Everything Needed by the Insurance Claims Professional from Barry Zalma

Over the last 55 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 Defeat of a Fake $10 Million Jewelry Robbery Insurance Claim

Barry Zalma, Esq., CFE, a Certified Fraud Examiner and a retired insurance coverage lawyer and active insurance claims, insurance coverage and insurance fraud expert has just published a fictionalized novella about how a thorough investigation defeated an attempted $10 million insurance fraud when a jeweler attempted to defraud the Underwriters at Lloyd’s, London by creating a false $10 million inventory with the assistance of a less than honorable accountant and public adjuster.

His attempted fraud was unexpectedly subject to the investigation of Morpheus Othello McCloskey (called only by his friends by his initials “MOM”) and insurance coverage lawyer Samuel B. Hazan who, at the instructions of the Lloyd’s Underwriters, conducted a thorough and effective good faith investigation of the policy and the claim and defeated the attempted fraud.

A jeweler attempted to defraud the Underwriters at Lloyd’s, London by creating a false $10 million inventory with the assistance of a less than honorable accountant and public adjuster. His attempted fraud was unexpectedly subject to the investigation of Morpheus Othello McCloskey (called only by his friends by his initials “MOM”) and insurance coverage lawyer Samuel B. Hazan who, at the instructions of the Lloyd’s Underwriters, conducted a thorough and effective good faith investigation of the policy and the claim and defeated the attempted fraud.

Available as a Kindle Book here. Available as a paperback here.

A Compact Book on How Judges Read, Understand, Interpret and Rule on Insurance Policy Issues

Every Person Who is Insured Needs to Understand How Judges interpret Insurance Policies.

The book provides those who are insured, insurance claims people, insurance claims executives, underwriters, insurance agents, insurance brokers, insurance coverage lawyers and policyholders lawyers an ability to understand how they should emulate the courts when interpreting an insurance policy to avoid taking untenable positions with regard to claims.

Understanding the Terms and Conditions of an Insurance Policy

The challenge faced by every person insured when making a claim is to determine what was insured and what was not insured. Similarly, every insurance claim professional when faced with the need to resolve a claim presented by an insured is required to determine if the insurance policy, by its wording, provides coverage to indemnify the insured or does not. To do so the insured and the insurance claim professional must read, understand, and interpret the policy and apply the wording of the policy to the facts determined by the claims investigation.

To present or investigate a claim fairly both those insured and those representing the insurer must understand what insurance is and its history of indemnifying those who incur losses as a result of a fortuitous event.

An insurance policy is a contract. It is a written agreement between the person named as insured and the insurer. Each party to the insurance contract make promises to each other. The insured, for example, promises to pay the premium charged and in the event of a claim cooperate in the investigation of the insurer and will do nothing to deprive the insurer of the benefits of the policy. The insurer, on the other hand, promises to thoroughly investigate each claim presented by the insured fairly and in good faith and to do nothing that will prevent the other to obtain the benefits of the contract.

The Contract of Adhesion

Since insurance policies are often contracts of adhesion written by the insurer that are available to an insured who is given two choices: to accept or reject the policy as written. Adhesion contracts are usually interpreted carefully to favor the insured since the insured had no choice regarding the promises made by the policy.

Insurers believe that the contracts of insurance that they offer to the public are all clear, fair, and unambiguous. People insured, especially when their claim is rejected, consider the contracts to be unclear, ambiguous, confusing, and designed to avoid payments of legitimate claims. When the insurer and the insured fail to agree on the meaning of the policy wording, they take their disputes to the courts.

Since courts in the United States have been asked to interpret insurance contracts for more than two centuries, they have developed methods and rules to allow fair and appropriate interpretations of a policy of insurance. Everyone faced with the need to deal with an insurance claim must be able to fulfill the requirements of the contract of insurance. To do so they must be ready and able to read and understand the policy. This book will help the reader read, understand and interpret an insurance policy the same way that a judge does so to resolve any claim without the need to seek the assistance of a court of law.

Insurance is a Written Contract

An insurance contract is one where one undertakes to indemnify another against loss, damage, or liability, arising from an unknown or contingent event.

Regardless of the simplicity of the definition, insurance contracts are the most litigated type of contract effected in the United States. As a result, judges across the country are called upon to interpret the terms, conditions, and limitations of the policy to be able to resolve disputes over insurance coverage.

When an insured, a claims representative, a claims manger, a coverage lawyer, or an insurance executive are faced with a dispute over coverage they must attempt to resolve the dispute applying the same methodology used by the courts.

Since the interpretation of an insurance policy is primarily a question of law for a court, if the language of the policy is clear and unambiguous, the court should analyze the language of the policy interpreting the policy language, so that its plain and ordinary meaning controls.

The Rules for Interpreting an Insurance Policy

Trial and appellate courts have, over the last few centuries, set up methods and rules to read, understand, interpret, and apply the terms and conditions of a policy of insurance. The methods used by the courts should be emulated by every insured, policyholder lawyer, or insurance claim professional when faced with the obligation to determine if the policy provides coverage to indemnify the insured or not.

Because insurance policies are contracts, judicial interpretation of them, like any other contract, is a question of law. [AIU Ins. Co. v. Superior Court (1990) 51 Cal.3d 807, 818; Bank of the West v. Superior Court (1992) 2 Cal.4th 1254, 1264]

While insurance contracts have distinctive features, they are still contracts to which the ordinary rules of contractual interpretation apply. The mutual intention of the parties at the time the contract was issued should govern its interpretation. Such intent is to be inferred, if possible, solely from the written provisions of the contract.

The words in the contract are understood by the trial or appellate court in their “ordinary and popular sense” unless “used by the parties in a technical sense, or unless a special meaning is given to them by usage.” Any ambiguous terms must be interpreted by the court in the sense the insurer believed the insured understood them at the time of formation, and ambiguities must be resolved in favor of coverage.

The Rules for Contract Interpretation

The California Supreme Court set forth rules for the interpretation of insurance policies, which is similar to that of almost every other state. As a result, courts must consider:

1. Any ambiguity or uncertainty in an insurance policy is to be resolved by the court to favor the insured.
2. If semantically permissible, the contract will be resolved by the court with a construction that will fairly achieve its manifest object of securing indemnity to the insured for the losses to which the insurance relates.
3. A court faced with any reasonable doubt as to uncertain language must resolve the language against the insurer whether that doubt relates to the peril insured against or other relevant matters.
4. The policy should be read as a layman would read it and not as it might be analyzed by an attorney or an insurance expert.
5. An exclusionary clause must be conspicuous, plain, and clear and must be construed strictly against the insurer and liberally in favor of the insured.

The policy should be read as a layman would read it and not as it might be analyzed by an attorney or an insurance expert.

The book is available at Amazon.com as a hardcover here; a paperback here; and as a Kindle Book here.

The Compact Book on Ethics

How Ethical Doctrines from the Beginning of the Written Word to the Present Resulted in the Incorporation of the Covenant of Good Faith

Every Person Involved in the Business of Insurance Must Act Ethically in the Business of Insurance

See the full video at https://rumble.com/v1n4avu-the-compact-book-on-ethics-for-the-insurance-professional.html  and at https://youtu.be/LB6g6O7c0hA

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, effective insurance to spread the risk of loss to a large community of insurance professionals, is impossible. One cannot act fairly and in good faith without being a person with a well-formed ethical compass.

In 1776, Lord Mansfield acting as an appellate judge serving in the House of Lords of Britain (the predecessor of the United Kingdom) for the first time referred to the covenant of good faith and fair dealing. In the case designated: Carter v. Boehm S.C. 1 Bl. Burr 1906, 11th May 1766. 593, 3 Lord Mansfield in the British House of Lords stated the rule of uberrimae fide (Latin for utmost good faith).

Ethics & Ethical Behavior are Essential to Every Insurance Professional

Good faith forbids either party by concealing what he privately knows, to draw the other into a bargain, from his ignorance of that fact, and his believing the contrary.

Insurers, when deciding to insure or not insure a risk, rely on the information provided to them by the insured. As Lord Mansfield instructed, the insured must provide the information requested thoroughly, honestly and in good faith.

The implied covenant is simply stated by explaining that no party to a contract of insurance should do anything to deprive the other of the benefits of the contract.

The implied covenant of good faith and fair dealing imposes obligations on all parties to the contract of insurance. It not only applied to claims by an insurer, a first party property insured, a third party liability policy insured, the insurer, the insurer’s employees, underwriters, and claims personnel.

Since at least 1766, the business of insurance is a business of the utmost good faith. Each party to a contract of insurance must deal with each other ethically. This book will consider and explain different ethical concepts from the Code of Hammurabi more than 3000 years ago to modern ethical philosophers.

The general duty of good faith and fair dealing incorporated by reference into every policy of insurance requires a complete understanding of ethics and ethical behavior. For Example, the California Supreme Court noted that: “In every insurance contract there is an implied covenant of good faith and fair dealing that neither party will do anything which will injure the right of the other to receive the benefits of the agreement.” [Gruenberg v. Aetna Insurance Co., 9 Cal.3d. 566, 108 Cal. Rptr. 480 (1973)].

The covenant is mutual, and the principles of good faith and fair dealing impose an affirmative obligation on the insured to cooperate as much as it requires the insurer to treat the insured fairly with regard to every claim presented.

This is a duty imposed by tradition, by the need to deal fairly and by court precedent and statutory law, not one arising from the terms of the contract itself.

The duty to deal fairly and in good faith is nonconsensual in origin rather than consensual. It is an unwritten, but essential part of every insurance contract.

It is imposed to fulfill the spirit, as well as the letter, of the insurance relationship and the implied covenant of good faith and fair dealing.

The Covenant of Good Faith and Fair Dealing is a statement of the ethical basis of the insurance business.

