Zalma on Insurance

Zalma on Insurance

By Barry ZalmaBusiness
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Zalma on Insurance episodes

  • Insurance Fraud Attempt Defeated

    The Hawaiian

    The following is a fictionalized True Crime Story of Insurance Fraud
    from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails
    You Lose” situation for Insurers.
    Post 4734
    The insured was a contractor in Honolulu. He made an excellent living
    cheating his customers. The insured’s most lucrative scheme was an
    electronic vermin killer. It consisted of a long wire and a transformer.
    The contractor strung the wire around a house and plugged it in a wall.
    The device, charged with low voltage from the transformer, allegedly
    repelled vermin. The insured guaranteed that all roaches, flying insects
    and rodents could not pass the charge in the wire.
    When it didn’t work and a customer called to complain the insured would
    ignore the complaints.
    Since the tropical Hawaiian climate is a prime breeding ground for
    insects, the insured had no lack of customers. He bought a Ferrari
    sports car with the profits.
    After gaining her confidence the adjuster confronted the secretary with
    the result of his investigation. He told her he knew that the appraisals
    were not done by the jeweler. He showed her where he had discovered
    that the typewriter used to type the description of the items of jewelry
    was different from the typewriter used to type the name of the
    appraiser. He told her that he liked her and would be very sorry if she
    was involved in aiding her boss in committing a crime.
    She began to cry. When he calmed her down, she confessed that she had
    typed in all of the descriptions and the values of the jewelry. Her
    boss, the insured, took the print ball out of the IBM Selectric
    typewriter and smashed it under his shoe. If asked, she was to say that
    his children broke the typewriter while playing with it. The adjuster
    thanked her, paid for lunch and suggested she get a new job. He told her
    he would do what he could to keep her out of criminal problems.
    He then got permission from his client, the insurer, to deny the claim.
    He wrote a simple brief, letter to the insured stating as follows: “Your
    claim is denied because it was presented by you with the knowledge that
    it was false and fraudulent.”
    He said nothing more. The adjuster, as required by law, reported his
    findings to the local police agency and to the U.S. Postal Inspectors.
    Both promised to complete a prompt criminal investigation and prosecute
    the insured for insurance fraud. The adjuster waited, patiently, for
    five years. Every twelve months he would ask the police concerning their
    investigation. He would always receive the same response “We’re working
    on it.”
    Five years elapsed since his conviction. He is still making a living as a
    contractor in Hawaii defrauding his customers. He paid when the
    probation officer caught him what he told the probation officer he could
    afford. In five years the insured paid, on the restitution order that
    is a condition of his probation, a total of $250.00. His probation is
    over.
    The crime did not succeed. He did not collect $500,000. The insurance
    company did not succeed. It paid out over $10,000 to its investigators
    which it will never recover and the ordered restitution was never paid.
    Adapted from my book "Insurance Fraud Costs Everyone" available at
    Available as a Kindle Book and Available as a Paperback from Amazon.com
    https://www.amazon.com/Candy-Abel-Murder-Insurance-Money/dp/1976823757/ref=sr_1_1?s=books&ie=UTF8&qid=1517924833&sr=1-1&keywords=%22candy+and+abel%22.
    Read the full article at https://zalma.com/blog
    (c) 2024 Barry Zalma & ClaimSchool, Inc.
    Go to X @bzalma; Go to the podcast Zalma On Insurance at
    https://podcasters.spotify.com/pod/show/barry-zalma/support; Go to Barry
    Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to
    Barry Zalma on YouTube-
    https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg;  Go to the
    Insurance Claims Library –
    http://zalma.com/blog/insurance-claims-library.


