Zalma on Insurance

By Barry Zalma

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

· Business

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The podcast currently has 842 episodes available.

Zalma on Insurance episodes:

December 27, 2023 Fictionalized True Crime
The Largest Residential Burglary of All Time
This is a 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 story is designed to help Everyone to
Understand How Insurance Fraud in America is Costing Those who Buy
Insurance Thousands of Dollars Every year and Why Insurance Fraud is
Safer and More Profitable for the Perpetrators than any Other Crime.
To obtain the insurance he concealed from the American insurers that he
was, at the time he purchased the insurance: an alien a court had
ordered deported; that in his home country he was a wanted criminal;
that he had left his home country with over $60,000,000.00 in checks
unpaid; that every insurer at Lloyd’s, London had refused to insure
him; that all of his property was appraised for more than twice its
actual retail replacement value; and that most of the antiques he
had insured in reliance on an “appraisal” attesting to a $3,500,000
value, were fakes.
Within seven days of the delivery of his policy, a “burglary” was
reported. A total of $7,000,000.00 of specifically identified and
scheduled personal property was reported stolen. He claimed an
additional $2,000,000 in unscheduled diamonds were stolen from their
hiding place in one of his 50 suit coats hanging in his master bedroom
closet.
The insurers refused to pay because they believed the insured made
material misrepresentations and he concealed material facts in the
purchase of the insurance.
The Insured retained a prestigious plaintiff’s bad faith lawyer to
represent his interests. Because of the reputation of counsel for the
Insured and the fear of an extra-contractual judgment, the insurers
(against the advice of three different defense firms) settled for more
than $4,000,000.00 of the $7,000,000.00 claim. The Insured’s lawyer took
a contingent fee of 50%, the insured’s creditors took 20%, and the
Insured took what remained. Because the IRS was unable to assert its
multi-million-dollar lien in time, it got nothing.
After a trip to China to take an examination under oath of the insured’s
sister – who was also named as an insured – and two years of discovery,
counsel for the insurers moved the court for summary judgment
confirming rescission of the policy. The evidence available of multiple
misrepresentations and the concealment of material facts, rescission was
warranted and counsel was confident the court would agree.
The day before the insurers’ counsel were to appear for oral argument on
the motion for summary judgment the insurers and the insured’s lawyer
settled the suit without communicating with defense counsel and against
the recommendations of defense counsel.
To recover the money lost by paying the Insured the insurers could only
pass the payment on to other, honest, insureds and the reinsurers.
Once an insurer gets a reputation for paying for fraudulent claims
rather than fighting with all of its assets those who perpetrate
fraudulent claims will gather like vultures over a rotting carcass ready
to pick the bones clean. The reverse is also true: when an insurer
makes it clear it will never pay a fraudulent claim, regardless of cost,
those who earn their living by fraud will stay away.
It is time that prosecutors learn that the victim is not the giant
insurance company but each and every person who buys insurance.
(c) 2023 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 the Insurance Claims Library –
http://zalma.com/blog/insurance-claims-library.

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13min
December 27, 2023 Insurance Fraud as a State Crime
Insurance Fraud as a State Crime
https://zalma.com/blog

