The Insured Has no Right to Control Settlements Made by Insurer
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Moses Taylor Foundation on behalf of Moses Taylor Hospital (“Moses Taylor”), to recover damages for the alleged breach of contract by Defendants, Coverys and Proselect Insurance Company (“Coverys”) for failure to negotiate a desirable settlement in a previous lawsuit (“the underlying suit”). In Moses Taylor Foundation O/B/A Moses Taylor Hospital v. Coverys and Proselect Insurance Company, CIVIL No. 3:20-CV-00990, United States District Court, M.D. Pennsylvania (November 22, 2021) the USDC was faced with a claim that the damages alleged by the plaintiff was speculative because it had not been damaged. The court allowed the plaintiffs one chance to amend and then ruled on the motion to dismiss the amended complaint.
FACTS
In February 2019, the minor plaintiff made a demand for the policy limits of the insurance coverage that Coverys provided to Moses Taylor. A few days after the demand, Moses Taylor claims that it informed Coverys of the need to settle the case within its policy limits at the scheduled March 1, 2019 pre-trial conference. Moses Taylor alleges that it persuaded Coverys to engage in a high-low arbitration after Moses Taylor agreed to contribute $500,000 of its own funds. The “low” limit was set at $2,500,000 and the “high” limit was set at $7,750,000.
ZALMA OPINION
Almost every liability policy, including those covering a hospital’s alleged malpractice, provides control of the payment of claims or the settlement of law suits to the insurer regardless of the demands made by the insured. The insurer, in this case, refused to settle, agreed to participate in a high/low arbitration and when the arbitrator entered an award higher than the high limit it paid the high limit agreed which was less than the available limits in its policy for Moses Taylor. Since Moses Taylor suffered no loss – claiming it might have a loss in the future because of the depletion of the policy limits, is speculative since it might never be sued. There was, therefore no harm and no damage to the insured.
© 2021 – Barry Zalma
Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.
Posted on September 18, 2026 by Barry Zalma
See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html
In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.
The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.
Law
The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...
150 Months in Prison for Tax Fraud
Post 4846
Posted on September 17, 2026 by Barry Zalma
See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.
The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...
Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution
Post 5489
Posted on September 14, 2026 by Barry Zalma
Fraudster Refuses to Answer Questions About His Alleged Fraud
See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr
In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.
Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.
After Great American ...
Plaintiff Must Allege the Who, What, When, Where, and How requirements of Federal Rule of Civil Procedure
Post 4573
Posted on October 30, 2026 by Barry Zalma
In Texoma Cowboy Church, Inc v. Church Mutual Insurance Company, S.I., Civil Action No. 7:26-CV-00062-O, United States District Court, N.D. Texas, Wichita Falls Division (October 22, 2026) Plaintiff Texoma Cowboy Church, Inc. was insured by Defendant Church Mutual Insurance Company, S.I. under a policy covering its property at 919 U.S. Hwy 281, Wichita Falls, Texas, from May 28, 2024, to May 28, 2025. The policy carried a $309,250.50 deductible for windstorm and/or hail coverage.
FACTS
On or about April 5, 2025, a hail and windstorm allegedly damaged the property. ProNet confirmed hail impact on April 5, 2025, producing dents and panel separations on the roofing, but found that water intrusion and interior damage predated the storm. Defendant also obtained a third-party contractor bid.
After deductible and depreciation, it paid $626,607.67. Plaintiff contended the estimate and ...
Plaintiff Must Allege the Who, What, When, Where, and How requirements of Federal Rule of Civil Procedure
Post 4573
Posted on October 30, 2026 by Barry Zalma
In Texoma Cowboy Church, Inc v. Church Mutual Insurance Company, S.I., Civil Action No. 7:26-CV-00062-O, United States District Court, N.D. Texas, Wichita Falls Division (October 22, 2026) Plaintiff Texoma Cowboy Church, Inc. was insured by Defendant Church Mutual Insurance Company, S.I. under a policy covering its property at 919 U.S. Hwy 281, Wichita Falls, Texas, from May 28, 2024, to May 28, 2025. The policy carried a $309,250.50 deductible for windstorm and/or hail coverage.
FACTS
On or about April 5, 2025, a hail and windstorm allegedly damaged the property. ProNet confirmed hail impact on April 5, 2025, producing dents and panel separations on the roofing, but found that water intrusion and interior damage predated the storm. Defendant also obtained a third-party contractor bid.
After deductible and depreciation, it paid $626,607.67. Plaintiff contended the estimate and ...
Plaintiff Must Allege the Who, What, When, Where, and How requirements of Federal Rule of Civil Procedure
Post 4573
Posted on October 30, 2026 by Barry Zalma
In Texoma Cowboy Church, Inc v. Church Mutual Insurance Company, S.I., Civil Action No. 7:26-CV-00062-O, United States District Court, N.D. Texas, Wichita Falls Division (October 22, 2026) Plaintiff Texoma Cowboy Church, Inc. was insured by Defendant Church Mutual Insurance Company, S.I. under a policy covering its property from May 28, 2024, to May 28, 2025.
FACTS
On or about April 5, 2025, a hail and windstorm allegedly damaged the property.
After deductible and depreciation, it paid $626,607.67.
1. The Original Petition asserted eight causes of action:
2. anticipatory breach and breach of contract;
3. breach of the duty of good faith and fair dealing;
4. deceptive trade practices and unconscionable conduct;
violations of Texas Insurance Code Chapter 542 (Prompt Payment of Claims Act);
5. unfair insurance practices;
6. negligent misrepresentation;...