    16 min
  • Agent's Statement Binds Insurer

    It is not Bad Faith Only to Deny a Claim

    Post 4734
    The California Court of Appeals dealt with a claim by Wynzell Lynn, Jr.
    in a breach of insurance contract case against defendants are AAA Life
    Insurance Company and its agent, Craigory Webb. Plaintiff appealed from a
    final judgment of dismissal that was entered after the trial court
    struck certain causes of action in plaintiff's operative complaint and
    sustained the defendants' demurrer as to other causes of action, without
    leave to amend.
    In Wynzell Lynn, Jr. v. AAA Life Insurance Company et al., F085402,
    California Court of Appeals, Fifth District (February 9, 2024) explained
    in a lengthy opinion why the trial court erred.
    FACTUAL BACKGROUND
    Plaintiff purchased from defendant AAA Life Insurance Company (AAA) a
    life insurance policy for himself, along with a child term rider (rider)
    providing up to $10,000 in coverage per insured child. According to the
    First Amended Complaint (FAC) plaintiff understood from his prepurchase
    conversations with Webb that the rider would cover all of the children
    in plaintiff's household.
    When plaintiff first contacted Webb within their household were four
    children under the age of 19.
    Webb, as the agent for the insurer, stated, "'the rider covers all your
    children for $7.00."
    The three-page rider contained the following relevant provisions. The
    rider "provides term life insurance coverage for each Insured Child." An
    Eligible Child must be dependent upon the Insured for support and
    living within the Insured's household or attending an educational
    institution as a full-time or part-time student.
    In November 2020, about seven months after plaintiff's policy became
    effective, tragically, Bowen was fatally shot. On the date of his death,
    Bowen was 17 years old, unmarried, financially dependent on plaintiff,
    and living in plaintiff's household.
    DISCUSSION
    Breach of Contract (Express Contract Theory)
    To the extent the rider can reasonably be interpreted to provide
    coverage for a child with a relationship to the insured akin to Bowen's
    relationship with plaintiff, the FAC properly pleads the element of
    breach-the only element the trial court found missing.
    In addition, in Shade Foods, Inc. v. Innovative Products Sales
    &Marketing, Inc. (2000) 78 Cal.App.4th 847 (Shade Foods) the Court
    of Appeals held that an insurance carrier is "bound by its agent's
    interpretation of coverage under the policy," and an agent's authority
    to bind the principal "unquestionably extends to giving ambiguous
    contract provisions an interpretation that the insurer itself might
    reasonably adopt." As a result, the court concluded, the insurer was
    "bound by its agent's interpretation of the contract."
    Breach of the Covenant of Good Faith and Fair Dealing
    Negligence
    Accordingly, it concluded the FAC alleges adequate facts to show a
    special duty of care, breach of that duty, causation, and damages.
    ZALMA OPINION
    This case, over a $10,000 dispute, went through a claim denial, a
    demurrer dismissing the entire action, an appeal, a reversal of the
    breach of contract claim, and a return to the trial court to allow
    amendment of a statutory breach claim, if possible, and trial on the
    breach of contract case. No bad faith because it took the court to find a
    statute making a person "held out as a son" to be a son even if there
    is no physical, natural relationship nor a relationship by adoption.
    This is a case where the concept of "millions for defense and not a dime
    for tribute" requires reconsideration, mediation and settlement.
    (c) 2024 Barry Zalma & ClaimSchool, Inc.
    Please tell your friends and colleagues about this blog and the videos
    and let them subscribe to the blog and the videos.
    Subscribe to my substack at
    https://barryzalma.substack.com/publish/post/107007808
    gO to the Insurance Claims Library –
    http://zalma.com/blog/insurance-claims-library.


