The Insured Has no Right to Control Settlements Made by Insurer
Read the full article at https://www.linkedin.com/pulse/bad-faith-claim-vacuum-actionable-barry-zalma-esq-cfe and at https://zalma.com/blog plus more than 4000 posts.
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
Who’s on First? State or Federal Court
Post 5222
Read the full article at https://lnkd.in/gWj97cFs, see the video at https://lnkd.in/gtS6CpUX and at https://lnkd.in/gQEAeyHc,
Conflict Between State & Federal Court Requires Abstention
See the video at https://lnkd.in/gtS6CpUX and at https://lnkd.in/gQEAeyHc,
Conflict Between State & Federal Court Requires Abstention
Hector David Campoverde was injured at a Brooklyn construction site in 2015. Campoverde was an employee of Vazquez Bro Restoration Inc., a subcontractor for C.C.C. Renovation Inc., which was itself a subcontractor for general contractor L&M Builders Group LLC. In Starr Indemnity & Liability Company v. Scottsdale Insurance Company, No. 24-CV-3309 (PKC) (TAM), United States District Court, E.D. New York (September 30, 2025) was asked to determine whether one or more of the involved insurers is obligated to indemnify Campoverde, and in what order Camporverde can receive indemnity, from one or more insurer.
Underlying Incident:
Campoverde sued the ...
National Flood Policy Bars Late Filed Suit
Post 5221
Read the full article at https://www.linkedin.com/pulse/one-year-suit-limitation-defeats-filed-two-years-zalma-esq-cfe-olr0c, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
No Excuse for Late Flood Suit After Claim Denial
In Domenico D’ambrosio, Michele D’ambrosio v. American Bankers Insurance Company Of Florida, No. 2:25-cv-155-KCD-NPM, United States District Court, M.D. Florida, Fort Myers Division (October 7, 2025) this is an insurance dispute stemming from Hurricane Ian. Plaintiffs Domenico and Michelle D’Ambrosio submitted a flood claim that Defendant American Bankers Insurance Company of Florida will not pay. To recover the funds allegedly owed, Plaintiffs sued for breach of contract.
Defendant’s moved to dismiss under Fed.R.Civ.P. 12(b)(6). Defendant presses one ...
ZIFL – Volume 29, Issue 21
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post 5220
Read the full article at https://lnkd.in/gRMJpi4s, see the video at https://lnkd.in/gwGSd6ZA & at https://lnkd.in/gbDiuFJy, and at https://zalma.com/blog plus more than 5200 posts.
See the video at & at https://rumble.com/v711hr0-zalmas-insurance-fraud-letter-november-1-2025.html
See the full 18 page issue of ZIFL at ZIFL-11-01-2025
Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th 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/
Conviction for Health Insurance Fraud Upheld
Physician Conspired with Bonavilla to Effect Health Insurance Fraud
Dennis Davin Bonavilla was involved in an insurance fraud scheme as an executive of Free Choice Healthcare. The scheme targeted indigent patients, often on ...
The Professional Claims Handler
Post 5219
Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
