Category Archives: Zalma on Insurance

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

Evidence Needed to Prove Fraud

A Video Explaining the Need to Gather Evidence to Prove Fraud See the full video at https://www.rumble.com/zalma and at https://youtu.be/nC6qi-AtCe4 Evidence is broken into two major categories: direct and circumstantial. Direct Evidence Direct evidence is proof that tends to show … Continue reading

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Even When Insured Fails to Defend Suit It is Difficult to Obtain Judgment

Hard Work Pays and Default Judgment Entered for Failure to Pay Additional Premium Starr Underwriting Agency, Inc., (“Starr”), sued S A S Services Group, Inc. (“S A S”) alleging one claim for breach of contract for failure to pay additional … Continue reading

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The False Claims Act and Qui Tam Actions

A Video Explaining the False Claims Act and How Insurers Can Take Advantage of it to Deter Fraud See the full video at https://www.rumble.com/zalma and at https://youtu.be/J2UXvt64pRU The False Claims Act, also known as the “Lincoln Law,” dates back to … Continue reading

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Insurers Beware: A Chink in the Armor of New York v. Sullivan

Actual Malice in Republication of Defamation by Implication Devin Nunes, a Member of Congress from California, appealed an order of the district court dismissing his complaint alleging defamation and conspiracy claims against Ryan Lizza and Hearst Magazine Media, Inc. The … Continue reading

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Retaining an Attorney by a Claims Person

A Video About Selecting and Working With Counsel See the full video at https://www.rumble.com/zalma and https://youtu.be/dTu6XuH6vHs In instances where insurance claims may entail litigation, insurers must move quickly to engage counsel. When an attorney is retained to defend a person … Continue reading

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Man Bites Dog Story: State Farm Sues Chiropractors for Fraudulent Claims

Insurers Frustrated by Lack of Prosecution for Insurance Fraud Proactively Sue Chiropractors they Claim Defrauded the Insurers Insurers, victims of insurance fraud, see little or no prosecution of those who defraud them. State Farm, not willing to wait, proactively sued … Continue reading

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Evaluation and Settlement of Liability Claim

A Video Explaining Evaluation & Settlement See the full video at https://youtu.be/OV06h8SdKIU and at https://www.rumble.com/zalma Case evaluation is necessary to the efficient operation of a third party liability claims department. The evaluation should be completed as soon as reasonably practical … Continue reading

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Business Use Exclusion Is Reasonable and Common in a Homeowners Policy

Warranty Statute Does Not Apply to an Exclusion Steven Kutchera bought a homeowners policy from defendant State Farm Fire and Casualty Company. In 2020, Kutchera submitted a claim to State Farm under that policy, alleging that his garage collapsed because … Continue reading

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Some Appellate Cases Establishing the Tort of Bad Faith

A Video About the Birth & Growth of the Tort of Bad Faith See the full video at https://rumble.com/zalma and at https://youtu.be/RMk_et9UDZ4 Fletcher v. Western Life In Fletcher v. Western Life Ins. Co., 10 Cal. App. 3d 376, 89 Cal. … Continue reading

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Cancellation Rule Requires Contradictory Evidence to be Ignored

It’s Not Nice to Lie to Your Insurer An insurance company sought a judgment that an automobile insurance policy issued to a mechanic does not provide coverage for an accident involving the mechanic. After examining the mechanic under oath, the … Continue reading

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How to Enforce Public Adjuster Ethics

A Video Explaining the Need for Ethical Public Adjusters See the full video at https://www.rumble.com/zalma at https://youtu.be/z91etOoeWYM Public Adjusters are claims professionals who are employed exclusively by a policyholder who has sustained an insured first party property loss. The public … Continue reading

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Claims Made Policies are Very Different from Occurrence Policies

Insured Who Settled Suit Without Insurer’s Consent Lost Indemnity Coverage Benecard Services, Inc. is a company that manages prescription drug benefit plans. In 2015, it was sued by its onetime business partner, another company that sponsors such plans under Medicare … Continue reading

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Ethical Behavior and Success

A Video Explaining the Connection Between Ethics and Excellence in Claims  See the full video at https://youtu.be/wIEuq6bta_U and at https://www.rumble.com/zalma To understand the connection between ethics and quality service it is important to understand the meaning of ethical values in … Continue reading

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Void Exclusion Does not Void Entire Policy

