAjM At trial on the breach of contract action plaintiffs sought to amend their complaint to include an otherwise untimely reformation claim based … Continue reading

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Claims Commandments

Claims Commandment III: Thou Shall Communicate Often With The Third Party Insured and the Claimant   See the full video at https://rumble.com/v1qrtao-claims-commandments.html and at https://youtu.be/V012MEVobJo Insurance claims is a service business. The claims person – whether acting for the insurer … Continue reading

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Zalma’s Insurance Fraud Letter – November 1, 2022

ZIFL – Volume 26 Issue 21 See the full video at https://rumble.com/v1qww88-zalmas-insurance-fraud-letter-november-1-2022.html  and at https://youtu.be/XB5dlDzqJ0E In this the 21st issue of the 26th year of publication of Zalma’s Insurance Fraud Letter you will find articles that discuss the following insurance … Continue reading

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Claims Commandment II

Thou Shall Always Conduct A Thorough Investigation See the full video at https://rumble.com/v1qhiq4-claims-commandment-ii.html and at https://youtu.be/tb4_cLhLy24 This is the second in a series of fifteen claims commandments that I believe must be followed by every insurance claims professional. INVESTIGATION Investigation … Continue reading

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ERISA Policy Rescinded

Material Misrepresentation About Prior Health Care Supports Rescission See the full video at https://rumble.com/v1qcjuy-erisa-policy-rescinded.html and at https://youtu.be/8ryzlIFL6Xg Happy Halloween & Feliz Dia De Los Murertos An ERISA Policy May be Rescinded In Provident Life & Accident Insurance Company v. Bradley … Continue reading

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Claims Commandments

Claims Commandment I – Thou Shall Confirm Coverage See the full video at https://rumble.com/v1qcsuk-claims-commandments.html  and at https://youtu.be/I96bU0kKmd4 How to Confirm Coverage When I was a young adjuster, I worked for the Fireman’s Fund Insurance Company. Occasionally confused insureds and brokers … Continue reading

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When Insured Lies

Insurer May Deny a Claim When Insured Lies on Application See the full video at https://rumble.com/v1q64ve-when-insured-lies.html and at https://youtu.be/-rg-pIT08-A Rescission Requires Return of Premium Denial of Claim Does Not Cesar Benitez appealed the trial court’s entry of final summary judgment … Continue reading

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Bad Faith Set-Up Fails

 Plaintiffs’ and their Counsel’s Bad Faith Defeats Suit Against Insurer See the full video at https://rumble.com/v1pzspr-bad-faith-set-up-fails.html  and at https://youtu.be/j5gv1qc2ebI No Good Deed Goes Unpunished –  Plaintiffs Abused the Tort of Bad Faith Julio Palma and Miriam Cortez (the Plaintiffs) appealed … Continue reading

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