True Crime of Insurance Fraud Number 38
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Posted on March 18, 2022 by Barry Zalma
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Barry Zalma, Esq., CFE presents videos so you can learn how insurance fraud is perpetrated and what is necessary to deter or defeat insurance fraud. This Video Blog of True Crime Stories of Insurance Fraud with the names and places changed to protect the guilty are all based upon investigations conducted by me and fictionalized to create a learning environment for claims personnel, SIU investigators, insurers, police, and lawyers better understand insurance fraud and weapons that can be used to deter or defeat a fraudulent insurance claim.
The EUO Is the Best Tool to Use to Defeat Insurance Fraud
The most effective tool an insurer has against fraud is the examination under oath. The right to compel an insured to appear for examination under oath has been part of the standard fire policy in every state of the United States that adopted the N.Y. Standard Fire Insurance policy. The right was recognized by the United States Supreme Court in Claflin.v Commonwealth Insurance Company, 110 U.S. 81, 3 S.C. 507, 28 L.Ed. 76 a decision unchanged since it was decided in 1888.
When an Insured is suspected of arson, or some other variation of insurance fraud, the insurer will almost always require testimony at examination under oath. The Insured often refuses to appear for examination under oath — a material condition of the policy — claiming the insurer’s demand was a bad faith attempt to deprive him of his right against self-incrimination stated in the Fifth Amendment to the US Constitution.
In Gruenberg v. Aetna Insurance Co. 9 Cal.3d 566, 108 Cal.Rptr. 480 (1973) the California Supreme Court ruled that an Insured had stated a cause of action for breach of the covenant of good faith and fair dealing when the insurer denied the claim for refusal to testify at examination under oath. In fact, the Insured agreed to testify as soon as the criminal proceeding was completed.
If Gruenberg stands for the proposition that insurers must wait until the Insured is exonerated in his criminal proceeding the California Supreme Court should revisit Gruenberg and adopt the reasoning of the Massachusetts Supreme Judicial Court in Mello and the California Court of Appeals in Fremont and Altfillisch to eliminate a long delay that would make defense of the insured’s suit beyond the ability to prove the defense of fraud. Insurers, to avoid the problem raised by the California Supreme Court should never file, in California, a complaint for declaratory relief against an insured and compel the insured to file since, as a plaintiff, he would be unable to assert the Fifth Amendment to prevent a deposition or trial where he may incriminate himself.
(c) 2022 Barry Zalma & ClaimSchool, Inc.
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected].
Over the last 54 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created a library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.
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Arsonist Tried To Represent Himself, Failed, and Sought Habeas Relief
Post number 5357
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Karacson’s Arson for Profit Attempt Required Skill & Experience to Succeed
In Steve Ellis Karacson v. David Shaver, Warden, No. 25-1089, United States Court of Appeals, Sixth Circuit (May 20, 2026) Steve Karacson was convicted in Michigan state court of arson and insurance fraud after evidence showed he burned his own insured home. Investigators found multiple points of origin, gasoline odor, and evidence tying him to the scene, including cell-phone location data and a receipt showing he had purchased a gas can and gloves shortly before the fire.
FACTS
Karacson initially had appointed counsel, but his relationships with both appointed attorneys ...
Foolish to Repeatedly Disobey Court Orders
All That Remains For Trial Is Plaintiff’s Damages On Each Of These Claims And Establishing Proximate Causation Of Those Damages.
Post number 5348
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In Linh Wang v. Esurance Insurance Company, No. C24-0447-JCC, United States District Court, W.D. Washington, Seattle (May 1, 2026) John C. Coughenour, United States District Judge, found that throughout this case, culminating with its briefing on Plaintiff’s renewed motion and that Defendant has subjected Plaintiff to unnecessary motion practice for clearly discoverable information and made dubious representations (including to the Court).