A Contractual Provision That Violates Public Policy Is Invalid, But Only To The Extent Of The Conflict Between The Stated Public Policy And The Contractual Provision. Following an automobile accident in March 2016, appellant Dinora Dominquez sought insurance coverage from … Continue reading

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Insurance Litigants Only Get One Bite of the Apple

When Insured’s Assignee Loses in South Dakota He May Not Sue in Minnesota Assignment of a Claim Where there is no Coverage is Valueless After being seriously injured in a car accident in Worthington, Minnesota, appellant Alaaldeen Mussa sued the … Continue reading

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Zalma’s Insurance Fraud Letter – September 15, 2021

A Video from ZIFL – 9/15/2021 – New Articles on Insurance Fraud See the full video at https://rumble.com/c/c-262921 and at https://youtu.be/IvHYv6qW4jI Cease And Desist Orders Issued to Four Companies Allegedly Selling Home Warranties Without a License The California Department of … Continue reading

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The Fortuity Doctrine

A Video Explaining Expected, Intended or Fortuity in Insurance See the full video at Rumble.com at https://rumble.com/zalma and at https://youtu.be/O9kKEHOUKnc The Fortuity Doctrine arises from the basic concept upon which insurance is founded: that insurance covers risks, not losses that … Continue reading

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USDC in Oregon Finds Covid Shutdowns Resulted Only in Economic Losses

Insurance Policies Must be Read Using the Common Meaning of the Words in the Policy Like “Physical Loss or Damage” Hillbro LLC d/b/a Hills Restaurant attempted a class action lawsuit against Oregon Mutual Insurance Company seeking a declaratory judgment that … Continue reading

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Zalma on Insurance

Free Insurance Videos With More than 280 Free Videos Available Barry Zalma, Esq., CFE has published five days a week videos on insurance claims, insurance claims law, insurance fraud and insurance coverage matters at https://rumble.com/zalma more than 280 free insurance … Continue reading

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False Swearing & Insurance Fraud

A Video Explaining that an Insurance Policy is Void if the Insured Swears Falsely in Presenting a Claim See the full video at https://rumble.com/c/c-262921 and at https://youtu.be/zpk191Y254o In common language the “false swearing” provision of an insurance policy merely means … Continue reading

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Convicted Insurance Fraud Perpetrator Could Not Understand Why He Was in Jail

A Person Capable to Commit 784 Fraudulent Acts is Capable of Understanding the Effects of a Guilty Plea After pleading guilty to multiple charges of insurance fraud and other crimes, Rafael Levi was sentenced to spend multiple years in Pennsylvania … Continue reading

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ClaimSchool, Inc. Presents Excellence in Claims Handling Programs

A Program of Video Training To Create Insurance Claims Professionals Barry Zalma Presents What You Need to Become an Insurance Claims Professional Mr. Zalma’s presentations are practical, thought-provoking, entertaining and will not cause you to reevaluate your budget. Barry is … Continue reading

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Zalma on Insurance Claims Part 105 Third Edition:    

Zalma on Insurance Claims Part 105 Third Edition: A Comprehensive Review of the law and Practicalities of Property, Casualty and Liability Insurance Claims by Barry Zalma | Sep 2, 2021 Kindle $9.95  Available instantly Hardcover , $35.95 Paperback , $25.95 … Continue reading

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Comunale v. Traders & General Ins. Co

A Video Revealing The Birth of the Tort of Bad Faith in Comunale See the full video and full text of the case at https://youtu.be/A0I909NN-nI and at https://rumble.com/c/c-262921  The California supreme court in Comunale v. Traders & General Ins. Co. … Continue reading

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Insurance Fraud Indictment Thrown Out Because of Inadequate Presentation to Grand Jury

Prosecutor Improperly Relied on Insurer’s Fraud Investigator’s Inadequate Investigation to Indict Physician and Assistant New Jersey State insurance law requires insurers to maintain a Special Investigative Unit (SIU) to investigate and report insurance fraud to the state. After the report … Continue reading

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Rosina Crisci v. Security Ins. Co.