    13 min
  • No Duty to Defend No Possible Duty to Indemnify

    Legal Conclusions are Not Allegations of Fact

    Post 4734
    Zox LLC ("Zox") appealed the district court's grant of summary judgment
    in favor of West American Insurance Company. The district court held
    that West American had no duty to defend or indemnify Zox in an
    underlying trademark dispute between Zox and a group of entrepreneurs
    known as the "Zox Brothers" ("the Zox Litigation"). Zox contends the
    district court erred because the Zox Brothers sought damages for three
    potentially covered claims: (1) malicious prosecution; (2)
    disparagement; and (3) use of an "advertising idea."
    In ZOX LLC, a California Limited Liability Company, v.  West American
    Insurance Company; et al., No. 23-55125, United States Court of Appeals,
    Ninth Circuit (February 9, 2024) the Ninth Circuit resolved the
    dispute.
    ANALYSIS
    Under California law, a liability insurer owes a broad duty to defend
    its insured against claims that potentially seek damages within the
    coverage of the policy. Coverage turns not on the technical legal cause
    of action pleaded by the third party but on the facts alleged.
    While the duty to defend is broad, an insurer will not be compelled to
    defend its insured when the potential for liability is tenuous and
    farfetched. To determine whether the duty to defend was triggered, the
    Ninth Circuit was compelled to compare the allegations in the Zox
    Brothers' pleadings ("the Pleadings") with the terms of West American's
    Insurance Policy ("the Policy").
    Malicious Prosecution
    To plead a malicious prosecution claim, the Zox Brothers must plead
    facts to prove that an underlying action was initiated or maintained (i)
    by, or at the direction of, [Zox] and pursued to a legal termination in
    favor of the Zox Brothers; (ii) without probable cause; and (iii) with
    malice. The Zox Brothers did not plead facts, nor provide extrinsic
    evidence, to satisfy any of the requisite elements of a malicious
    prosecution claim. The Pleadings did not trigger coverage for malicious
    prosecution.
    Disparagement
    To plead a disparagement claim, the Zox Brothers must plead facts to
    show a false or misleading statement that (1) specifically refers to the
    Zox Brothers' product or business and (2) clearly derogates that
    product or business. The Ninth Circuit was required to look past labels
    and at the facts alleged. Zox was unable to cite a single factual
    pleading in support of a disparagement claim.
    Appropriation of Advertising Ideas
    Where there is a duty to defend, there may be a duty to indemnify; but
    where there is no duty to defend, there cannot be a duty to indemnify.
    ZALMA OPINION
    The Ninth Circuit applied the clear and unambiguous language of the
    policy to the "facts" alleged; found that the allegations were mostly
    speculative or based on legal conclusions, failure to allege facts to
    support the three claims failed and, therefore, the Ninth Circuit had no
    choice but to affirm the summary judgment find no duty to defend nor a
    duty to indemnify.
    (c) 2024 Barry Zalma & ClaimSchool, Inc.
    Please tell your friends and colleagues about this blog and the videos
    and let them subscribe to the blog and the videos.
    Subscribe to my substack at
    https://barryzalma.substack.com/publish/post/107007808
    Go to Newsbreak.com  https://www.newsbreak.com/@c/1653419?s=01
    Go to X @bzalma; Go to the podcast Zalma On Insurance at
    https://podcasters.spotify.com/pod/show/barry-zalma/support; Go to Barry
    Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to
    Barry Zalma on YouTube-
    https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg;  Go to the
    Insurance Claims Library –
    http://zalma.com/blog/insurance-claims-library.


    7 min
  • Ambiguous Exclusion Unenforceable

    Unrepaid, Unrecoverable, or Outstanding Credit Exclusion Unrepaid, Unrecoverable, or Outstanding Credit Exclusion Unenforceable