Without the covenant of good faith and fair dealing, and ethical people who work in the insurance industry applying and fulfilling the covenant, effective insurance to spread the risk of loss to a large community of insurance professionals, is impossible. One cannot act fairly and in good faith without being a person with a well-formed ethical compass.
In 1776, Lord Mansfield acting as an appellate judge serving in the House of Lords of Britain (the predecessor of the United Kingdom) for the first time referred to the covenant of good faith and fair dealing. In the case designated: Carter v. Boehm S.C. 1 Bl. Burr 1906, 11th May 1766. 593, 3 Lord Mansfield in the British House of Lords stated the rule of uberrimae fide (Latin for utmost good faith):

Good faith forbids either party by concealing what he privately knows, to draw the other into a bargain, from his ignorance of that fact, and his believing the contrary.

Insurers, when deciding to insure or not insure a risk, when deciding to honor or reject a claim, rely on the information provided to them by the insured. As Lord Mansfield instructed, the insured must provide the information requested thoroughly, honestly and in good faith.

The implied covenant of good faith and fair dealing imposes obligations on all parties to the contract of insurance. It not only applied to claims by an insurer, a first party property insured, a third party liability policy insured, the insurer, the insurer’s employees, underwriters, and claims personnel.Since at least 1766, the business of insurance is a business of the utmost good faith. Each party to a contract of insurance must deal with each other ethically.

What is The Purpose of the Book

This book considers and explains different ethical concepts from the Code of Hammurabi more than 3000 years ago to modern ethical philosophers.

The book covers, at least:

• What is Insurance?
• Ethics & Ethical Behavior.
• Ethical Insurance
• The Development of the Implied Covenant of Good Faith & Fair Dealing.
• The Tort of Bad Faith
• The Ethical Insurance Professional
• Applying Ethics to the Work of the Insurance Professional
• Sarbanes Oxley & the Ethical Insurance Professional
• What Happens When a Cort Creates an Ethical Conflict When None Exists?
• Ethics and Insurance Fraud
• Ethics in the Insurance Industry
• Case Studies of Ethical Breach

The general duty of good faith and fair dealing incorporated by reference into every policy of insurance requires a complete understanding of ethics and ethical behavior.

It is imposed to fulfill the spirit, as well as the letter, of the insurance relationship and the implied covenant of good faith and fair dealing.

The Covenant of Good Faith and Fair Dealing is a statement of the ethical basis of the insurance business.

The book is available as a Kindle book, a Paperback or a Hardcover

Who Needs This Book?

If you employ people in the business of insurance your business will be improved if every one of your employees reads and applies the ethical concepts described in the book.

If you are an insurance claims professional, an adjuster, supervisor, claims manager, defense counsel, or insurance coverage counsel the book will provide the knowledge necessary to apply the ethical concepts described in this book.

If you are a person insured or about to be insured you need this book to understand your ethical obligations to the insurer and the insurer’s ethical obligations to you.

“How to Acquire, Understand, and Make a Successful Claim on a Commercial Property Insurance Policy: Information Needed for Individuals and Insurance Pros to Deal With Commercial Property Insurance”

The New Book is now available as a Kindle book here, paperback here and as a hardcover here

Commericial Property Insurance is a necessity for any person or entity owning a piece of commercial property whether it is small or large, whether it is an office building or a warehouse or a factory.

A property owner – unless exceptionally wealthy – cannot afford the risk of losing that property, what it earns from tenants paying rent or from the product produced at the property.

Commercial property insurance is a specialized form of insurance designed to to protect the owner or lessee of the property from loss due to perils like fire, lightning, windstorm, hail, earthquake, flood, tornado or other risks of loss.

Most commercial property insurance policies are written on a “direct risk of physical loss” or “all risk of physical loss” basis subject to exclusions that are directly related to to the risks faced by the property or some standard exclusions.

This books explains the coverages provided by a commercial property insurance policy, how to acquire a policy of commercial property insurance, what the policy of commercial property insurance insures, how to present a claim, and how to successfully present a claim and collect the funds needed to repair or replace the structure and indemnify the insured against the losses incurred because of the interruption of the business of the insured.

The Tort of Bad Faith

Read the full article at https://www.linkedin.com/pulse/new-book-from-barry-zalma-tort-bad-faith-barry-zalma-esq-cfe and at https://zalma.com/blog plus more than 4300 posts.

The Tort of Bad Faith

What Every Insurance Professional, Every Insurance Coverage Lawyer, Every Plaintiffs Bad Faith Lawyer, and Every Insurance Claims Person Must know About the Tort of Bad Faith 

A Book Needed by Every Insurance Claims Professional

The implied covenant of good faith and fair dealing is a concept of insurance law at least three centuries old. It first appeared in British jurisprudence in a case decided by Lord Mansfield sitting in the House of Lords as the highest court in Britain. In Carter v. Boehm. 3Burrow, 1905, Lord Mansfield explained that insurance is a contract upon speculation; the special facts upon which the contingent chance is to be computed, lie, most commonly, in the knowledge of the insured only. The underwriter trusts to his representation, and proceeds upon confidence that he does not keep back any circumstance in his knowledge, to mislead the underwriter into a belief that the circumstance does not exist, and to induce him to estimate the risk as if it did not exist.The keeping back such circumstance is a fraud, and therefore the policy is void.

Lord Mansfield stated the rule still followed to this day: “Good faith forbids either party by concealing what he privately knows, to draw the other into a bargain, from his ignorance of that fact, and his believing the contrary.

The implied covenant explains that no party to a contract of insurance should do anything to deprive the other of the benefits of the contract.”

For insurance to work; for each insurer to properly evaluate the risks presented; for each insurer to obtain the insurance desired; and for each insured and insurer resolve all claims fairly and equitably they must treat each other with the utmost good faith and do nothing to deprive the other of the benefits of the contract.

Each party to the contract of insurance is expected to treat the other fairly in the acquisition and performance of the contract. For example, the prospective insured is required to answer all questions about the risk he, she or it are asking the insurer to take and about the person the insurer is asked to insure. Similarly, the insurer must honestly, clearly and in good faith explain to the insured(s) the risks the insurer is willing to take and the terms, conditions and provisions of the contract of insurance.

Available as a Hardcover   Available as a paperback  Available as a Kindle Book

The Equitable Remedy of Rescission of Insurance

An Effective Tool to detect, deter and defeat insurance Fraud Hardcover – June 17, 2022

The Equitable Remedy of Rescission

Rescission is an equitable remedy first created in the ecclesiastical courts of Elizabethan England.

When the United States was conceived in 1776 the founders were concerned with protecting their rights under British common law.

 

Common Law is a form of law developed by judges through tribunals and decisions of courts rather than executive branch action and legislative statutes.

Following the common law tradition, legal principles were referred to courts of equity to “mitigate the rigor” of the common law.

The new United States of America adopted British common law as the law once the U.S. Constitution was adopted in 1789. British common law was only modified by the limitations placed on the central government by the Constitution.

The viability and ability to enforce contracts was recognized as essential to commerce. Courts of law, following the British Common Law, were charged with enforcing legitimate contracts and rendering money judgments against the party who breached the contract.

It became clear, however, that some contract disputes cannot be resolved with a money judgment. Rather, it needed the assistance of the courts of equity whose judges, in the Elizabethan era were presided over by priests who were believed to be better able to render fair judgments.

The term “equity” is associated with notions of fairness, morality and justice. It is an ethical jurisdiction. On a more legalistic level, however, “equity” is the branch of law that was administered in the Court of Chancery prior to the Judicature Acts 1873 and 1875.

 

This was a jurisdiction evolved to achieve justice and to overcome the rigorous and deficiencies of the common-law. Although application of conscience pervades this aspect of the law, equity never bestowed an unfettered jurisdiction on the Court of Chancery to do what was fair in the settlement of a dispute. Embodying aspects of ecclesiastical law and Roman law, equity developed and gradually emerged as a distinct body of law.

It was not until 1875 that equity was practiced in the common law courts. The existence of a dual system entailed that, for example, when a defendant had an equitable defense to a common law action, he would have to go to the Court of Chancery to obtain an injunction to suspend the proceedings in common-law court. He would then begin a fresh action for relief in the Court of Chancery. Facing duality persisted until the Judicature Acts which created the Supreme Court of Judicature and allowed all courts to exercise both a common law and equitable jurisdiction.

The courts of equity were charged with, among other things, protecting contracting parties from mistake, fraud, misrepresentation and concealment where no damages were involved. It was the obligation of the courts of equity to reach a result that was fair to all of the parties to the contract. The founders of the United States, and the British common law, concluded that equity required that enforcing a contract based on mistake, fraud, misrepresentation or concealment would not be fair.

 

A court of equity is a court which can apply equitable remedies to disputes. These courts operate within the legal system, but rather than focusing on the application of law, they look at cases and determine outcomes based on fairness. They can be found in many regions of the world. In modern usage in the United States trial courts are empowered to handle both legal and equitable remedies.
A court of equity can hand down a judgment which includes an equitable remedy such as an injunction, as opposed to simple monetary damages.

The judge in a court of equity can weigh many different sides to a case and explore different perspectives to arrive at a judgment.

Available as: A Kindle book A Paperback or a hardcover .

Insurance Fraudsters Deserve No Quarter

New Book That Explains How to Defeat or Deter Insurance Fraud

What every insurer should know about how it can be proactive in the efforts against insurance fraud by refusing to pay every fraudulent claim.