A Video Recitation of Crisci v. Security Ins. Co. of New Haven, Conn. See the full video at https://youtu.be/ok3Q2wa1K_k and at https://rumble.com/c/c-262921  A jury awarded Mrs. DiMare $100,000 and her husband $1,000. After an appeal (DIMARE V. CRESCI, 58 CAL.2D … Continue reading

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Insurance Fraud Results in Murder

Insurance Fraud is a Violent Crime Willie Hall, appealed judgments of the Lucas County Court of Common Pleas which, following a jury trial convicting him of aggravated murder, aggravated burglary, and burglary sentenced him to life imprisonment. In State of … Continue reading

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Multiple Types of Insurance Fraud

Insurance Fraud Perpetrators are Creative See the full video at https://rumble.com/c/c-262921 and at https://youtu.be/Y5UEJ8wkrMM We All Do it Fraud The California Court of Appeal, in Cassim v. Allstate Insurance Co., 94 P.3d 513, 33 Cal.4th 780, 16 Cal. Rptr.3d 374 … Continue reading

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Covid Class Action Insurance Claim Fails in Florida

Covid Shut Down is not Direct Physical Loss or Damage Defendants Certain Underwriters at Lloyd’s, London moved to dismiss the Amended Class Action Complaint (the “Motion”) brought in Sun Cuisine, LLC d/b/a Zest Restaurant and Market, individually and on behalf … Continue reading

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Tests For Determining Duty To Defend

A Video Explaining Duty to Defend and the Four Corners Rule See the full video at https://rumble.com/c/c-262921 and at  https://youtu.be/a6KfQ-sMIsA Some states apply a rule of interpretation of the duty to defend a liability claim by limiting their review to … Continue reading

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Damage by Thief to Real Property Clearly Excluded

Courts do not Have the Power to Rewrite an Insurance Policy When Richard Hermanns bought his first citrus grove in 2009, he hired Richard McKenzie – who had experience with starting and managing citrus groves – to take care of … Continue reading

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The Adjuster & Good Faith Claims Handling

A Video Explaining How to Avoid Charges of Bad Faith Claims Handling See the full video at https://youtu.be/fbQDfOb5-L0 and at https://rumble.com/zalma The basic test in bad faith cases is whether the insurer has unreasonably and “without proper cause” refused to … Continue reading

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Reporting Requirement of a Claims Made Policy is a Condition Precedent

Insureds Try Creative Analysis of Policy and Fail Day Kimball Healthcare, Inc. and Erica J. Kesselman appealed from the judgment of the United States District Court for the District of Connecticut (Dooley, J.) dismissing their complaint that sought a declaratory … Continue reading

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The Tort of Bad Faith & Investigation of Insurance Fraud

Fraud Must be Defeated Even in the Face of Claims of Bad Faith See the full video at https://rumble.com/c/c-262921 and at https://youtu.be/7pC0y9ZnkCQ It has been said that where fear enters, reason flees. Doubt, with its wavering in opinion and judgment, … Continue reading

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Coverage Counsel Should Not Act Outside the Obligation to Advise the Insurer Client

Neither the Attorney Client Privilege Nor the Work Product Protection Apply if Outside the Representation of the Insurer The Court of Appeals was asked to resolve a discovery-related issue relating to the attorney-client privilege and work product doctrine. in State … Continue reading

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Zalma’s Insurance Fraud Letter – September 1, 2021

ZIFL – September 1, 2021 See the full video at https://rumble.com/zalma at https://youtu.be/1SbFs6FxrQo California Legislature Wants to Make Application Fraud a Crime Application fraud in California is only recognized with regard to workers’ compensation policies. The proposed new statute provides … Continue reading

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When the Notice-Prejudice Rule Does Not Apply

A Video Explaining Why a Claims Made Policy’s Notice Require is not Subject to the Notice Prejudice Rule See the full video at https://youtu.be/e-cVLVIN47U and https://rumble.com/c/c-26292 Claims made and claims made and reported policies contain a date certain notice requirement. … Continue reading

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A Theft is a Taking of Property

A Decision Finding Theft Can Be a Taking of More than Money Costs National Union $22,114,883  Plus Interest Cargill, Inc.’s (Cargill) moved for judgment on the pleadings. Cargill seeks judgment in its favor as to the one disputed claim between … Continue reading

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Declaring an Insurance Policy Void

A Video Explaining the Contractual Right of an Insurer to Declare a Policy Void See the full video at https://rumble.com/c/c-262921 and at https://youtu.be/1RTrAJywESg A life insurance policy procured with the intent to benefit persons without an insurable interest in the … Continue reading

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Limited Stacking Provisions in Auto Policies Limits Recovery of UM/UIM Benefits

RTFP (Read the Full Policy) Benefits Limited to Statutory Limits American Family Mutual Insurance Company, S.I. (“American Family”) appealed the entry of summary judgment in favor of Ms. Courtney Jones (“Jones”) on her claim for additional uninsured motorist (“UM”) benefits … Continue reading

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