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Zalma on Insurance 

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Presently there are 29 videos on insurance, insurance claims and insurance law including:

Video thumbnail: A Video Explaining the Evidence Needed to Prove Fraud
17:17

A Video Explaining the Evidence Needed to Prove Fraud

Direct Evidence Direct evidence is proof that tends to show existence of a fact in question without the intervention of the proof of any fact. It includes testimony that tends to prove or disprove a fact in issue directly, such as eye-witness testimony or a confession. Sometimes, direct evidence may not exist because records have been destroyed in a fire, destroyed by water, stolen, discarded, or eaten by vermin. If direct evidence does not exist for any reason, circumstantial evidence
Video thumbnail: A Video Explaining How a Claims Person Should Select Counsel
13:29

A Video Explaining How a Claims Person Should Select Counsel

Retaining an Attorney In instances where insurance claims may entail litigation, insurers must move quickly to engage counsel. When an attorney is retained to defend a person insured, the fact should be documented in writing by the attorney, the adjuster, and the insured who is to be defended. Before an insurer retains an attorney to represent an insured to defend an insured who has been sued for a tort the claims person should be certain the lawyer is competent to defend the insured. This can
Video thumbnail: A Video Explaining the Use of an Independent Medical Examinations
18:16

A Video Explaining the Use of an Independent Medical Examinations

When a claimant claims an injury that does not agree with the facts of the incident claimed to have caused the injury, the adjuster will often seek the assistance of an Independent Medical Examiner (IME) to verify the extent of the claimed injury. The IME is usually a forensic physician or a chiropractor who has agreed to evaluate an injured person for a fee and is not involved in the treatment of the injured person. In Pennsylvania, an insurer providing medical benefits to its insureds followi
Video thumbnail: Defenses to the Tort of Bad Faith
17:33

Defenses to the Tort of Bad Faith

The Genuine Dispute Doctrine Insurers in states where the tort of bad faith exists deny fraudulent insurance claims with fear and trembling. The specter of punitive damages has worked to make multi-millionaires of many insurance criminals who convince insurers to settle rather than take a chance on trial. Insurers pay claims they believe they do not owe because they are fearful—regardless of the merits of their position—of being assessed punitive damages in a bad faith action. The fear is not
Video thumbnail: A Video Explaining the Concurrent Cause Doctrine
16:18

A Video Explaining the Concurrent Cause Doctrine

Concurrent Cause Doctrine The concurrent cause doctrine holds that if more than one cause concurred to cause a loss, one of which is excluded and the other not, the entire loss is covered. It was finalized by the California Supreme Court in State Farm Mutual Auto Ins. Co. v. Partridge, 10 Cal. 3d 94, 109 Cal. Rptr. 811 (1973). In this case, the court found that coverage existed for defense and indemnity under a homeowners policy, even though the accident occurred while the insured was operating
Video thumbnail: A Video Explaining Why Bodily Injury Caused by Mold or Fungi is Uncertain
15:21

A Video Explaining Why Bodily Injury Caused by Mold or Fungi is Uncertain

The Guid ance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure and Moisture Indoors (Guidance) is one of the most recent studies of the effects of mold in the environment and its effect on human health when combined with other causes. The authors found that there is strong evidence that significant disease can result from dampness and fungi in the home or workplace Recognizing that dust mites in damp environments explain some of the relationship betwee
Video thumbnail: A Video Explaining When the Notice-Prejudice Rule Does Not Apply
12:12

A Video Explaining When the Notice-Prejudice Rule Does Not Apply

The Notice-Prejudice Rule Doesn’t Always Apply Claims made and claims made and reported policies contain a date certain notice requirement. In Colorado, the Colorado Supreme Court found:­­ “The notice-prejudice rule does not apply to a date-certain notice requirement in a claims-made insurance policy. In a claims-made policy, the date-certain notice requirement defines the scope of coverage. Thus, to excuse late notice in violation of such a requirement would rewrite a fundamental term of the
Video thumbnail: A Video Explaining the Duties of the Public Adjuster
19:05

A Video Explaining the Duties of the Public Adjuster

Public Insurance Adjusters 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 repairs, may be dealt with easily, others, which involve more complex damages and different potential causes of loss, are much harder to assess. Resolving them may require expertise in understanding the scope of coverage provided by the applicable property insurance poli
Video thumbnail: Trigger of Coverage/Property Damage
10:47

Trigger of Coverage/Property Damage

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 to be ‘triggered.'” [In Re Feature Realty Litig., 468 F. Supp.2d 1287, 1295, n.2 (E.D. Wash. 2006)] After the California Supreme Court adopted a continuous trigger in Montrose Chemical Corp. v. Admiral Ins. Co. (1995) 10 Cal.4th 645, 685, 42 Cal.Rptr.2d 324, 913 P.2d 87
Video thumbnail: Claims Personnel
17:37

