Zalma on Insurance
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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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April 04, 2022
Zalma’s Insurance Fraud Letter April 1, 2022

Mr. Biden & Mr. Putin: Exegetically Speaking Know Thy Self

Read the full article at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-april-1-2022-barry-zalma-esq-cfe and see the video Explanation at https://rumble.com/vz6m5h-zalmas-insurance-fraud-letter-april-1-2022.html?mref=6zof&mrefc=2 and at

read The full pdf version https://zalma.com/blog/wp-content/uploads/2022/03/ZIFL-04-01-2022..pdf and at https://zalma.com/blog plus more than 4150 posts.

Zalma’s April 1, 2022, with no April Fools Jokes, provides information needed by every insurance claims and insurance fraud professional, all available FREE on line.

A ClaimSchool™ Publication © 2022, Barry Zalma & ClaimSchool, Inc., Go to my blog & Videos at: Zalma on Insurance, And at https://zalma.com/blog, Go to the Insurance Claims Library, Listen to the Podcast: Zalma on Insurance, Videos from Zalma on Insurance, Subscribe to Barry Zalma on Substack.com.

Volume 26, Issue 7 – April 1, 2022, Subscribe to e-mail Version of ZIFL, it’s Free!Read last two issues of ZIFL here. Go to the Barry Zalma, Inc. web site here Videos from “Barry Zalma on YouTube” Go to Barry Zalma videos at Rumble.com at https://rumble.com/zalma
Quote of the Issue

“We Cannot Solve Our Problems with The Same Thinking We Used When We Created Them.”

Albert Einstein
Russian Immigrant Who was Convicted of Fraud Must Leave the U.S.

COMMIT INSURANCE FRAUD GO DIRECTLY TO JAIL AND THE BACK TO RUSSIA

Alexie Legassov, a convicted insurance fraud perpetrator, petitioned the USCA for review of a final order of removal and the denial of a motion to remand. In Alexei Legassov v. Attorney General United States of America, No. 21-2586, United States Court of Appeals, Third Circuit (February 24, 2022) the USCA decided it was time he returned to mother Russia.

FACTS

Legassov, a Russian citizen, has lived in the United States since 1993. In 2018, he was convicted in New Jersey of insurance fraud and operating a corporation for criminal purposes. He was sentenced to prison terms of four and five years, respectively, and ordered to pay over $1.2 million in restitution. After the Government initiated removal proceedings in 2019, an Immigration Judge (IJ) concluded that Legassov was removable as a noncitizen convicted of two or more offenses for which the aggregated sentences were five years or more and as a noncitizen convicted of a crime involving moral.

In August 2020, Legassov, proceeding pro se, applied for asylum, withholding of removal, and protection under the Convention Against Torture (CAT). At a hearing in January 2021, Legassov testified that he entered the United States due to fears relating to his father’s involvement in investigating the 1986 Chernobyl disaster. Although the official cause of his father’s death in 1988 was suicide, Legassov claimed that the Russian government had his father killed and he was warned to stop discussing that topic. Legassov stated that he was not harmed while in Russia, but he believed that the KGB initiated charges against him in 1996 after his departure and that he had been included on a wanted list.

The IJ ruled on several grounds that Legassov did not qualify for relief. In addition to making an adverse credibility finding, the IJ concluded that the one-year filing deadline barred the asylum application, and Legassov failed to provide a significantly changed circumstance to extend the time for filing. Even aside from the one-year bar, the IJ explained that he would deny asylum as a matter of discretion due to Legassov’s criminal history. The IJ likewise decided that Legassov had committed a “particularly serious crime” which rendered him ineligible for withholding of removal, and that Legassov did not qualify for CAT relief where he had not shown it would be more likely than not that he would be tortured upon his return to Russia. The IJ also denied voluntary departure.

On appeal, the BIA agreed with the IJ’s reasoning, rejected all grounds advanced in Legassov’s counseled brief, and dismissed the appeal. The BIA also denied a motion to remand because the evidence submitted did not rebut any of the IJ’s findings.

ANALYSIS

Notably, Legassov has not disputed that he is removable on the statutory grounds cited by the agency based on his criminal history (for committing a CIMT and for convictions of offenses carrying aggregated sentences of five or more years’ imprisonment). Also, he did not previously challenge the IJ’s conclusions that he was ineligible for asylum, withholding of removal, or CAT relief on appeal in the BIA; although he now claims, in very general terms, that he was eligible.

What remains are jurisdictional and due process arguments Legassov raised before, and the court rejected them for largely the same reasons the BIA did.