How Giving No Quarter Worked

Many years ago a client I represented was offended that an insured tried to defraud him and the people who were names in the syndicate he represented at Lloyd’s, London. I walked the Underwriter through the debris of the house that was burned, showed him some of the remains of the allegedly highly valuable fine arts, and then explained how he was deceived into issuing the policy. I was the attorney for Lloyd’s underwriters for the fine arts and Imperial Casualty for the homeowners policy. Once it became clear to the Underwriter I was given the following instruction:

“Take No Prisoners!” The military instruction to give no mercy to the enemy. Typically if you give or grant no quarter, you treat someone—usually an opponent or foe of some kind—harshly. You don’t take pity on them or give them any leeway or concession. That is what I did. The claim was denied, the policy was rescinded, and the bad faith suit that resulted was litigated without quarter or concession. It took more than five years, a motion for summary judgment, an appeal, and eventually a judgment in favor of the insurers that resulted in payment to the insurers of every dollar advanced and every dollar expended in investigation and defense of the bad faith suit. That was followed by suits against the claims adjuster, death threats and a bomb threat that took 15 years of my professional life. The appellate decision can be read at Imperial Casualty & Indemnity Co. v. Sogomonian, 243 Cal.Rptr. 639, 198 Cal.App.3d 169 (Cal. App. 1988).

After Mr. Sogomonian and his co-defendants were compelled to pay fraudulent claims against Imperial and the Lloyd’s underwriters dropped precipitously. Giving no quarter to a fraud perpetrator not only defeated a fraudulent claim but deterred others from attempting fraud.

The Imperial v. Sogomonian case and many similar cases is why I am convinced that giving no quarter to a fraud perpetrator is the best way to deter and defeat insurance fraud and why I wrote this book to convince more insurance professionals to emulate the insurers that defeated the Sogomonian attempt at fraud.

How to Proactively Work to Defeat or Deter Insurance Fraud

Available as a Kindle Edition, a Paperback or a Hardcover

What every insurer should know about how it can be proactive in the efforts against insurance fraud by refusing to pay every fraudulent claim, by refusing to settle litigation brought by fraud perpetrators and by proactively taking the fraud perpetrators to court by seeking damages for common law fraud and take the profit out of insurance fraud.

No one knows the true extent of insurance fraud because most attempts at insurance fraud succeed. Estimates are extrapolated from those few people who attempt insurance fraud that are caught.

Insurance fraud is a crime in most states of the United States and in most countries the usual victims of the crime of insurance fraud are insurers. Some creative people have created fraudulent insurance companies that exist to defraud the insurance buying public who acquire insurance from the fraudulent insurers.

The crime of insurance fraud is ubiquitous and is committed by every race, gender, national origin, religion, or sexual orientation.

Unlike other victims of crime state legislatures require insurers create special investigative units (SIU) to thoroughly investigate all potential insurance fraud and present evidence to the authorities so that they can prosecute insurance fraud. Unfortunately, experience of the insurance industry has established that even when the insurer’s SIU presents a case to the state’s Fraud Division or Fraud Bureau for criminal prosecution, it is rare that a prosecution is commenced and a conviction obtained.

State insurance departments brag about convictions in double digits when they receive as many as 1500 reports of suspected fraudulent claims every 30 days. Prosecutors dislike insurance fraud cases because they are usually document heavy while an assault, rape, murder or drunk driving are usually summarized by a single police report and are, therefore, relatively easy to prosecute to a jury or obtain a plea of guilty.

Some insurers are buying Artificial Intelligence software to detect insurance fraud. Others hire retired police officers to operate the SIU and ignore their experienced insurance claims handlers.

Most do the minimum necessary to fulfill the requirements of the anti-fraud statutes and regulations concluding that it is better to pay the fraudsters than to fight fraud attempts proactively.

All insurers and those who regulate insurers agree that regardless of where the insurance is sold, regardless of where the promises made by an insurance policy are required to indemnify an insured, insurance fraud is a serious problem for the insurance industry. All attempt to deter or defeat insurance fraud to one extent or another.

All recognize that if there is an insurance claims that is denied for fraud it is axiomatic that the insured, so accused, will file suit for breach of contract and for the tort of bad faith. Bad faith lawsuits, even when they fail, take the value out of the effort to deter or defeat insurance fraud since defense of the bad faith suit will usually exceed the amount of the claim that was denied.

On an individual claim basis it is never cost effective to reject the claim for fraud. However, knowledgeable insurance fraud investigative professionals recognize that an aggressive effort against insurance fraud, refusal to pay a settlement to avoid litigation, and forcing the fraud perpetrator to litigate through trial and appeal will become known to those who make a living defrauding insurers, that the insurer is not a pushover and will avoid fraud attempts against that insurer and move to insurers the fraud perpetrators know will pay rather than fight.

Available as a paperback here.  Available as a hardcover here. Available as a Kindle Book here.

The Examination Under Oath to Resolve Insurance Claims

The Most Effective Tool Available to Insurers to Defeat Attempts at Insurance Fraud & to Resolve Questionable Claims

Insurance Fraud – Volume I & Volume II Second Edition

Insurance fraud continually takes more money each year than it did the last from the insurance buying public. No one knows the actual amount with any certainty because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year. Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance criminals is endemic. Most insurance fraud criminals are not detected. Those that are detected do so because they became greedy, sloppy and unprofessional so that the attempted fraud becomes so obvious it cannot be ignored. No one will ever be able to place an exact number on the amount lost to insurance fraud. Everyone who has looked at the issue knows – whether based on their heart, their gut or empirical fact determined from convictions for the crime of insurance fraud – that the number is enormous. When insurers and governments put on a serious effort to reduce the amount of insurance fraud the number of claims presented to insurers and the pseudo-government-based or funded insurers drops logarithmically. The effort to stop insurance fraud against Medicare and Medicaid has increased in recent years. This book contains appellate decisions regarding insurance fraud from federal and state appellate courts across the country and full text of many insurance fraud statutes. It is available as both a legal research tool and a product to assist insurers, insurance company personnel, independent insurance adjusters, special investigation unit investigators, state fraud investigators and insurance lawyers to become effective persons involved in the attempt to defeat or reduce the effect of insurance fraud.

Volume I of Insurance Fraud includes the following:

• Insurance Fraud is Epidemic.
• Measuring Insurance Fraud
• What is Insurance Fraud?
• Arson for profit.
• Soft Fraud
• Hard Fraud
• Insurance Against the Risk of Loss of Real or Personal Property
• Liability Insurance
• Interpretation of Insurance Contracts
• Ethics & The Insurance Fraud Investigation
• Fraud by Professionals
• First Party Property Fraud
• Health Insurance Fraud
• Insurance Fraud is a Crime
• Fraud Created by Legal Professionals
• Fraud in the Acquisition of Insurance
• Fraud in the Presentation of a Claim
• Investigation of a Claim for Fortuity
• Investigating Fraud
• Arson for Profit Investigation
• Investigation Methods
• Evaluation of Medical Records

Available as a Kindle book; Available as a Hardcover;  Available as a Paperback 

Volume II of Insurance Fraud provides coverage of the issues not covered by Volume I and, together with Volume I becomes a complete manual for how lawyers and claims people can effectively work to deter or defeat insurance fraud.
INSURANCE FRAUD IS EPIDEMIC
The following are covered in this volume including:

• The Federal Crime of Insurance Fraud
• Insurance Fraud as a State Crime
• Insurance Fraud by Insurers
• California SIU Regulations
• Investigating Insurance Fraud
• The Examination Under Oath
• The Taking of an Examination Under Oath
• The Mutability of Memory
• Rescission
• Insurance Fraud Statutes
• The Tort of Bad Faith and Insurance Fraud
• Sample California Rescission Letters
• Sample Complaint for Declaratory Relief
• Form of Mutual Rescission Agreement
• Fom Declaration of Underwriter in Support of Rescission
• Insurance Fraud Statutes
• Outline of Training for Integral Anti-Fraud Personnel
• Form of EUO Demand Letter
• EUO Testimony admitting fraud.

Available as a Kindle book;  Available as a Hardcover;  Available as a Paperback

“Construction Defects and Insurance Second Edition”

The Second Edition of all Eight Volumes now Available at Amazon.com

Construction Defects and Insurance Second Edition:

Volume 1: The Structure, The Construction Contract, and Construction Defect Insurance.

Construction defects have grown into one of the most active areas of litigation in the United States.

This Second Edition of a multi-volume treatise is the newest addition to Barry Zalma’s insurance claims books that thoroughly explain how to identify construction defects, how to insure, investigate, prosecute, and defend cases that result from construction defect claims.

Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense; both policyholder and insurer), and business owners will benefit greatly from the multiple volumes. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of construction defect law and construction insurance law.

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.

Available as a hard cover, a paperback and as a Kindle Book

Construction Defect and Insurance Volume Two Second Edition”

The Defects and Understanding Construction Defects Insurance and Underwriting

The Treatise, Construction Defects & Insurance addresses a wide range of topics associated with this escalating and expensive problem.

In this the second volume of the series of books he has also provided checklists that walk the reader through an analysis of construction defects, the process of purchasing and later invoking construction defect insurance, and what is necessary to prosecute or defend a construction defect lawsuit. The books also include helpful sample forms to assist in the identification of defects and numerous case studies to illustrate the state of litigation.

Available as a paperback  and a Kindle book  Available as a hardcover 

All of Barry Zalma’s books are available at Zalma’s Insurance Claims Library https://lnkd.in/gKCTg53

Construction Defects and Insurance Volume Three Second Edition

The Commercial General Liability Policy the Construction Defect Policy; CGL Policy Format and Structure; Exclusions to CGL Insurance

This, the third volume of the eight volume multi-volume treatise is the newest addition to Barry Zalma’s insurance claims books that thoroughly explain how to identify construction defects, how to insure, investigate, prosecute, and defend cases that result from construction defect claims.This, the third volume of Construction Defects & Insurance, includes materials concerning:

• Overview
• The Commercial General Liability Policy the Construction Defect Policy
• CGL Policy Format and Structure
• Exclusions to CGL Insurance
• Claims Made Provisions
• Coverage After Project is Completed
• Additional Insured Endorsements
• Failure of Agent or Broker to Obtain Insurance Requested
• Contractor’s Pollution Liability
• Property Insurance
• Construction Related Exclusions
• Deductibles, Self-Insured-Retention & Coinsurance
• Public Insurance Adjusters
• Certificates of Insurance
• Builders Risk Insurance
• Obligations of a Condominium Association
• Surety, Performance and Payment Bond Claims
• Flood Insurance

Construction Defects and Insurance Volume Four Second Edition

Liability Insurance & Construction Defects

This, the second edition of volume four of the eight volume series is the newest addition to Barry Zalma’s insurance claims books that thoroughly explain how to identify construction defects, how to insure, investigate, prosecute, and defend cases that result from construction defect claims.