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12min
December 20, 2023 Waiver of Right to Appeal Effective
Insurance Agent Defrauded Clients by Taking Premium Money and Keeping it
for Personal Expenses
When a criminal defendant's valid guilty plea includes a waiver of the
right to appeal, the Fourth Circuit Court of Appeals generally enforces
the waiver by dismissing any subsequent appeal that raises issues within
the scope of the waiver. However, even if an appeal waiver is valid and
applicable, the Fourth Circuit will review a claim that a district
court's sentence or restitution order exceeded the court's statutory
authority.
In United States Of America v. Glenda Taylor-Sanders, Nos. 21-4136,
20-4604, United States Court of Appeals, Fourth Circuit (December 12,
2023) the Defendant sought a change of the sentence and restitution
order.
FACTS
From February 2017 through May 2019, Taylor-Sanders took advantage of
her role as a licensed insurance agent to defraud several trucking
companies and the insurance finance company BankDirect Capital Finance.
She defrauded the trucking companies by misappropriating funds that the
companies provided her to pay for their insurance policy premiums and
BankDirect Capital Finance by obtaining loans under the guise of
nonexistent insurance policies. Instead of using the funds she obtained
to pay insurance policy premiums or to pay back BankDirect Capital
Finance for the legitimate loans it made to the trucking companies,
Taylor-Sanders spent the funds on personal expenditures including cars,
football tickets, and mortgage payments.
Predictably, some of the trucking companies' insurance policies
ZALMA OPINION
Fraud perpetrators have no honor. Even after obtaining a plea agreement
that saved her years in prison, Taylor-Sanders took up the time of the
District Court and the Fourth Circuit to hear a spurious motion to
withdraw her guilty plea after knowingly entering into the plea
agreement and waiving her right to appeal. She will pay restitution and
spend an appropriate time in jail.
(c) 2023 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
Follow me on LinkedIn:
www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257
Go to the Insurance Claims Library –
http://zalma.com/blog/insurance-claims-library.

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9min
December 20, 2023 A Christmas Fable of Fraud
The Christmas Gift of Insurance Fraud

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19min
December 18, 2023 Subrogation Must be Fair
Insurer May Never Subrogate Against its own Insured
Zurich American Insurance et al sued their coinsurers - Appellant
Certain Underwriters at Lloyd's, London Subscribing to Policy Number
B12630308616 (Lloyd's) and Defendant Arch Insurance Company (Arch) -
seeking a declaratory judgment that Lloyd's is barred under New York law
from bringing a common law indemnification or contribution claim
against a party insured by Zurich, Arch, and Lloyd's.
The district court granted Zurich's motion for summary judgment, holding
that New York's anti-subrogation rule precludes Lloyd's from bringing
that claim.
In Zurich American Insurance Company, American Zurich Insurance Company
v. Certain Underwriters at Lloyd's of London Subscribing to Policy
Number B12630308616, Arch Insurance Company, No. 22-2697, United States
Court of Appeals, Second Circuit (December 12, 2023) the Second Circuit
resolved the dispute.
Many Layers of Insurance
This dispute arose from a large construction project at LaGuardia
Airport. Pursuant to the contract, Skanska and LGA obtained a
Contractors Controlled Insurance Program for the project, which included
a "tower" of general liability insurance with $300 million of coverage
in three layers. Zurich underwrote the base layer of coverage, Arch
provided a first layer of excess coverage, and then Lloyd's provided a
second excess policy, i.e. a third layer of coverage on top of Arch's.
Zurich arranged for counsel to represent Port Authority and LGA
beginning in August 2018. Roughly three years later, Lloyd's contacted
that counsel and requested that LGA and Port Authority commence a
third-party claim for common law indemnification or contribution against
Skanska. Counsel analyzed the feasibility of such a claim but concluded
that New York's anti-subrogation rule would bar it.
The Anti-Subrogation Rule
New York courts have established an anti-subrogation rule that is an
exception to an insurer's usual right of subrogation against third
parties. It provides that an insurer has no right of subrogation against
its own insured for a claim arising from the very risk for which the
insured was covered.
The anti-subrogation rule is needed both to prevent the insurer from
passing the incidence of loss to its own insured and to guard against
the potential for conflict of interest that may affect the insurer's
incentive to provide a vigorous defense for its insured.
ZALMA OPINION
Subrogation is an equitable remedy where, when an insurer pays a debt
owed by its insured, fairness requires the insured to provide the
insurer with the insured's rights against third parties to recoup its
payment on behalf of the insured. Regardless, it is unfair for an
insurer to seek damages from its own insured because doing so violates
the public policy of the state of New York and is, on its face, unfair.
When two people are in a simple auto accident but are insured by the
same insurer, they will both be paid regardless of who is at fault since
the insurer can't subrogate against its own insured.
(c) 2023 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
Follow me on LinkedIn:
www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257
Daily articles are published at https://zalma.substack.com. 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.