Claims Personnel

The Claims Adjuster The claims adjuster is the contact between the insured and the insurer. He or she can be an employee of the insurer or an independent contractor retained by the insurer to investigate and adjust insurance claims on its behalf.  The adjuster is person charged with investigating a claim to fulfill the promises made by the policy of insurance and establish whether the company is liable to the insured or a claimant and to what extent. The investigation can include interviews of
Video thumbnail: ZALMA’S INSURANCE FRAUD LETTER - JULY 15, 2020
18:32

ZALMA’S INSURANCE FRAUD LETTER – JULY 15, 2020

Insurance Fraud Is Often A Violent Crime Murder as a Side-Effect To An Insurance Fraud There is a myth that abounds in the criminal and civil courts of the United States that insurance fraud is a non-violent crime. Abdullah Alkhalidi (“Alkhalidi”) was convicted of murder, robbery, and theft. The Indiana state court denied relief, holding Alkhalidi’s innocence claim strongly indicated he would not have accepted the plea deal. The state court also held that Indiana requires a defendant to adm
Video thumbnail: A Video Explaining How the Law of Unintended Consequences Destroyed the the Tort of Bad Faith
18:11

A Video Explaining How the Law of Unintended Consequences Destroyed the the Tort of Bad Faith

The Law of Unintended Consequences and the Tort of Bad Faith The concept of unintended consequences is one of the building blocks of economics. Adam Smith’s “invisible hand,” the most famous metaphor in social science, is an example of a positive unintended consequence. Most often, however, the law of unintended consequences illuminates the perverse unanticipated effects of legislation and regulation. In 1692 the English philosopher John Locke, a forerunner of modern economists, urged the defe
Video thumbnail: A Video Explaining the Claims Made CGL
15:25

A Video Explaining the Claims Made CGL

The insurance industry spent 10 years trying to restrict their liability for long tail losses. They tried wording that would prohibit stacking, as well as wording that would only allow coverage for losses first discovered during the policy period. “Claims Made” wording, which would only allow coverage to be triggered upon the making of a claim, and limited “occurrence” coverages were also attempted. Ultimately, the decision was made by the ISO and its supporters to use a Claims Made approach, p
Video thumbnail: California Fair Claims Settlement Practices Regulations

California Fair Claims Settlement Practices Regulations

The Reasons Behind the California Fair Claims Settlement Practices Regulations In 1993 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) to enforce the mandate created by the California Fair Claims Settlement Practices statute, California Insurance Code Section
Video thumbnail: Ethics and The Insurance Product
16:53

Ethics and The Insurance Product

The basic insurance product is a promise that the insurer may never be called upon to fulfill. The value of the promise is based on the trust of the policyholder in the insurer being able and willing to fulfill the promises made by the insurance policy. Gallup polls since 1977 have consistently ranked insurance sales persons among the lowest in terms of perceived honesty and ethical standards. In the November 1999 poll, insurance sales persons ranked third from last, just above telemarketers
Video thumbnail: Considerations for Early Settlement of Construction Defect Claims
17:29

Considerations for Early Settlement of Construction Defect Claims

It is an axiom followed by almost every attorney that the sooner a suit is settled the less it will cost the defendants. Invariably as suits drag on, as discovery is received and analyzed, the positions of the parties become less amenable to compromise. If defendants and their counsel believe that liability against the defendant is reasonably clear, they should work to bring the parties together to attempt an early settlement. Some of the reasons for the early settlement are discussed below. Ad
Video thumbnail: A Video Explaining How to Negotiate the Settlement of a Liability Claim
19:28

A Video Explaining How to Negotiate the Settlement of a Liability Claim

After the adjuster determines that coverage exists, that the insured is probably liable for causing bodily injury or property damage to a third person, the adjuster must negotiate a settlement with the claimant or his or her attorney. Just like the plaintiff’s attorney in a personal injury case, the insurance adjuster will investigate the claim – the facts of the accident and the plaintiff’s damages. A very skillful and well-prepared insurance adjuster will often know more about the accident a
Video thumbnail: Heads I Win, Tails You Lose - True Crime Stories of Insurance Fraud
14:55

Heads I Win, Tails You Lose – True Crime Stories of Insurance Fraud

This video includes two true crime stories from my book “Heads I Win, Tails You Lose. The title, “Heads I Win, Tails You Lose” is meant to describe insurance fraud as it works in the Unites States. It means that whenever a person succeeds in perpetrating an insurance fraud everyone who buys insurance is the loser. If the fraud succeeds the insurer must charge more premium to cover the expense of defending the fraud and payment of funds to the fraud perpetrator. If the fraud fails the insurer m
Video thumbnail: How the Covenant of Good Faith and Fair Dealing Requires Ethical Insurance Representatives
16:11

How the Covenant of Good Faith and Fair Dealing Requires Ethical Insurance Representatives

ETHICS FOR THE INSURANCE PROFESSIONAL Insurance is, by definition, a business of the utmost good faith. This means that both parties to the contract of insurance must act fairly and in good faith to each other and do nothing that will deprive the other of the benefits the contract of insurance promised. Without the covenant of good faith and fair dealing and ethical people who work in the insurance industry applying and fulfilling the covenant, insurance is impossible. One cannot act fairly a
Video thumbnail: False Swearing About Material Facts Voids an Insurance Policy and Defeats a Fraudulent Claim
14:28