This, the fourth volume of Construction Defects & Insurance, includes materials concerning Liability Insurance and covers the following subjects:

1. Overview
2. What is Involved?
3. Liability Insurance
4. How To Shop for Insurance
5. A Resource for Victims of Fraudulent Insurance Applications
6. Duties of the Insured and Insurer
7. Other Insurance Clauses
8. Subrogation
9. Insurance Fraud
10. Checklist A – Liability Insurance
11. Appendix A Sample Request for Insurance Quotation Form
12. Appendix B Commercial General Liability Coverage Form
13. Appendix C Claims Made CGL

Construction Defects and Insurance Volume Five Second Edition

The Tort of Bad Faith and Construction Defects

This, the fifth volume, of the eight-volume series is the newest addition to Barry Zalma’s insurance claims books that thoroughly explain how to identify construction defects, how to insure, investigate, prosecute, and defend cases that result from construction defect claims.

This, the fifth volume of the treatise Construction Defects & Insurance, includes materials concerning the Tort of Bad Faith as it relates to construction defect claims and suits.
In this volume you will see material including:

• Overview
• Bad Faith
• Duties of the Insurer
• Duties of the Insured
• Avoiding Charges of Bad Faith
• Survey of Bad Faith by State
• Defenses to the Tort of Bad Faith
• Required Continuing Education

Construction Defects and Insurance Volume Six Second Edition

Construction defects have grown into one of the most active areas of litigation in the United States.

This, the sixth volume of the eight volume treatise is the newest addition to Barry Zalma’s insurance claims books that thoroughly explain how to identify construction defects, how to insure, investigate, prosecute, and defend cases that result from construction defect claims.

Written by nationally-renowned expert, Barry Zalma, Construction Defects & Insurance Volume Six, Second Edition is improved, brought up to date and designed to help property owners, developers, builders, contractors, subcontractors, insurers, lenders, risk managers and lawyers avoid construction litigation, confidently and rapidly resolve claims associated with construction defect issues, or litigate construction defect litigation.

The treatise Construction Defects & Insurance addresses a wide range of topics associated with this escalating and expensive problem. As you read through the various volumes and pages, you will find comprehensive insights into:

• The construction process
• Risks to be managed
• What is required in an application for insurance protecting the insured against the risks of loss anticipated from construction
• How to acquire the correct and complete construction insurance
• How insurers underwrite against construction defect claims
• How insurers decide to insure/not insure
• Confronting losses caused by construction defects
• Litigation or alternative dispute resolution of construction defect claims

Barry Zalma, has more than 50 years’ practical experience in this area. He is a highly sought after consultant and insurance claims handling expert witness nationally.

In this series of books Mr. Zalma has also provided checklists that walk the reader through an analysis of construction defects, the process of purchasing and later invoking construction defect insurance, and what is necessary to prosecute or defend a construction defect lawsuit. The books also include helpful sample forms to assist in the identification of defects and numerous case studies to illustrate the state of litigation.

Thorough, yet practical, this series of books form the ideal guide for any professional who works in or frequently interacts with the construction industry, construction defect insurance or the legal practice.

Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from the multiple volumes. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of construction defect law and construction insurance law.

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.
This, the sixth volume of Construction Defects & Insurance Second Edition, includes materials concerning:

• Construction Defect Suits.
• Overview
• Avoiding Construction Defect Claims
• Using Contracts to Avoid the Cost of Claims & Suits
• The Parties to a Construction Defect Suit
• The Complaint
• Post-Trial Litigation Tactics
• California Modifies the Rights to Indemnity For Residential Construction
• Additional Insured
• Litigation with Design Professionals
• Statutes of Limitation and Repose
• Risk Transfer
• Right to Cure
• AIA Sample Contract

Construction Defects and Insurance Volume 7 Second Edition

Construction defects have grown into one of the most active areas of litigation in the United States.
This, the seventh volume, of the multi-volume series is the newest addition to Barry Zalma’s insurance claims books that thoroughly explain how to identify construction defects, how to insure, investigate, prosecute, and defend cases that result from construction defect claims.
Written by nationally-renowned expert, Barry Zalma, Construction Defects & Insurance is designed to help property owners, developers, builders, contractors, subcontractors, insurers, lenders, risk managers and lawyers avoid construction litigation, confidently and rapidly resolve claims associated with construction defect issues, or litigate construction defect litigation.
Construction Defects & Insurance addresses a wide range of topics associated with this escalating and expensive problem. As you read through the various volumes and pages, you will find comprehensive insights into:

• The construction process
• Risks to be managed
• What is required in an application for insurance protecting the insured against the risks of loss anticipated from construction
• How to acquire the correct and complete construction insurance
• How insurers underwrite against construction defect claims
• How insurers decide to insure/not insure
• Confronting losses caused by construction defects
• Litigation or alternative dispute resolution of construction defect claims

Barry Zalma, has more than 54 years practical experience in this area. He is a highly sought after consultant and insurance claims handling expert witness nationally.
In this series of books, he has also provided checklists that walk the reader through an analysis of construction defects, the process of purchasing and later invoking construction defect insurance, and what is necessary to prosecute or defend a construction defect lawsuit. The books also include helpful sample forms to assist in the identification of defects and numerous case studies to illustrate the state of litigation.
Thorough, yet practical, this series of books form the ideal guide for any professional who works in or frequently interacts with the construction industry, construction defect insurance or the legal practice.
Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from the multiple volumes. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of construction defect law and construction insurance law.
As you read through the various volumes of Construction Defects and Insurance, you will find comprehensive—yet comprehensible—coverage of key topics, including:

• What is a structure?
• How is a structure built?
• The building.
• The construction contract.
• Plans and Specifications
• The Property Inspection.
• The Defects
• Understanding insurance and underwriting.
• Construction Defect Policies.
• Liability Insurance.
• Insurance Bad Faith.
• The Construction Defect Suit.
• Tort Defenses.
• The Trial.
• Evaluation and Settlement.
• Alternative Dispute Resolution.

This, the seventh volume of Construction Defects & Insurance Second Edition, includes materials concerning the tort defenses and the trial of the construction defect suit.

Construction Defects and Insurance Volume 8 Second Edition

Construction defects have grown into one of the most active areas of litigation in the United States.

This, the eighth and last volume, of the multi-volume treatise is the newest addition to Barry Zalma’s insurance claims books that thoroughly explain how to identify construction defects, how to insure, investigate, prosecute, and defend cases that result from construction defect claims.

Written by nationally-renowned insurance claims and insurance coverage expert, Barry Zalma, Construction Defects & Insurance is designed to help property owners, developers, builders, contractors, subcontractors, insurers, lenders, risk managers and lawyers avoid construction litigation, confidently and rapidly resolve claims associated with construction defect issues, or litigate construction defect litigation.

Construction Defects & Insurance addresses a wide range of topics associated with this escalating and expensive problem. As you read through the various volumes and pages, you will find comprehensive insights into t.he construction process.

The Homeowners Insurance Policy Handbook

How To Buy An Appropriate Homeowners Policy And Successfully Make A Claim To The Insurer

Of all insurance acquired in the United States, the most common is the homeowners policy and its sister the tenant’s policy that covers everything a homeowners policy covers but the structure.Homeowners insurance is nothing more than a contract between a person seeking insurance and an insurer who promises to protect the insured against the risks of loss to certain described property or liability to third parties. The insurer can be set up as a stock insurance corporation, a mutual insurance company, an interinsurance exchange or a syndicate of insurers writing through an insurance market place like Lloyd’s, London. The person insured can be an individual, a corporation, a partnership, a limited liability company, a limited liability partnership, a joint venture or any other legal entity.

Available as a Kindle Book here.   Available as a paperback here.

It’s Time to Abolish 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. INSURANCE AS A NECESSITY Neither the courts nor the governmental agencies seem to be aware that in a modern, capitalistic society, insurance is a necessity. No prudent person would take the risk of starting a business, buying a home, or driving a car without insurance. The risk of losing everything would be too great. By using insurance to spread the risk, taking the risk to start a business, buy a home, or drive a car becomes possible. Insurance has existed since a group of Sumerian farmers, more than 5,000 years ago, scratched an agreement on a clay tablet that if one of their number lost his crop to storms, the others would pay part of their earnings to the one damaged. Over the eons, insurance has become more sophisticated, but the deal is essentially the same. An insurer, whether an individual or a corporate entity, takes contributions (premiums) from many and holds the money to pay those few who lose their property from some calamity, like fire. The agreement, a written contract to pay indemnity to another in case a certain problem, calamity, or damage that is fortuitous, that is that occurs by accident, is called insurance. In a modern industrial society, almost everyone is involved in or with the business of insurance. They insure against the risk of becoming ill, losing a car in an accident, losing business due to fire, becoming disabled, losing their life, losing a home due to flood or earthquake, or being sued for accidentally causing injury to another. The insurers, insureds, or people damaged by those insured are dependent on one another. In a country where human interactions are governed solely by the terms of written contracts, insurance would be a simple means of spreading risk and providing indemnity based on the promises made by the contract of insurance. But, in this the real world, insurance contracts are controlled by statutes enacted to ostensibly protect the consumer of insurance, regulations imposing obligations on the conduct of insurers and the decisions of trial and appellate courts interpreting insurance contracts. A simple insurance contract between two parties might say: “I insure you against the risk of loss of your engagement ring valued at $15,000 by all risks of direct physical loss except wear and tear for a premium paid by you of $15.00.” Anyone who could read would understand that contract. If something happens to damage, destroy or lose the ring the insurer will pay you $15,000.00. However, insurers cannot write such a simple contract because the state requires many terms and conditions that complicate the policy wording and confuse the common person. The states and courts that did so had nothing but good intentions to protect the consumer against the insurer and control the actions of the insurer. The tort of bad faith was created because courts felt that insurers treated their insureds badly and defeated the purpose for which insurance is acquired. It has served its purpose. Fair Claims Settlement Practices laws and regulations are now available to control insurers who do not act in good faith. Insurance fraud statutes and Regulations provide assistance to insurers who have been deceived by those they insure or who are victims of attempted insurance fraud. It is time that all contracts, including insurance contracts, are treated like any other contract, and insureds who believe the insurer breached the contract of insurance can sue to recover the benefits promised by the policy. Available as a paperback here.  Available as a Kindle book here.