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8min
December 18, 2023 Zalma's Insurance Fraud Letter - December 15, 2023
Zalma's Insurance Fraud Letter - December 15, 2023
Merry Christmas, Happy Hanukah, and May the Winter Solstice be Peaceful & Mild

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11min
December 14, 2023 Insurance Litigation Never Easy
When Appraisers Fail to Agree on Umpire Court Must Appoint One

When a claim for damages due to a hurricane was disputed the parties demanded appraisal and appointed their respective appraisers. However, the appraisers could not agree on an umpire for reasons unclear and bad faith litigation ensured. Because of the inability of the appraisers to agree on an umpire the parties went to the District Court to appoint an umpire so the appraisal process can proceed.
In DORIAN THEODORE v. ALLIED TRUST INSURANCE COMPANY, Civil Action No. 22-951-SDD-RLB, United States District Court, M.D. Louisiana (October 18, 2023) the parties moved the USDC in Louisiana to appoint an Appraisal Umpire. The parties submitted separate lists of proposed umpires and their respective CVs for the Court's consideration.
The lawsuit involves claims for damage to property located in Gonzales, Louisiana as a result of Hurricane Ida. Dorian Theodore (“Plaintiff”) sought coverage and statutory bad faith damages related to claims made under an insurance policy (the “Policy”) issued by Allied Trust Insurance Company (“Defendant”).
The parties represent that the Policy provides the following language with respect to appraisals, including the appointment of an umpire:
Appraisal
If you and we fail to agree on the amount of loss, either may demand an appraisal of the loss. In this event, each party will choose a competent and impartial appraiser within 20 days after receiving a written request from the other. The two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of a court of record in the state where the "residence premises" is located. The appraisers will separately set the amount of loss. If the appraisers submit a written report of an agreement to us, the amount agreed upon will be the amount of loss. If they fail to agree, they will submit their differences to the umpire. Any outcome of the appraisal will not be binding on either party.
Each party will:
1. Pay its own appraiser; and
2. Bear the other expenses of the appraisal and umpire equally.
Prior to the filing of this lawsuit, the parties selected their initial appraisers when Defendant demanded an appraisal of the loss. Plaintiff designated Matthew Addison as Plaintiff's appraiser, and Defendant designated Ronald West as its appraiser. After the filing of this lawsuit, Plaintiff designated Mike Deckelman as Plaintiff's appraiser. The parties' appraisers were unsuccessful in jointly selecting an umpire in accordance with the Policy.
As ordered, the parties submitted separate lists of proposed umpires for potential appointment.
There is no dispute between the parties that the appraisal provision in the Policy is enforceable. The parties have jointly sought court appointment of an umpire in accordance with the appraisal provision in the Policy.
If Mr. Cole declines to serve as umpire in this matter, then the Court selects Joel Moore as umpire. His resume demonstrates that he is As discussed above, although both Mr. Cole and Mr. Moore were proposed by the Plaintiff, the Court has no reason to suggest that both can fulfill this role in a fair, neutral and impartial manner.
Insurance claims resulting from hurricanes that have struck Louisiana have become aggressive, unfair and unreasonable. For two appraisers to fail to pick an umpire is an indication of litigation game playing forcing the District Court to appoint an umpire. This litigation requiring a judge to do what insurance appraisers do every day with little or no discussion reflects a desire to make the process more expensive and difficult rather than fulfill its purpose to quickly and fairly resolve the quantum of a loss.
(c) 2023 Barry Zalma & ClaimSchool, Inc.