    Post 4731
    Huntington National Bank ("Huntington") sued AIG Specialty Insurance
    Company and National Union Fire Insurance Company of Pittsburgh,
    Pennsylvania (together, "AIG") alleging breach of contract and bad faith
    stemming from AIG's denial of insurance coverage for Huntington's
    settlement of a bankruptcy fraudulent transfer proceeding brought by the
    trustee of a bankrupt company. In granting summary judgment for AIG,
    the district court held that:
    In Huntington National Bank v. AIG Specialty Insurance Co., et al., No.
    23-3039, United States Court of Appeals, Sixth Circuit (February 1,
    2024) the Sixth Circuit resolved the dispute.
    FACTS
    AIG issued to Huntington a bankers professional liability insurance
    (BPL) policy for that provided coverage up to $15 million, after a $10
    million retention. Any liability exceeding the primary policy was
    covered by an excess policy issued by National Union for the same
    coverage period, which provided $10 million in excess coverage. The
    parties do not dispute that these policies apply to Huntington's claim.
    Following the FBI raid, creditors of Cyberco and Teleservices, both
    entirely fraudulent companies, discovered that the companies were
    bankrupt. The trustees of Cyberco and Teleservices filed adversary
    proceedings against Huntington, claiming that Huntington put its desire
    to be repaid ahead of its concerns that Watson was committing fraud and,
    by doing so, perpetuated the Ponzi scheme to its benefit and other
    lenders' detriment.
    The bankruptcy proceedings were long and complex, including two trials
    and multiple opinions.  Huntington argued it was not liable for any
    repayments before April 30, 2004, and that its liability was thus
    limited to the $12,821,897.07 in loan repayments for which the Sixth
    Circuit had already found Huntington liable.
    THE INSURANCE CLAIM
    Throughout the bankruptcy litigation, Huntington sent AIG several
    requests for coverage. AIG disclaimed coverage, acknowledging that there
    was "potential coverage" under the policy because the Wrongful Acts
    alleged arose from Huntington's performance of banking services to
    Cyberco, but citing  exclusions. AIG refused Huntington's claims.
    Huntington subsequently sued AIG. AIG also moved for summary judgment,
    asserting that Huntington's settlement payment was not a "Loss" under
    the policy and, even if it was, Endorsements 5, 7, and 10 precluded
    coverage.
    The district court granted AIG's motion for summary judgment.
    ANALYSIS
    The Sixth Circuit reversed the district court's grant of summary
    judgment for AIG on the insurability of Huntington's claim under Ohio
    law and the exclusion of Huntington's claim under Endorsement 7.
    ZALMA OPINION
    Bankruptcy litigation, banking, and fraud upon a bank by a Ponzi schemer
    who, when caught by the FBI committed suicide, was sued by creditors of
    the Ponzi scheme because the bank had its loan repaid and they did not.
    After lengthy litigation the bank settled the bankruptcy suits only to
    have its insurer refuse to pay based upon an exclusion that was not
    sufficiently clear to be enforced. AIG will need to pay its limits to
    its insured and the excess - that followed form with AIG - will probably
    find it must pay its limits as well. The Sixth Circuit read the full
    policy and interpreted it in line with Ohio law as should AIG before it
    rejected coverage.
    (c) 2024 Barry Zalma & ClaimSchool, Inc.
    Please tell your friends and colleagues about this blog and the videos
    and let them subscribe to the blog and the videos.
    Subscribe to my substack at
    https://barryzalma.substack.com/publish/post/107007808
    Go to the Insurance Claims Library –
    http://zalma.com/blog/insurance-claims-library.

    8 min
  • Ambiguous Exclusion Unenforceable

    Unrepaid, Unrecoverable, or Outstanding Credit Exclusion Unenforceable

    Post 4731
    Huntington National Bank ("Huntington") sued AIG Specialty Insurance
    Company and National Union Fire Insurance Company of Pittsburgh,
    Pennsylvania (together, "AIG") alleging breach of contract and bad faith
    stemming from AIG's denial of insurance coverage for Huntington's
    settlement of a bankruptcy fraudulent transfer proceeding brought by the
    trustee of a bankrupt company. In granting summary judgment for AIG,
    the district court held that:
    In Huntington National Bank v. AIG Specialty Insurance Co., et al., No.
    23-3039, United States Court of Appeals, Sixth Circuit (February 1,
    2024) the Sixth Circuit resolved the dispute.
    FACTS
    AIG issued to Huntington a bankers professional liability insurance
    (BPL) policy for that provided coverage up to $15 million, after a $10
    million retention. Any liability exceeding the primary policy was
    covered by an excess policy issued by National Union for the same
    coverage period, which provided $10 million in excess coverage. The
    parties do not dispute that these policies apply to Huntington's claim.
    Following the FBI raid, creditors of Cyberco and Teleservices, both
    entirely fraudulent companies, discovered that the companies were
    bankrupt. The trustees of Cyberco and Teleservices filed adversary
    proceedings against Huntington, claiming that Huntington put its desire
    to be repaid ahead of its concerns that Watson was committing fraud and,
    by doing so, perpetuated the Ponzi scheme to its benefit and other
    lenders' detriment.
    The bankruptcy proceedings were long and complex, including two trials
    and multiple opinions.  Huntington argued it was not liable for any
    repayments before April 30, 2004, and that its liability was thus
    limited to the $12,821,897.07 in loan repayments for which the Sixth
    Circuit had already found Huntington liable.
    THE INSURANCE CLAIM
    Throughout the bankruptcy litigation, Huntington sent AIG several
    requests for coverage. AIG disclaimed coverage, acknowledging that there
    was "potential coverage" under the policy because the Wrongful Acts
    alleged arose from Huntington's performance of banking services to
    Cyberco, but citing  exclusions. AIG refused Huntington's claims.
    Huntington subsequently sued AIG. AIG also moved for summary judgment,
    asserting that Huntington's settlement payment was not a "Loss" under
    the policy and, even if it was, Endorsements 5, 7, and 10 precluded
    coverage.
    The district court granted AIG's motion for summary judgment.
    ANALYSIS
    Under Ohio law, an insurance policy is a contract between the insurer
    and the insured. It is "well-settled" in Ohio law that, where provisions
    of a contract of insurance are reasonably susceptible of more than one
    interpretation, they will be construed strictly against the insurer and
    liberally in favor of the insured.
    Under the insurance policy, the definition of "Loss" excludes "civil or
    criminal fines or penalties imposed by law, punitive or exemplary
    damages . . . or matters that may be deemed uninsurable under the law
    pursuant to which this policy shall be construed."
    Go to the Insurance Claims Library –
    http://zalma.com/blog/insurance-claims-library.