FACTUAL BACKGROUND
This case involves an underinsured/uninsured motorist insurance bad faith claim arising from a 2017 motor vehicle collision. The plaintiff, Linh Wang, alleges that Esurance Insurance ...
The Right to Negotiate with Insurer is Not an Assignment of Claims
Post number 5347
Read the full article at https://www.linkedin.com/pulse/ambiguous-contract-repair-assignment-barry-zalma-esq-cfe-2xppc, see the full video at https://rumble.com/v79is1s-ambiguous-contract-to-repair-not-an-assignment.html and at and at https://zalma.com/blog plus more than 5300 posts.
Nebraska Requires an Actual Assignment to Allow Contractor to Sue Insurer
In Millard Gutter Company, a corporation doing business as Millard Roofing and Gutter v. Farmers Mutual Insurance Company of Nebraska, also known as Farmers Mutual Insurance, also known as Farmers Mutual, No. A-24-818, Court of Appeals of Nebraska (May 5, 2026) Millard sued Farmers as an assignee of Jane Anzalone who had hired Millard Gutter to repair the roof of her home and agreed to allow Millard Gutter to coordinate with her insurer, Farmers Mutual, concerning reimbursement for repairs authorized under her insurance policy.
FACTUAL BACKGROUND
In ...
Applicant for Insurance is Obligated to Advise Insurer in Material Changes After Application Was Signed
Post number 5371
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Doctor Criminally Charged and License Suspended After Application Signed had Policy Rescinded for Failure to Advise Insurer of Change
In Xiang (Sean) Yuan, M.D. v. Positive Physicians Insurance Company, No. 1821 EDA 2025, No. J-A08033-26, Superior Court of Pennsylvania (May 29, 2026) Dr. Xiang (Sean) Yuan, a physician, sought renewal of his professional liability insurance policy with Positive Physicians Insurance Company (PPIC) in June 2020 and again in May 2021.
In the June 2020 renewal application, he answered “no” to questions asking whether he knew of any circumstances that might lead to a professional liability claim.
Two days after signing the 2020 renewal application, Dr. Yuan was charged with 36 criminal offenses, and...
Claim and Suit Time Barred by Private Limitation of Action
Post number 5370
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Suit Fails Because the Plaintiffs Ignored the Policy’s Private Limitation of Action
In Shree Ugtai Express, Inc. d/b/a Hollday Express Shop v. West Bend Insurance Company, No. 1:26-cv-01050-STA-jay, United States District Court, W.D. Tennessee, Eastern Division (June 9, 2026) Shree Ugtai Express, Inc., doing business as Holladay Express Shop, sued West Bend Insurance Company for wrongful denial of insurance benefits after property damage allegedly caused by a burst water heater pipe on December 25, 2022.
The insurance policy required any suit to be brought within two years of the date of direct physical loss or damage. Plaintiff filed its complaint in Tennessee state court on December 17, 2024, which was within that two-year period.
FACTS
However, although a summons ...
Claim and Suit Time Barred by Private Limitation of Action
Post number 5370
Read the full article at https://www.linkedin.com/pulse/you-lose-when-sit-your-rights-barry-zalma-esq-cfe-vfxsc and at https://zalma.com/blog plus more than 5350 posts.
Suit Fails Because the Plaintiffs Ignored the Policy’s Private Limitation of Action
In Shree Ugtai Express, Inc. d/b/a Hollday Express Shop v. West Bend Insurance Company, No. 1:26-cv-01050-STA-jay, United States District Court, W.D. Tennessee, Eastern Division (June 9, 2026) Shree Ugtai Express, Inc., doing business as Holladay Express Shop, sued West Bend Insurance Company for wrongful denial of insurance benefits after property damage allegedly caused by a burst water heater pipe on December 25, 2022.
The insurance policy required any suit to be brought within two years of the date of direct physical loss or damage. Plaintiff filed its complaint in Tennessee state court on December 17, 2024, which was within that two-year period.
FACTS
However, although a summons ...