Insurance Fraud Costs Everyone

Fictionalized True Crime Stories of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.

Fictionalized True Crime Stories of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The stories help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime. This book started as a collection of columns I wrote and published in the magazines “Insurance Journal,” “Insurance Week,” and “The John Cooke Insurance Fraud Report” insurance trade publications serving the insurance community in the United States. Since the last edition I have added more stories that were published in my twice monthly newsletter, Zalma’s Insurance Fraud Letter which is available free to anyone who clicks the links. Available as a Kindle Book and Available as a Paperback from Amazon.com.

California SIU Regulations 2020

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.” Available as a Kindle book here.  Available as a paperback here.

California Fair Claims Settlement Practices Regulations 2022 Now Available

“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; •Bacteria; •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.

Kindle Edition

Paperback Edition

“Getting the Whole Truth: Interviewing Techniques for the Lawyer”

by Barry Zalma, Esq., CFE

Zalma on Insurance Claims –  Third Edition

Ten Volumes Comprising A Comprehensive Group of Materials on Property & Casualty Insurance Claims

Insurance claims professional and expert witness Kevin Quinley said about the following ten volumes: “Zalma’s series of books is a terrific blend of both the legal underpinnings and the practical implications for the claim practitioner.” Insurance Maven Bill Willson said: “’Zalma On Insurance Claims’ is a tour de force, an indispensable tool that should be a part of every claims training program in America and in the library of every claims professional for quick and frequent reference. This comprehensive guide belongs in the library of every insurance defense AND policyholder law firm. It should be a part of every claims training program of carriers, independent adjusting firms, and public adjusters. Many of these parts should be part of the training or reference programs for non-claims personnel, from agents to underwriters to risk managers.” This series of books is the latest addition to Barry Zalma’s insurance claims series of books and articles that will form the most thorough, up-to-date, expert-authored insurance claims guide available today. Thorough, yet practical, this series of books form the ideal guide for any professional who works in or frequently interacts with the insurance industry. Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from the ten volume guide. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of insurance law. A Comprehensive Review of insurance, insurance claims, the law of insurance policy interpretations, the practicalities of Property, Casualty and Liability Insurance Claims.

Zalma on Insurance Claims Volume 101 – Third Edition

A Comprehensive Review of insurance, insurance claims, the law of insurance and policy interpretation Paperback– May 26, 20211

This volume covers

1. WHAT IS INSURANCE?
2. THE HISTORY OF INSURANCE,
3. ACQUISITION OF THE POLICY,
4. CLAIMS PERSONNEL,
5. KINDS OF INSURANCE POLICIES,
6. Casualty Insurance
7. THE LIABILITY POLICY.

The author has provided checklists, sample procedures, form letters, tables and information and references to model statutes, state statutes, administrative regulations, and requirements of insurance departments nationwide.

Zalma on Insurance Claims Part 102 – Third Edition

Available as a hardcover Available as a Kindle book  Available as a paperback

Zalma on Insurance Claims Part 103 Third Edition

This, the third part of a 10-volume treatise on insurance claims is the latest addition to Barry Zalma’s insurance claims series of books and articles is part of the most thorough, up-to-date, expert-authored insurance claims guide available today. Written by nationally-renowned insurance coverage expert Barry Zalma, an insurance coverage attorney, consultant, expert witness and blogger, Zalma on Insurance Claims provides in-depth explanations, analysis, examples, and detailed discussion of:

• Duties Of The Insured And The Insurer
• Duties Of The Public Adjuster
• Excellence In Claims Handling
• Liability Insurance Claims
• No Tort Remedy For Non-Insurance Claims Bad Faith.
• Duties And Liabilities Of Insurance Brokers
• Declaring A Policy Void
• Rescission
• Processing A Claim
• The Public Adjuster
• Common Mistakes And Omissions To Avoid.
• The Proof Of Loss
• California Insurance Code § 2071.
•  Letter To Insured From Adjuster.
• Form Letter To Insured Re: Contractor
• Amendment To The California Insurance Code Re: Public Adjusters
• Amendment To The California Insurance Code.
• Form Letter: Advising Of Right To Appraisal
•  Form Letter: Reservation Of Rights Letter

The author has provided checklists, sample procedures, form letters, tables and information and references to model statutes, state statutes, administrative regulations, and requirements of insurance departments nationwide. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. Available as a paperback  and Available as a Kindle Book

Zalma on Insurance Claims Part 104 Third Edition

This, the fourth volume in the series of ten books that makes up the treatise, Zalma on Insurance Claims. It is the latest addition to Barry Zalma’s insurance claims series of books and articles that will form the most thorough, up-to-date, expert-authored insurance claims guide available today.

Written by nationally-renowned insurance coverage expert Barry Zalma, a retired from the practice of law insurance coverage attorney, consultant, expert witness and blogger.

As you read through the various volumes of Zalma on Insurance Claims, you will find comprehensive—yet comprehensible—coverage of key topics, including:

• What is Insurance?
• The History of Insurance
• The covenant of good faith and fair dealing.
• The tort of Bad faith
• Conditions,
• Warranties,
• Exclusions
• Declaring a policy void
• Duties of insured and insurer
• Evaluation and settlement
• Identifying insurance fraud
• Investigation
• Kinds of insurance policies
• Other insurance clauses
• Preparing a case for trial
• Processing a claim
• Responses to fraud
• Subrogation and salvage
• Underwriting and
• Many more property and casualty insurance matters.

Available as a Kindle book; Available as a hardcover; Available as a paperback;

Zalma on Insurance Claims Part 105 Third Edition

Zalma on Insurance Claims Part 105 Third Edition
This is the fifth part of a Treatise on Insurance Claims consisting of a series of ten books, of which this is the latest addition to Barry Zalma’s insurance claims Treatise that will form the most thorough, up-to-date, expert-authored insurance claims guide available today.

As you read through the various volumes of Zalma on Insurance Claims, you will find comprehensive—yet comprehensible—coverage of key topics, including:

• What is Insurance?
• The History of Insurance
• The covenant of good faith and fair dealing.
• The tort of Bad faith
• Conditions,
• Warranties,
• Exclusions
• Declaring a policy void
• Duties of insured and insurer
• Evaluation and settlement
• Identifying insurance fraud
• Investigation
• Kinds of insurance policies
• Other insurance clauses
• Preparing a case for trial
• Processing a claim
• Responses to fraud
• Subrogation and salvage
• Underwriting and
• Many more property and casualty insurance matters.

Table of Contents
Chapter 1 Investigation Of Liability Claims.
Chapter 2 Errors & Omissions & the Claims Made & Reported Policies
Chapter 3 The Notice-Prejudice Rule.
Chapter 4 Types Of Torts.
Chapter 5 The Liability Claim File.
Chapter 6 Duty To Defend.
Chapter 7 Tests For Determining Duty To Defend:
Chapter 8 Scope Of The Duty To Defend.
Chapter 9 Grounds To Reject Coverage For Defense Or Indemnity.
Appendix 1 Form Letter To Expert
Appendix 2 Form Letter To Independent Medical Examiner
Appendix 3 Non Waiver Agreements
Appendix 4 Form Letter: Rescinding Automobile Policy.
Appendix 5 Form Letter: Rescission And Denial Letter
Appendix 6 Form Letter: Advising Of Right To Appraisal
Appendix 7 Form Letter: Reservation Of Rights Letter To Insured.
Appendix 8 Form Letter: Reservation Of Rights Letter B.
Appendix 9 Authorization Forms
Appendix 10 California Actual Cash Value Statute.

Available as a Kindle Book Available as a paperback Available as a hardcover

Zalma on Insurance Claims Part 107 – Third Edition

This latest addition to Barry Zalma’s ten volume insurance claims treatise and series of books and articles is part of the most thorough, up-to-date, expert-authored insurance claims guides available today. Written by nationally-renowned insurance coverage expert Barry Zalma, an insurance coverage attorney, consultant, expert witness and blogger, Zalma on Insurance Claims provides in-depth explanations, analysis, examples, and detailed discussion of:

• Property insurance claims
• Third-party liability claims
• Casualty claims
• Insurance Coverage
• Insurance Claims Law and
• Insurance Fraud

Thorough, yet practical, this book is the ideal guide for any professional who works in or frequently interacts with the insurance industry. Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from this multiple volume guide. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of insurance law. As you read through the various volumes of Zalma on Insurance Claims, you will find comprehensive—yet comprehensible—coverage of key topics, including:

• What is Insurance?
• The History of Insurance
• Bad faith
• Conditions,
• Warranties,
• Exclusions
• Declaring a policy void
• Duties of insured and insurer
• Evaluation and settlement
• Identifying insurance fraud
• Investigation
• Kinds of insurance policies
• Other insurance clauses
• Preparing a case for trial
• Processing a claim
• Responses to fraud
• Subrogation and salvage
• Underwriting

The author has provided checklists, sample procedures, form letters, tables and information and references to model statutes, state statutes, administrative regulations, and requirements of insurance departments nationwide. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional person should be sought. Available as a paperback or Kindle Book Available as a hard cover