    14 min
  • Serious Injury Does Not Change Policy Wording

    UIM Policy Reduced Limit Reduced by Amount Paid by Other Insurers

    In an interpleader action involving the insurance coverage for survivors
    of a tragic auto accident. De Smet Insurance Company of South Dakota
    (De Smet) proposed distribution of the available insurance funds that
    had been paid into the Court.
    Go to X @bzalma; Go to the Insurance Claims Library –
    http://zalma.com/blog/insurance-claims-library.


    10 min
  • Appraisal Pointless if Coverage Not Provided

    If Policy Says Building Coverage is "Not Provided" There Can be no Claim

    Post 4728
    Plaintiff Kota Me Patates LLC (“KMP”) filed a motion to compel appraisal
    to abate this insurance coverage dispute. Defendant Nationwide Mutual
    Fire Insurance Company responded with a separate motion for summary
    judgment asserting that the policy does not cover KMP's claimed losses.
    In Kota Me Patates LLC v. Nationwide Mutual Fire Insurance Company, No. 4:23-cv-01573,
    United States District Court, S.D. Texas, Houston Division (December
    21, 2023) the USDC's magistrate judge recommended a resolution of the
    disputes.
    BACKGROUND
    KMP had a business insurance policy with Nationwide (the “Policy”),
    effective from January 1, 2020 to January 1, 2021. The Policy states
    that it “includes Buildings ..., Business Personal Property ..., or
    both, depending on whether a Limit of Insurance is shown in the
    Declarations for that type of property.” (emphasis added). The
    referenced Declarations page explicitly states that coverage for KMP's
    building is “NOT PROVIDED[.]”
    On January 24, 2022, a year after expiration of the policy a
    representative from the office of KMP's attorney contacted Nationwide to
    report a claim for structural damage to KMP's property. The damage
    allegedly resulted from a plant explosion two years earlier, on January
    24, 2020.
    KMP sued Nationwide in Texas state court. Nationwide removed the suit to
    the USDC. In the meantime, Nationwide contacted KMP's counsel to obtain
    more information about KMP's claim. Eventually, KMP's attorney sent a
    formal notice of claim, stating that KMP intended to invoke the Policy's
    appraisal provision. Nationwide requested more information, including
    an opportunity to inspect the asserted damage and a sworn proof of loss.
    KMP failed to provide the information that Nationwide requested.
    Nationwide therefore denied coverage for the loss, noting that KMP
    failed to provide a description of how, when and where the loss or
    damage occurred, did not provide prompt notice of the loss or damage,
    and failed to submit a signed, sworn proof of loss as requested.
    Despite filing the suit months earlier, KMP's attorney finally sent
    Nationwide a demand letter on October 2, 2022. The letter included an
    estimate of $92,508.92 to repair KMP's structure. KMP then filed a
    motion to compel appraisal and abate the suit. Nationwide instead filed a
    motion for summary judgment.
    ANALYSIS
    Nationwide sought summary judgment on KMP's breach of contract claim on
    multiple grounds, including that the Policy does not cover KMP's claim
    for damages to its building. Given the clear Policy language, the Court
    had no need to address Nationwide's alternative contentions.
    The Policy provides zero coverage for any damage to the building.
    Because Nationwide did not breach the Policy by denying coverage, it is
    entitled to summary judgment on KMP's breach-of-contract claim.
    ZALMA OPINION
    The KMP claim was incompetent on many bases, not the least of which was a
    claim for damage to a building that the policy explicitly said in bold
    print that building coverage was "NOT PROVIDED." Add to that a two year
    late report, no compliance with policy conditions, and a spurious
    argument for tort damages and the Magistrate apparently had no choice
    but to recommend granting Nationwide's motion and sending KMP and its
    counsel home with a total loss. Counsel for KMP apparently failed to
    read the Declarations page of the policy. A total waste of time for the
    litigants and the court.
    (c) 2024 Barry Zalma & ClaimSchool, Inc.
    Go to the Insurance Claims Library –
    http://zalma.com/blog/insurance-claims-library.