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7min
December 12, 2023 No Right to Insurance Proceeds After Foreclosure
Foreclosure Changes Insurable Interest from Borrower to Lender
Post 4787
In this contested residential mortgage foreclosure, defendants Mitchell
and Deanna Minchello appealed from the entry of summary judgment.
Defendants contended that plaintiff violated the covenant of good faith
and fair dealing by "refusing to disburse defendants' insurance proceeds
and forcing defendants' home to remain in disrepair" and that the trial
court applied an improper standard.
In Wilmington Savings Fund Society, FSB, d/b/a Christiana Trust, as
owner trustee of the Residential Credit Opportunities Trust V v.
Mitchell Minchello and Deanna Minchello, and J Hofert Company, FIA Card
Services NA, Schumann Hanlon LLC, Discover Bank, Vanz LLC-December 10
Series01, Mri-West Morris Associates, and State Of New Jersey, No.
A-3522-21, Superior Court of New Jersey, Appellate Division (December 8,
2023) the issues were resolved.
FACTS
The essential facts were undisputed. Defendants borrowed $522,000 in
January 2007, secured by a thirty-year purchase money mortgage on their
home in Mt. Arlington. Defendants stopped making their loan payments in
2010, and in 2012 they stopped paying the taxes and insurance on the
property. In 2014 the lenders asserted its rights by suing for
foreclosure in March 2015.
Defendants filed a bankruptcy petition under Chapter 13. The following
day, December 7, defendant Deanna Minchello drove her car into
defendants' home, resulting in structural damage. The only insurance was
forced placed insurance in the name of the lender.
ANALYSIS
The trial judge granted plaintiff's motion for summary judgment. The
judge found no dispute over the validity of the note and mortgage,
defendants' default in 2010 and plaintiff's standing to foreclose the
mortgage. Whether the lender allowed the insurance money to go to repair
the structure was irrelevant since the foreclosure put the insurable
interest in the lender and the lender was the only person insured.
Although the procedural history is long and complicated with the
parties' appendices exceeding 800 pages, the legal issues are
straightforward, and the Court of Appeals had no hesitation in holding
plaintiff established its entitlement to both summary judgment.
CONCLUSION
The trial court's orders that plaintiff established its right to
foreclose the mortgage, that defendants did not succeed in establishing
plaintiff should be barred from asserting that equitable remedy, and
that final judgment of foreclosure was properly entered against
defendants.
ZALMA OPINION
When borrowers fail to pay mortgage payments, insurance premiums and
taxes they have no insurance in their name, only the insurance acquired
by the lender to protect its interests. The lendER can apply the
insurance to repair or simply apply it to reduce the debt. It took some
unmitigated gall to sue the lenders in this after defaulting in every
obligation owed by a property owner that pledged the property as
security for the loan. The court found it necessary to read and analyze
all 800 pages and still found the trial court's judgment in favor of the
lender to be appropriate. Why the court did not sanction the borrowers
and their attorneys is confusing to me.
(c) 2023 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
Follow me on LinkedIn:
www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257

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6min
December 12, 2023 When Parties Agree to Appraisal Court has no Choice but to Agree
Appraisal Required to Resolve Extent of Loss
Post 4786
In an insurance dispute stemming from Hurricane Ian. The parties agree
that their case should go to appraisal to determine the extent of the
loss.
When an insurance policy contains an appraisal provision, “the right to
appraisal is not permissiv
e but is instead mandatory, so once a demand for appraisal is made,
‘neither party has the right to deny that demand.'” [McGowan v. First
Acceptance Ins. Co., Inc., 411 F.Supp.3d 1293, 1296 (M.D. Fla. 2019)
(quoting United Cmty. Ins. Co. v. Lewis, 642 So.2d 59, 60 (Fla. 3d DCA
1994)].
Like other stipulations about dispute resolution, the Court enforces
contractual appraisal provisions by non-dispositive order. Therefore, in
Buena Vista Of Deep Creek Condominium Association, Inc. v. Clear Blue
Specialty Insurance Company, No. 2:23-cv-957-SPC-KCD, United States
District Court, M.D. Florida (November 27, 2023) the court concluded
that because appraisal will not dispose of any claims or defenses, the
Court did not treat the motion to compel appraisal as one for summary
judgment.
Since the parties agreed that appraisal is appropriate, their request
was granted. Further, the parties requested a stay during appraisal
which was also granted because the Hurricane Ian Scheduling Order
contemplates such relief if the parties agree that appraisal is
appropriate. Thus, the case will be stayed.
All deadlines and events in the Hurricane Ian Scheduling Order are
suspended. The parties have agreed that the appraisal panel must itemize
the awarded damages by coverage, to be accompanied by a supporting
estimate. Though the parties cite no contractual provision that requires
such an award, because the parties agree, their request will be
granted.
According, it is hereby ORDERED:
The Joint Stipulation for Appraisal and Stay of the Case was GRANTED,
and the appraisal panel must itemize the awarded damages by coverage, to
be accompanied by a supporting estimate.
This case is STAYED pending appraisal, and the Clerk must add a stay
flag to the file and administratively close the case.
The parties are DIRECTED to file a joint report on the status of
appraisal on or before February 26, 2024, and every ninety days
thereafter until appraisal has ended.
Within 15 days of a signed appraisal award, the parties are directed to
jointly notify the Court of (a) what issues, if any, remain for the
Court to resolve; (b) whether the stay needs to be lifted; and (c) how
this action should proceed, if at all.
ZALMA OPINION
The Appraisal condition of a first party property policy is an
extra-judicial means of resolving disputes between an insurer and an
insured about the amount of loss. Since the parties agreed that
appraisal was an appropriate manner of resolving that limited dispute
they moved to stay the action in hopes that the appraisal result will
allow the parties to resolve all their differences. The court understood
and issued orders to fulfill the agreement of the parties.
(c) 2023 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
Follow me on LinkedIn:
www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257
Daily articles are published at https://zalma.substack.com. 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.