Zalma on Insurance Claims Part 108 – Third Edition

This latest addition to Barry Zalma’s insurance claims series of books and articles is part of the most thorough, up-to-date, expert-authored insurance claims guide available today, the ten part treatise, Zalma on Insurance Claims.
Written by nationally-renowned insurance coverage expert Barry Zalma, an insurance coverage attorney, consultant, expert witness and blogger, Zalma on Insurance Claims provides in-depth explanations, analysis, examples, and detailed discussion of:

• Property insurance claims
• Third-party liability claims
• Casualty claims
• Insurance Fraud

Thorough, yet practical, this book is the ideal guide for any professional who works in or frequently interacts with the insurance industry. Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from this multiple volume guide. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of insurance law.
As you read through the various volumes of Zalma on Insurance Claims, you will find comprehensive—yet comprehensible—coverage of key topics, including:

• What is Insurance?
• The History of Insurance
• Bad faith
• Conditions,
• Warranties,
• Exclusions
• Declaring a policy void
• Duties of insured and insurer
• Evaluation and settlement
• Identifying insurance fraud
• Investigation
• Kinds of insurance policies
• Other insurance clauses
• Preparing a case for trial
• Processing a claim
• Responses to fraud
• Subrogation and salvage
• Underwriting

The author has provided checklists, sample procedures, form letters, tables and information and references to model statutes, state statutes, administrative regulations, and requirements of insurance departments nationwide including in this volume:

1. Preparing a Case for Trial
2. Involvement of the Adjuster in Defense of the Insured.
3. Conflicts of Interest Between Insured and Insurer
4. The Need to Prove the Policy
5. Interviewing Techniques
6. The Art of the Interview
7. Interview General Principles
8. The Interviewer
9. Preparing for the Interview
10. Conducting the Interview
11. Control of the Interview
12. Dealing with Witness Types
13. Interview Approaches that Work
14. Dealing with the Nervous Person
15. The Use of Bluffs In an Interview
16. The mutability of Memory
17. The Insurance Examination Under Oath

Appendices

• Actual Interview 1: Fire Loss Witness
• Interview 2: Earthquake Loss
• Interview 3: Cross examination of Expert on False Memory
• Interview 4 Elizabeth Loftus on False Memory Syndrome

Available as a paperback  Available as a Kindle book.

Zalma on Insurance Claims Part 109 Third Edition

This is the latest addition to Barry Zalma’s insurance claims treatise on insurance claims and is the Ninth part of the most thorough, up-to-date, expert-authored insurance claims guide available today.
Written by nationally-renowned insurance coverage expert Barry Zalma, an insurance coverage attorney, consultant, expert witness, Certified Fraud Examiner and blogger. Zalma on Insurance Claims provides in-depth explanations, analysis, examples, and detailed discussion of:

• Property insurance claims
• Third-party liability claims
• Casualty claims
• Insurance Fraud

Thorough, yet practical, this book, and the Treatise of which it is a part, is the ideal guide for any professional who works in or frequently interacts with the insurance industry. Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from this multiple volume guide. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of insurance law.
As you read through the various volumes of Zalma on Insurance Claims, you will find comprehensive—yet comprehensible—coverage of key topics, including:

• What is Insurance?
• The History of Insurance
• Bad faith
• Conditions,
• Warranties,
• Exclusions
• Declaring a policy void
• Duties of insured and insurer
• Evaluation and settlement
• Identifying insurance fraud
• Investigation
• Kinds of insurance policies
• Other insurance clauses
• Preparing a case for trial
• Processing a claim
• Responses to fraud
• Subrogation and salvage
• Underwriting

The author has provided checklists, sample procedures, form letters, tables and information and references to model statutes, state statutes, administrative regulations, and requirements of insurance departments nationwide.
This, the ninth part of Zalma on Insurance Claims, includes materials concerning:

• Identifying Insurance Fraud
• Professional Conspiracies
• Multiple Types of Insurance Fraud
• How to Join the Fraud Fight
• Case Studies of Successful Fraud Investigations
• Checklist 1 – Types of Insurance Fraud
• Checklist 2 – Red Flags of Fraud – Property Insurance
• Checklist 3 – Red Flags of Fraud – Liability Insurance
• Appendix A – Commonly Used Medical Acronyms and Abbreviations
• Appendix B – Glossary of Medical Terms

Available as a paperback, Kindle book or hardcover

Zalma on Insurance Claims Part 110 Third Edition

This, the latest addition to Barry Zalma’s insurance claims Treatise in a series of ten books that is part of the most thorough, up-to-date, expert-authored insurance claims guide available today.

Written by nationally-renowned insurance coverage expert Barry Zalma, an insurance coverage attorney, consultant, expert witness and blogger, Zalma on Insurance Claims provides in-depth explanations, analysis, examples, and detailed discussion of:

• Property insurance claims
• Third-party liability claims
• Casualty claims
• Insurance Fraud

Thorough, yet practical, this book is the ideal guide for any professional who works in or frequently interacts with the insurance industry. Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from this multiple volume guide. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of insurance law.
As you read through the various volumes of Zalma on Insurance Claims, you will find comprehensive—yet comprehensible—coverage of key topics.
The author has provided checklists, sample procedures, form letters, tables and information and references to model statutes, state statutes, administrative regulations, and requirements of insurance departments nationwide.All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher.
May include copyrighted material of Insurance Services Office, Inc., with its permission.
This product may include information which is proprietary to Insurance Services Office, Inc. ISO does not guarantee the accuracy or timeliness of the ISO information provided. ISO shall not be liable for any loss or damage of any kind and howsoever caused resulting from your use of the ISO information.
This, the tenth part of Zalma on Insurance Claims, and includes materials concerning:

• Responses to Fraud
• Grounds For Rescission
• The Denial Letter
• Taking a Fraud Case to Trial
• Evidence Needed to Prove Fraud
• Preparing The Insurance Fraud Case For Trial
• The Fight Against Fraud
• The Legislative Arsenal Against Fraud
• Fraud Control at the State Level
• Is the Fight Against Fraud Being Lost?
• The Fifth Amendment Is No Use To A Fraudster Plaintiff
• Checklist 1—Responses to Fraud
• Checklist 2 – The Fight Against Fraud
• Appendix 1 Insurance Fraud Statutes
• Appendix 2 Rescission For Fraud
• Appendix 3 U.S. v. DeGeorge
• Appendix 4 Form Of An Examination Under Oath Demand
• Appendix 5 EUO Outline

Available as a Kindle book;  Available as a Paperback; Available as a hardcover

Mold Claims

This series of books is the latest addition to Barry Zalma’s insurance claims series of books and articles that will form the most thorough, up-to-date, expert-authored insurance claims guide available today. Written by nationally-renowned insurance coverage expert Barry Zalma, a semi-retired insurance coverage attorney, consultant, expert witness and blogger, Mold Claims provides in-depth explanations, analysis, examples, and detailed discussion of:

1. Mold;
2. Fungi;
3. Bacteria;
4. Mold,
5. fungi and bacteria claims; and
6. Mold, Fungi, Bacteria litigation.

Thorough, yet practical, this series of books form the ideal guide for any professional who works in or frequently interacts with the insurance industry or is involved in litigation. Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from the mold volumes. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of insurance law as it relates to mold, fungi and bacterial infestations. The author has provided checklists, sample procedures, form letters, tables and information and references to model statutes, state statutes, administrative regulations, and requirements of insurance departments nationwide.

The Compact Book of Adjusting Property Insurance Claims – Third Edition

A Manual for the First Party Property Insurance Adjuster

The insurance adjuster is not mentioned in a policy of insurance. The obligation to investigate and prove a claim falls on the insured. Standard first party property insurance policies, based upon the New York Standard Fire Insurance policy, contain conditions that require the insured to, within sixty days of the loss, submit a sworn proof of loss to prove to the insurer the facts and amount of loss. The policy allows the insurer to then, and only then, respond to the insured’s proof of loss. The insurer can then either accept or reject the proof submitted by the insured. Technically, if the wording of the policy was followed literally the insurer could sit back, do nothing, and wait for the proof. If the insured was late in submitting the proof the insurer could reject the claim. If the insured submits a timely proof of loss the insurer could either accept or reject the proof of loss. If the insurer rejected the proof of loss the insured could either send a new one or give up and gain nothing from the claim. Suit on the policy would be difficult because the policy contract limited the right to sue to times when the proof of loss condition had been met. Insureds and insurers were not happy with that system. It made it too difficult for a lay person to successfully present a claim. The system, as written into the standard fire policy seemed to run counter to the covenant of good faith and fair dealing that had been the basis of the insurance contract for centuries. Most insurers understood that their insureds were mostly incapable of complying with the strict enforcement of the policy conditions. To fulfill the covenant of good faith and fair dealing insurers created the insurance adjuster to fulfill its obligation to deal fairly and in good faith with the insured. The Second edition adds new material from 2018 and 2019, is easier to use and more compact than the original. Available as a Kindle book. Available as a paperback.

The Compact Book on Adjusting Liability Claims, Third Edition

A Handbook for the Liability Claims Adjuster

This Compact Book of Adjusting Liability Claims is designed to provide the new adjuster with a basic grounding in what is needed to become a competent and effective insurance adjuster. It is also available as a refresher for the experienced adjuster. The liability claims adjuster quickly learns that there is little difficulty with a claimant (the person alleging bodily injury or property damage against a person insured) if the claim is paid as demanded. The insured may be unhappy if the claimant’s claim is paid as presented since most do not believe they did anything wrong or fear an increase in premiums charged for subsequent policies. The adjuster must be prepared to salve the insured’s emotions, explain why in the law and the policy it was appropriate to pay the claimant and that the settlement is in the best interest of both the insured and the insurer the adjuster represents. The adjuster knows, and must be prepared to explain to an insured, that if a claim is resisted or denied the claimant will be unhappy, will probably file suit. If not promptly settled the claimant’s lawyers will rake the insured over the coals to prove that the insured is liable for the claimant’s injuries. The litigation will take time, effort, and money to establish the extent of the injuries and who is responsible for the injuries. Failure to settle promptly can cost the insured his or her reputation and will certainly cost the insurer much more than the claim could have been resolved for had it been resolved before the claimant retained a lawyer. Available as a Kindle book Available as a paperback.