    9 min
  • A Incomplete Aircraft is Still an Aircraft

    Injured by an Aircraft Fuselage Arose Out of Ownership of Aircraft

    Post 4727
    A woman was severely injured while moving an inoperable airplane. She
    now seeks to recover from her husband's homeowner's insurance policy.
    The insurance policy excludes injuries "arising out of" the ownership,
    maintenance, use, loading or unloading of an aircraft. The policy
    further defines "aircraft" as "any conveyance used or designed for
    flight."
    In Lisa Thompson v. United Services Automobile Association and Matthew
    Mrzena, No. S-18462, Supreme Court of Alaska (January 26, 2024) the
    Supreme Court resolved the dispute over interpretation of the policy
    wording.
    FACTS
    Claiming that the policy should cover her injury because in her view the
    aircraft became mere "parts" after her husband removed the wings,
    elevators, and tail rudder. The superior court disagreed, concluding
    that the fuselage was still an "airplane" and that, in any event, her
    injuries arose from her husband's ownership of the aircraft. The court
    determined that her injuries were therefore not covered by the policy.
    Around 2011 Matthew Mrzena purchased a 1946 Piper PA-12 airplane
    (Piper). Mrzena stopped using the Piper in 2014 when it failed an annual
    inspection and was deemed no longer airworthy. Mrzena removed the
    wings, tail rudder, and elevators from the fuselage, leaving the
    remainder of the fuselage and many other parts intact, including the
    wheeled landing gear, propeller, seats, windows, and engine. Mrzena kept
    the Piper in a plastic temporary garage at his home in Palmer, Alaska.
    In 2019, Mrzena purchased a new residence where he planned to live with
    his now-wife Lisa Thompson. During the summer Thompson and Mrzena were
    in the process of moving their belongings, including the Piper, to the
    new home. As part of the move the Piper needed to be pushed out of the
    garage and onto a trailer. Mrzena was pushing from the back of the
    Piper, with Thompson at the front, when Thompson became pinned under the
    Piper's nose. Thompson's resulting injuries were severe.
    At the time of the injury Mrzena had the Piper registered as an aircraft
    with the Federal Aviation Administration (FAA). He also held an
    aircraft owner-specific liability policy on the Piper with Avemco
    Insurance Company (Avemco). Throughout his ownership of the Piper,
    Mrzena continued to renew both the Piper's FAA registration and the
    Avemco aircraft policy.
    DISCUSSION
    Interpreting USAA's aircraft exclusion pursuant to the reasonable
    expectations of the lay insured, the Supreme Court concluded that the
    policy's exclusion of coverage for injuries arising out of the ownership
    or maintenance of an aircraft applies to exclude coverage for
    Thompson's injuries.
    The USAA policy broadly excludes coverage for bodily injury "arising out
    of"  ownership and maintenance of an aircraft. This language supports
    the reasonable expectation that Thompson's injuries would not be covered
    because Mrzena and Thompson's movement of the fuselage, and her
    resulting injuries, "ar[ose] out of" Mrzena's ownership and maintenance
    of the Piper.
    Reasonable plane owners would not expect that their planes cease to be
    aircraft solely because the aircraft had been partially disassembled to
    perform maintenance.
    .
    ZALMA OPINION
    Common sense exists in the Alaska Supreme Court. An aircraft under
    repair is still an aircraft even if it cannot fly. The Plaintiff was
    injured while she an her husband were moving the aircraft to a new home
    where the intended repairs could continue. Therefore, the Plaintiff and
    her husband were involved in the ownership, maintenance use of an
    aircraft and the exclusion applies.
    (c) 2024 Barry Zalma & ClaimSchool, Inc.
    Go to the Insurance Claims Library –
    http://zalma.com/blog/insurance-claims-library.