False Swearing About Material Facts Voids an Insurance Policy and Defeats a Fraudulent Claim

FALSE SWEARING 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 loss or at an examination under oath. In Texas and Oklahoma, false swearing is explained this way: Where an insured knowingly and willfully overestimates the value of property destroyed or damaged, the policy is voided and the insured’s right to recover is defeated. The reason for the false swearing
Video thumbnail: Getting the Whole Truth, Interviewing Techniques for the Lawyer
17:43

Getting the Whole Truth, Interviewing Techniques for the Lawyer

The interview is an essential form of fact gathering for every type of human interaction. Interviews happen everywhere; they are performed by almost everyone. Interviewing is also an art, and the most effective interviews are conducted by those who are knowledgeable and skilled in this art. Everyone has been interviewed. And everyone has, at some point in life, interviewed another person. Not everyone conducting an interview, however, has accomplished the desired outcome. One type of informal
Video thumbnail: What Can Insurance People Do to Change the Poor Insurance Fraud Conviction Statistics?
14:50

What Can Insurance People Do to Change the Poor Insurance Fraud Conviction Statistics?

he Obligation of an Insurance Professional to Defeat Insurance Fraud It is the obligation of all who work to protect insurers against insurance fraud to do something to change the situation. Methods that are available and that should be exercised by every person who wants to reduce the effect of insurance fraud include: Lobby to change the system so that: all the money goes to all kinds of insurance fraud at the discretion of the Commissioner of Insurance; prosecutors must be assigned to
Video thumbnail: A Video Explaining Why Arson is a Named Peril
10:38

A Video Explaining Why Arson is a Named Peril

Because arson is a fire, it is not an excluded peril in any first party property policy of insurance. An arson is never a defense to an insurance claim alone. Only when arson is caused by the named insured, or any insured is involved in causing the fire to occur for the purpose of defrauding an insurer. In Eddie P. Bates v. Hartford Insurance Company of the Midwest, No. 09-12840 (E.D.Mich. 03/03/2011) the insurer attempted to deny coverage by claiming that the fire was a “vandalism.” Since the h
Video thumbnail: A Video Explaining the Hazard Created Mutability of Memory for the Lawyer or Investigator
16:43

A Video Explaining the Hazard Created Mutability of Memory for the Lawyer or Investigator

THE MUTABILITY OF MEMORY It is important that every investigator or lawyer preparing a case for trial must understand how memory influences the information obtained. Very few people have a perfect eidetic (photographic) memory. Memory is a fluid and often unreliable human function. During my time as a trainee investigator at the Army Intelligence School at Fort Holabird, Maryland, a classroom lecture on interviewing was interrupted by a man dressed in a clown mask, a tuxedo, swim fins, a co
Video thumbnail: Investigation of Mold Claims of Bodily Injury or Property Damage
12:13

Investigation of Mold Claims of Bodily Injury or Property Damage

Because multiple exclusions in a CGL policy or other liability policy may involve an adjuster, an insured or the attorney for either, the adjuster starting an investigation should protect the insurer from potential misunderstanding or inadvertent waiver of the insurer’s rights. In that regard the adjuster should make immediate, but no later than 24 hours after notice is received, contact with the insured. The insured should be asked at the first meeting to sign a non-waiver agreement that is a c
Video thumbnail: The Law of Unintended Consequences and the Tort of Bad Faith
13:40

The Law of Unintended Consequences and the Tort of Bad Faith

The concept of unintended consequences is one of the building blocks of economics. Adam Smith’s “invisible hand,” the most famous metaphor in social science, is an example of a positive unintended consequence.Most often, however, the law of unintended consequences illuminates the perverse unanticipated effects of legislation and regulation. In 1692 the English philosopher John Locke, a forerunner of modern economists, urged the defeat of a parliamentary bill designed to cut the maximum permissib
Video thumbnail: Subrogation Waiver
15:14

Subrogation Waiver

The Waiver of Subrogation Subrogation is an equitable remedy where a person who pays the debt of another is entitled to assume the rights of the person whose debt he or she paid. In insurance, when an insurer pays a claim, it assumes all of the rights of the person insured, to sue and recover the amounts paid from any third party who was responsible for the loss. Equity allows creative remedies for wrongs that do not fit within the confines of traditional tort or contract remedies (i.e., wi
Video thumbnail: Sick Building Syndrome and Construction Defects
17:08

Sick Building Syndrome and Construction Defects

Sick Building Syndrome Sick building syndrome (SBS) covers a whole range of health problems that are related to toxin exposure in a building. There are serious questions raised by physicians and mold experts about the existence of a true relationship between the mold and bacterial infections that have been reported to be the cause of SBS. SBS is used to describe situations in which building occupants experience acute health and discomfort effects that appear to be linked to time spent in a buil
Video thumbnail: Adjusting Property Claims
19:28

Adjusting Property Claims

A site for the insurance claims professional and anyone who wants to know something about insurance, insurance claims, insurance coverage, and insurance law. https://zalma.com/blog
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