The Little Book on Ethics for the American Lawyer

The practice of law demands more than knowledge of statutory and case law. It requires more than technical proficiency in the nuts and bolts of legal practice. A lawyer is an officer of the legal system whose conduct should conform to the requirements of the law, both in professional service to clients and in the lawyer’s business and personal affairs. The practice of law requires that every lawyer treat each client, each adversary, and the court ethically and in good faith. The practice of law is different from other professions because it requires that the lawyer act for his or her client, not him or herself, only if the actions for the client are ethical and in good faith.

What is Ethical Behavior?

The concept of ethical behavior refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues, all of which are essential to the lawyer.

Ethics, for example, refers to those standards that impose the reasonable obligations to refrain from murder, rape, theft, assault, slander, and fraud. Ethical standards also include those that imply virtues of honesty, compassion, and loyalty.

There are rights presumed to exist such as those described in the Declaration of Independence submitted to King George of England in 1776 that held: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness.” The unalienable rights also include the right to life, the right to freedom from injury, and the right to liberty. Such standards are adequate standards of ethics because they are supported by consistent and well-founded reasons.

Ethics, for example, refers to those standards that impose the reasonable obligations to refrain from murder, rape, theft, assault, slander, and fraud. Ethical standards also include those that imply virtues of honesty, compassion, and loyalty.

There are rights presumed to exist such as those described in the Declaration of Independence submitted to King George of England in 1776 that held: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness.” The unalienable rights also include the right to life, the right to freedom from injury, and the right to liberty. Such standards are adequate standards of ethics because they are supported by consistent and well-founded reasons. Ethics also refers to the study and development of one’s standards of conduct.

Feelings, laws, and social norms can deviate from what is ethical. It is necessary, especially to people involved in the practice of law, to constantly examine one’s standards to ensure that they are reasonable and well-founded conduct that ethically treats a client, an adversary, and the court with the utmost good faith.

There is no single answer to the question of what is ethical behavior by a lawyer. Ethical behavior is subjective and fact dependent.

Available as a Kindle book here. Available as a paperback here.

1.  

Random Thoughts on Insurance

After more than 53 years acting as a claims person and insurance coverage lawyer I enjoy reading court decisions concerning insurance. The idea of this blog is to find new cases that are interesting to me and then write a summary. Some of the cases reviewed will be important. Some may be of first impression. Others will be totally unimportant. All will be interesting. The case digests and articles from 2010 to the present, now in elenven volumes, where I digest cases published by courts of the various states and the United States. The court decisions have been modified from the actual language of the court decisions, were condensed for ease of reading, and convey the opinions of the author regarding each case. Available as a paperback. Available as a Kindle book.

Fictionalized True Insurance Crime Books

Insurance Fraud Costs Everyone

Fictionalized True Crime Stories of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.

Fictionalized True Crime Stories of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The stories help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime. This book started as a collection of columns I wrote and published in the magazines “Insurance Journal,” “Insurance Week,” and “The John Cooke Insurance Fraud Report” insurance trade publications serving the insurance community in the United States. Since the last edition I have added more stories that were published in my twice monthly newsletter, Zalma’s Insurance Fraud Letter which is available free to anyone who clicks the links. The original title was “Heads I Win, Tails You Lose” and was 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 must charge more premium to cover the expense of defending the fraud. Everyone, except the lawyers, lose. As you read the stories I hope they help you understand the effect that insurance fraud has on the perpetrators, the insurers, the people who need insurance, the people who buy insurance, and the people who keep the promises made by insurance policies. Available as a Kindle Book and Available as a Paperback from Amazon.com.

Candy and Abel: Murder for Insurance Money

How a young lawyer and wise old investigator defeated an attempt at life insurance fraud. Available as a Kindle Book. Available as a paperback.

Murder And Insurance Fraud Don’t Mix

My name is Marion Orpheus Montague. My friends, and some enemies, call me “MOM.” It is not a designation of my ability to nurture my clients. I have never been, nor will I ever be, maternal. I accept the play on my initials because it causes adversaries to underestimate me. I am 66-years-old. My grayish blond hair is thin and my full beard is a bit scraggly. My face is round and often tinged with red. My nose is full, my eyes green and my cheeks bulge out to the sides trying to emulate the belly that precedes every other part of my body as I walk. People see me and do not believe that I am a private investigator. Seeing me they often think that I am on leave from my winter work as a Macy’s Santa Claus. I like being underestimated. It makes my job as an investigator easier. See how a fake robbery at a jewelry store led to murder and prison. Available as a Kindle book. Available as a paperback

Murder & Old Lace: Solving Murders Performed for Insurance Money

When the women first met – 20 years ago at a Santa Monica health spa – Magogassasanian appeared taken with Gogolivesky. The women moved Alvarado into an apartment, then started applying for life insurance policies on him. They jointly took out four policies, each as 50% beneficiaries in addition to the individual policies they bought from my client. Gogolivesky also took out three more policies on her own while Magogassasanian only took out a single individual policy on Earnest. The two women pocketed nearly $6,000,000 in insurance benefits on Alvarado alone and $4,000,000 in insurance benefits on Earnest. They also recovered a total of $5,000,000 on the other six old men they killed. Available as a Kindle book. Available as a paperback.

Arson for Terrorism and Profit

How an Insurance Investigator and Insurance Lawyer Defeated a Plot to use a Fire to Fund Terrorism (c) 2020 by Barry Zalma & ClaimSchool, Inc.

There are many excuses for the inability of the criminal justice system to effectively handle arson cases and eventually, almost universally, the prosecutor will find an excuse not to prosecute an arson case regardless of the amount of evidence produced. As a result, with regard to an arson-for-profit scheme, the time, investigative work, and litigation is left to the insurer to refuse to pay a claim based on fraud, pay the investigators and lawyers needed to prosecute a civil fraud defense to a fraudulent claim created with an arson-for-profit scheme. The following story is based upon an attempted arson-for-profit that took up a large portion of my professional career. Although fiction, the story is based on a true crime that involved the efforts of the intended victims – an English insurer and an American insurer – the work of professional fire cause and origin investigators, private investigators, insurance claims handlers, insurance coverage lawyers and insurers who refused to pay tribute to a criminal. After five years of investigation and litigation the defendants established that the arson-for-profit scheme was designed for more than cash but was intended to obtain funds to support a terrorist organization whose purpose was to kill or maim anyone connected to the government of Germany.The names, places, professions, organizations, fire departments, police, prosecutorial agencies and of the individuals involved have been changed to protect the innocent, criminal, and professional. Available as a Paperback Available as a Kindle book

M.O.M. & The Taipei Fraud

How an Experienced Adjuster Defeated a $7 Million Fake Burglary Claim

The problem is that each option the insurers have available have a down side and Feng is represented by a lawyer who has proved highly successful in suing insurers and collecting large compensatory and punitive damage awards. Since the claims exceed $6 million dollars, he can expect, applying the law set out by the U.S. Supreme Court in State Farm Mut. Automobile Ins. Co. v. Campbell and BMW of North America, Inc. v. Gore as much as $60 million in punitive damages. So I need to explain to the insurers that they face an exposure anywhere from their policy limits to ten times the policy limit. They need the courage of their convictions to reject this major claim. Available as a paperback. Available as a Kindle book.

Arson-For-Profit Fire at the Cowboy Bar & Grill

A true crime novel based on the experience of the author, Barry Zalma, who for more than 51 years has acted for insurers who were faced with arson-for-profit, one of the most dangerous insurance fraud schemes. The book explains how an insurance claims adjuster, working with a fire cause and origin expert, a forensic accountant and insurance coverage lawyer, were able to defeat an arson-for-profit scheme and obtain a judgment requiring the perpetrator to take nothing and repay the insurer all of its expenses in defeating the claim. Available as a paperback. Available as a Kindle book.

New Books from Full Court Press

The Insurance Law Deskbook

The Insurance Law Deskbook is intended to help law students, practitioners, insurance lawyers, professional claims personnel, insured persons, and anyone else involved in insurance. The book, published for the first time under Full Court Press, includes the full texts and digests of insurance-related decisions of the U.S. Supreme Court, the U.S. District Courts of Appeal, state appellate courts, and foreign courts that have molded the American insurance law, as well as vital explanatory chapters, historical context, form letters, and more. Paperback, only $95.00 available at https://www.fastcase.com/store/fcp/insurance-law-deskbook-2/

California Insurance Law Deskbook

Zalma on Property and Casualty Insurance

The earnings of almost every civil lawyer in the United States are funded by the insurance industry. Insurance can best be described as the mother’s milk of the law profession. The civil defense lawyer is paid by an insurer for each hour he or she works. The civil plaintiffs’ lawyer is usually paid by taking a percentage of any judgment entered in favor of the plaintiff, which judgment is usually paid by the defendant’s insurer. In almost every situation in which a civil lawyer practices law the funds for that work come, either directly or indirectly, from insurance. Consequently, lawyers must use their wits and energies to avoid or to pursue litigation to the benefit of the client. Both sides understand that an insurer will eventually pay one or both sides in the dispute. Insurance is important to every civil dispute and even some that fall within the criminal courts. Every lawyer retained to prosecute or defend a civil suit should begin the representation with a serious effort to find insurance coverage for the benefit of the client or the defendant the client is suing. Without that knowledge, the lawyer will find he or she is litigating with duct tape firmly self-placed across his or her mouth.

Insurance Law Deskbook

Learn the insurance basics that are essential to every civil practitioner. Available at Fastcase.com bookstore.

California Insurance Law Deskbook

California has long led the way when it comes to insurance jurisprudence in the United States, and few know more about California insurance law than Barry Zalma.  Available at Fastcase.com bookstore.