    9 min
  • Zalma's Insurance Fraud Letter February 1, 2024

    ZIFL Volume 28 Issue 3

    Post 4726Subscribe AT
    https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D
    Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th year of
    publication dedicated to those involved in reducing the effect of
    insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is
    written by Barry Zalma.  It is provided FREE to anyone who visits the
    site at http://zalma.com/zalmas-insurance-fraud-letter-2/
    The current issue can be read in full at
    http://zalma.com/blog/wp-content/uploads/2024/01/ZIFL-02-01-2024.pdf and
    includes the following articles:
    Fraudulently Submitting Fake Applications Violates Licensing Statutes
    Insurance Producer Fraudulently Submits Applications to Insurer
    Read this full article and the entire issue of ZIFL
    http://zalma.com/blog/wp-content/uploads/2024/01/ZIFL-02-01-2024.pdf
    More McClenny Moseley & Associates Issues
    This is ZIFL’s twenty third installment of the saga of McClenny, Moseley
    & Associates and its problems with the federal courts in the State
    of Louisiana and what appears to be an effort to profit from what some
    Magistrate and District judges indicate may be criminal conduct to
    profit from insurance claims relating to hurricane damage to the public
    of the state of Louisiana.
    12/19/2023
    $10,170,665.53 Default Judgment Against MMA (Including Interest)
    Read this full article and the entire issue of ZIFL
    http://zalma.com/blog/wp-content/uploads/2024/01/ZIFL-02-01-2024.pdf
    Now Available The Compact Book of Adjusting Property Claims – Fourth
    Edition
    On January 2, 2024, in Kindle, paperback and hardback formats, The
    Compact Book of Adjusting Property Claims, Fourth Edition is now
    available for purchase here.and here.
    Read this full article and the entire issue of ZIFL
    http://zalma.com/blog/wp-content/uploads/2024/01/ZIFL-02-01-2024.pdf
    Convictions From the Coalition Against Insurance Fraud
    Dr. Michael Villarroel, working as a doctor in the US Navy, was
    sentenced in federal court to one year and one day in custody.
    Villarroel admitted that from 2012 to at least December 2015, he
    conspired with other members of the Navy to obtain money from the United
    States by making claims for life insurance payments based on
    exaggerated or fake injuries and disabilities. Villarroel certified that
    he reviewed the records and determined the injuries were legitimate
    when in fact he knew they were fake or exaggerated.
    Read this full article and the entire issue of ZIFL
    here.http://zalma.com/blog/wp-content/uploads/2024/01/ZIFL-02-01-2024.pdf
    Health Insurance Fraud Convictions
    Four Plead Guilty to Healthcare Offenses, Including Doctors and Lab
    Owners
    Mark Rubin, 58, Renee Field, 44, Kelly Nelson, 52, and Carlos Hornedo,
    61, were all charged via felony informations in December 2023. Mr.
    Rubin, on January 17th, and Mr. Hornedo, on January 10th, both pleaded
    guilty to one count of conspiracy to solicit and receive illegal
    kickbacks. federal prison, a $250,000 fine, and may be ordered to pay
    restitution.
    Read this full article and the entire issue of ZIFL
    http://zalma.com/blog/wp-content/uploads/2024/01/ZIFL-02-01-2024.pdf
    Lawyer With Unfortunate Name & Advertising Asking that People Should
    ‘Hire A Dick’ Faces Six Figure Sanctions
    Eric B. Dick, Esq, for the second time in three months has been ordered
    to reimburse an insurer more than $100,000 for filing a “frivolous,
    groundless” lawsuit made “solely for the purpose of harassment.”
    Read this full article and the entire issue of ZIFL
    http://zalma.com/blog/wp-content/uploads/2024/01/ZIFL-02-01-2024.pdf


    9 min

About Zalma on Insurance

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Presentation of insurance issues relating to claims handling, insurance coverage, interpretation of insurance policy coverages, insurance fraud, and investigation.