...more
6min
December 12, 2023 Drunk Driving into a Pole Not a Covered Loss
No Coverage for Loss After Policy Cancelled
In an action for declaratory judgment to determine whether the
plaintiffs had a duty to defend and indemnify the defendants under
certain insurance policies for injuries sustained in a motor vehicle
accident, where the trial court granted the plaintiffs' motion for
summary judgment.
In Liberty Insurance Corporation et al. v. Theodore Johnson et al., No.
AC 45933, Court of Appeals of Connecticut (December 5, 2023) the Court
of Appeals resolved the dispute.FACTSThe defendants, Theodore Johnson
(Theodore) and Kim Johnson (Kim), appealed from the judgment rendered by
the trial court following its granting of a motion for summary judgment
filed by the plaintiffs, Liberty Insurance et al and Safeco Insurance
Company of Illinois (Safeco).
The primary issue is duty to defend a separate action that stemmed from a
motor vehicle accident in which the defendants' son, Aaron Johnson
(Aaron), was driving a motor vehicle owned by Theodore when he lost
control of the vehicle and struck a telephone pole, causing serious
injuries to a passenger in the vehicle, Jordan Torres.At some point
prior to 1:33 a.m. on December 26, 2019, Aaron left the defendants'
house and operated a 1997 Audi A4 2.8 Quattro (Audi) owned by Theodore.
Torres was a passenger in the Audi at the time.
As Aaron attempted to navigate a curve, he lost control of the Audi,
crossed into the westbound lane of traffic, and left the roadway,
striking a telephone pole.Torres sustained personal injuries in the
accident and sued a bar in Newington and its backer, as well as
Theodore, Kim and Aaron. In the Torres action, Torres alleged that, on
December 25, 2019, Aaron, a minor, consumed alcohol at the bar, after
which he went to the defendants' house in Glastonbury, where he was
visibly intoxicated and consumed more alcohol.
Following the commencement of the Torres action, the defendants sought
coverage from the plaintiffs for Torres' claims under three policies of
insurance:a homeowners insurance policy issued to the defendants by
Liberty Insurance (homeowners policy);an automobile insurance policy
issued to the defendants by Safeco (automobile policy); andan umbrella
insurance policy issued to the defendants by Liberty Mutual (umbrella
policy).
Thereafter, the insurer plaintiffs sued seeking a judgment declaring
that the plaintiffs are not obligated to defend or indemnify the
defendants with respect to Torres’ action.Specifically, the insurers
based that argument on an exclusion in the homeowners policy that
excludes coverage for" 'bodily injury' or 'property damage' . . .
arising out of (1) [t]he ownership, ... of motor vehicles ... operated
by or rented or loaned to an 'insured' [motor vehicle exclusion] . . .
."

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6min

FAQs about Zalma on Insurance:

How many episodes does Zalma on Insurance have?

The podcast currently has 842 episodes available.