Insurance Bad Faith and Punitive Damages Deskbook

Understand the relationship between insurance, the tort of bad faith, and why punitive damages are awarded to punish insurers. An annual subscription to secondary content on the Fastcase platform includes new editions and updates published by the author as they are rolled out, so you can rest assured that your research is up to date. Go to fastcase.com for more detail and how to use the material on-line as part of your legal or insurance research or as stand-alone e-books. All available at fastcase.com bookstore.

Books from ClaimSchool, Inc.

Insurance Law

Insurance Law is the most comprehensive, and yet practical, insurance law authority available today. Written by nationally-renowned insurance coverage expert Barry Zalma, an insurance coverage attorney, consultant, expert witness and blogger, Insurance Law introduces the new insurance professional to the fundamental principles of insurance and provides the experienced litigator analyses of today’s leading insurance law decisions nationwide. Insurance Law is the most comprehensive, and yet practical, insurance law authority available today. This book is ideal for any professional who works in or frequently interacts with the insurance industry. Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), business owners, and students will benefit greatly from this all-inclusive reference. It is also the perfect resource for educators and trainers whose role requires an understanding of insurance law. In addition to case law, the author has provided countless citations to relevant statutory, regulatory, and judicial sources which are guaranteed to kickstart your research. Price Reduced from $196- Send Check for $75.00 to ClaimSchool, Inc., 4441 Sepulveda Blvd., Culver City, Ca 90230 and the book will be mailed to you.

Mold Claims Coverage Guide

Today, mold claims are common, but they continue to grow in complexity, involving not only property damage but bodily injury as well. Mold-related lawsuits have dramatically increased over the past few years, and the numbers continue to rise. Coverage requirements—and related issues—can be complicated and confusing.  This resource will remove the complexity and allow the insurer, insured, property owner or developer and their counsel to deal with mold quickly and effectively and, if possible, avoid unnecessary litigation. Price Reduced – Send Check for $50.00 to ClaimSchool, Inc., 4441 Sepulveda Blvd., Culver City, Ca 90230 and the book will be mailed to you.

Construction Defects Coverage Guide

This insightful and practical two volume resource was envisioned and written by nationally renowned expert Barry Zalma, and it thoroughly explains how to identify construction defects and how to insure, investigate, prosecute, and defend cases that result from construction defect claims. Construction Defects Coverage Guide was designed to help property owners, developers, builders, contractors, subcontractors, insurers, and lenders, as well as their risk managers and lawyers rapidly resolve construction defect claims when they arise and avoid construction litigation.  If litigation becomes necessary it will help the prosecution or defense of construction defect suits effectively. Price Reduced from $196 – Send Check for $75.00 to ClaimSchool, Inc., 4441 Sepulveda Blvd., Culver City, Ca 90230 and the book will be mailed to you.

Insurance Claims: A Comprehensive Guide

Insurance contracts and clauses are specific in nature—but the manner in which insurance claims are pursued and resolved can be remarkably different.  Mistakes in handling a claim can undermine the outcome—and ultimate value—of the claim itself. Insurance Claims: A Comprehensive Guide is the one resource that enables insurance professionals, producers, underwriters, attorneys, risk managers, and business owners to successfully handle insurance claims from start to finish—employing proven, practical techniques and best practices every step of the way.

Price Reduced from $196 – Send Check for $75.00 to ClaimSchool, Inc., 4441 Sepulveda Blvd., Culver City, Ca 90230 and the book will be mailed to you.

Books from the American Bar Association

The Insurance Fraud Deskbook

Author: Barry Zalma

Sponsor(s):  Tort Trial and Insurance Practice Section, Publisher(s):   ABA Book Publishing

ISBN: 978-1-62722-676-9 Product Code: 5190506 2014, 638 pages, 7 x 10 This book is written for individuals who are focused on the effort to reduce expensive and pervasive occurrences of insurance fraud. Lawyers who represent insurers, claims personnel, prosecutors and their investigators can all benefit from this exhaustive resource. The Insurance Fraud Deskbook is a valuable resource for those who are engaged in the effort to reduce expensive and pervasive occurrences of insurance fraud. It explains the elements of the crime and the tort to claims personnel, and it provides information for lawyers who represent insurers, so they can adequately advise their clients. Prosecutors and their investigators can use this book to determine what is required to prove the crime and win their case. The full text of decisions from courts of appeal and supreme courts across the country are provided so the reader can understand what happens after the investigation is completed and can apply that information to undertake their own thorough investigations. It allows claims personnel and their lawyers to understand what errors would cause a defeat or a not-guilty verdict. The effort to reduce insurance fraud requires the assistance of both civil and criminal courts. The Insurance Fraud Deskbook can help the prudent fraud investigator, insurance adjuster, insurance attorney, insurance Special Investigation Unit, and insurance company management to attain the information needed to deal with state investigators and prosecutors. Available from the American Bar Association at: http://shop.americanbar.org/eBus/Default.aspx?TabID=251&productId=214624; or  orders@americanbar.org, or 800-285-2221.

Diminution in Value Damages

How to Determine the Proper Measure of Damage to Real and Personal Property

ISBN: 978-1-63425-295-8 Product Code: 5190524 2015, 235 pages, 7 x 10, Paperback

This book was written to provide sufficient information to those who became interested in the issue since the Georgia Supreme Court decided State Farm Mutual Automobile Insurance Co. v. Mabry, 274 Ga. 498, 556 S.E.2d 114 (Ga. 11/28/2001) and includes cases dealing with the use of diminution in value as a method of determining the amount of loss incurred by a plaintiff seeking indemnity for damage to real or personal property. Because confusion has reigned across the United States concerning the proper measure of damages for property damage to property that has been repaired, Diminution In Value Damages assists the reader in answering the questions concerning the proper measure of damage in each of the fifty United States and federal United States jurisdictions This edition has been totally rewritten and expanded, providing the most extensive and detailed coverage of the issue and a thorough explanation of how to apply diminution in value damages to losses to property.

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Author:Barry Zalma

“Property Insurance Checklists, 13th Edition” Now Available from Thomson Reuters a New Book From Barry Zalma

Read the full article at https://www.linkedin.com/pulse/new-property-insurance-checklists-13th-edition-barry-zalma-esq-cfe and at https://zalma.com/blog plus more than 3700 posts. Property Investigation Checklists: Uncovering Insurance Fraud 13th Edition provides detailed guidance and practical information on the four primary areas of any investigation of suspicious claims:

• Recognizing suspicious claims;
• Proper investigation procedures;
• Analysis of laws concerning fraudulent personal and real property claims; and
• Evaluating and settling claim.

The book also examines recent developments in areas such as arson investigation procedures, bad faith, and extracontractual damages. The appendix includes the NAIC Insurance Information and Privacy Protection Model Act, forms useful to investigators, and the full text of how thorough investigation defeated a fraudulent claim and convicted a lawyer to a long term in prison. Available at https://store.legal.thomsonreuters.com/law-products/Forms/Property-Investigation-Checklists-Uncovering-Insurance-Fraud-13th/p/106702361 and as a THOMSON REUTERS PROVIEW eBOOK EDITION https://store.legal.thomsonreuters.com/law-products/Forms/Property-Investigation-Checklists-Uncovering-Insurance-Fraud-13th/p/106702363

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“The Passover Seder For Americans”

For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lost the ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah. Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and wonder how did all these wonderful things come into being. Jews believe the force we call G_d created the entire universe and everything in it. Jews feel G_d is all seeing and knowing and although we can’t see Him, He is everywhere and in everyone.We understand that when G_d began to create the world there was nothing and that time, as we know it, had no meaning. G_d created all. Because of the creation we are able to track time and celebrate Passover every year at the same time. We do so based on the lunar calendar used by our ancestors not the Julian calendar modern people use. As a result, Passover se We feel G_d gave people a conscience hoping it would help us decide right from wrong, to do our best to make good choices, to try to help others, not hurt others and to try to make right the wrongs we have done to others. The rituals that make up the Jewish holidays help remind us how thankful we are for how much we have accomplished with G_d ’s help and how grateful we are to G_d for everything we have and everything we are. Thea and Barry Zalma have created this English only Seder that works for our family and will allow you and your families to tell the story of the Exodus painlessly and with the joy and celebration it deserves so that no member of our family forgets what G_d did for us when He took us out of slavery in Egypt and led us to a promised land. Available as a Kindle Book  Available as a Paperback

ZALMA ON INSURANCE:  A BLOG

Go to Home Page Write to Barry Zalma Follow Zalma on Twitter at https://twitter.com/bzalma After more than 50 years acting as a claims person and insurance coverage lawyer I enjoy reading court decisions concerning insurance. The idea of this blog is to find new cases that are interesting to me and then write a summary. Some of the cases reviewed will be important. Some may be of first impression. Others will be totally unimportant. All will be interesting. Zalma on Insurance, a Blog is published five days a week.

(c) 2022 Barry Zalma, Inc.

Barry Zalma & ClaimSchool, Inc.

Go to Zalma Books – E-Books and Articles by Barry Zalma  at the Insurance Claims Library where ClaimSchool publishes the ZIFL, several books and e-books written by Barry Zalma and sponsors Mr. Zalma’s speaking engagements. 

Written by Barry Zalma &
ClaimSchool, Inc.
4441 Sepulveda Boulevard, Inc.
CULVER CITY CA 90230-4844
310-390-4455; https://claimschool.com; zalma@claimshool.com
Follow Barry Zalma on Twitter at https://twitter.com/bzalma
Read Mr. Zalma’s blog “Zalma on Insurance”
Go to “Zalma’s Insurance 101” Video Training  

Go to the Insurance Claims Library; Subscribe to Barry Zalma on Substack.com, Go to Barry Zalma videos at Rumble.com at https://rumble.com/zalma Videos from “Barry Zalma on YouTube; Go to the Insurance Claims Library; Listen to the Podcast: Zalma on Insurance