Legassov argues in his petition that the immigration court violated his due process rights by failing to adequately explain the proceedings or to develop the record. However, the record reveals no due process violation in Legassov’s proceedings.

the IJ explained to Legassov how he might retain an attorney and, after granting one continuance, the IJ was poised to grant another for Legassov to find an attorney. However, Legassov demurred and asked if the proceedings could move forward, and the IJ obliged. The IJ explained that Legassov would testify in support of his asylum application at the next hearing, and the IJ gave him time to submit documentation; Legassov did both. Legassov does not detail what else the IJ should have explained. Further, he has not shown that any deficiency prejudiced him, which is fatal to a due process claim.

Legassov did not show the requisite prejudice. In addition to the State Department report on country conditions in Russia in the record, the IJ considered statements of Legassov’s relatives and an article concerning the Russian opposition leader Alexei Navalny. Legassov does not state what other evidence that the IJ should have helped him obtain or how he was prejudiced by the absence of that material.

Finally, Legassov requested a remand so that his CAT claim could be considered in light of “new” evidence, including his birth certificate, articles about the Chernobyl disaster and his father, and articles about Russian intelligence activities. However, as the BIA explained, this evidence did not meaningfully address the shortcomings of his claims. Therefore, the BIA appropriately denied remand.

The BIA may deny a remand motion where the movant has not established prima facie eligibility for relief, fails to introduce previously unavailable, material evidence, or would not be entitled to discretionary relief even if the motion were granted.

Accordingly, the petition for review was denied.

ZIFL OPINION

In 1993 the United States allowed a Russian Criminal, Legassov, who was wanted by the then KGB, to enter the United States and enter into multiple state and federal crimes until he was finally caught, prosecuted and convicted and sentence to five years in a federal prison and an order to remove him from the U.S. back to Russia. He used the judicial system including appeals to the Third Circuit. He should never have been allowed in the U.S. and remaining in the U.S. violates the law as did his insurance fraud. He should be put on a plane and sent to the mercy of Vladamir Putin. Perhaps he will be conscripted into the Russian military.
Wisdom

“My mind rebels at stagnation... I abhor the dull routine of existence. I crave for mental exaltation.” – Sir Arthur Conan Doyle

“Truth is heavy, so few men carry it.” — Jewish saying

“Never assume the obvious is true.” — William Safire

“Learning is not attained by chance; it must be sought for with ardor and attended to with diligence.” – Abigail Adams

“All warfare is based on deception. There is no place where espionage is not used. Offer the enemy bait to lure him.” —Sun Tzu

“The simplest acts of kindness are by far more powerful than a thousand heads bowing in prayer.” ― Mahatma Gandhi

“I wish I could show you when you are lonely or in darkness the astonishing light of your own being.“ – Hafiz

“It is a fair, even-handed, noble adjustment of things, that while there is infection in disease and sorrow, there is nothing in the world so irresistibly contagious as laughter and good humor.” – Charles Dickens

“The foundation of national morality must be laid in private families.” —John Adams

“More tears are shed over answered prayers than unanswered ones.”– Teresa of Ávila

“Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt.“ – William Shakespeare

“We are all visitors to this time, this place. We are just passing through. Our purpose here is to observe, to learn, to grow, to love… and then we return home.” — Aboriginal Australian proverb

“Diligence is the mother of good fortune, and idleness — its opposite — never brought a man to the goal of any of his best wishes.” – Miguel de Cervantes
Pandemic Resulted in Less Workers’ Compensation Fraud Claims

New York State Inspector General Lucy Lang on released the 2021 Workers Compensation Fraud Annual Report, publishing results on workers’ compensation claims and fraud investigation results last year.

With New Yorkers beginning to come back to work, new workers’ compensation claims rose slightly in 2021 but continued to be reported at more than 18% lower than pre-pandemic levels, according to the report.

Additionally, while courts across New York State reopened in 2021, a significant backlog caused by closures during the pandemic resulted in the limitation or delay of criminal proceedings and the presentation of new cases to grand juries by district attorneys throughout the state, according to the IG.

Investigations conducted by the WCFIG led to criminal prosecutions resulting in seven arrests, including one arrest involving a provider/professional matter, four involving employer matters and two involving claimant matters.

Additionally, through completed prosecutions in 2021, WCFIG’s investigations facilitated the recovery of hundreds of thousands of dollars in fines and orders of restitution for New York State agencies, insurers including the New York State Insurance Fund and private insurers, and self-insured employers that were the victims of workers compensation fraud.

In 2021, WCFIG received 1,118 fraud complaints in total and dismissed 492 matters as unsubstantiated.

Even if no one was working in a job where they could be hurt, seven arrests, and the recovery of some money, is a woefully bad result for the insurance fraud investigators and prosecutors. A pandemic is no excuse for not arresting and convicting more than 600 fraud complaints that were not unsubstantiated. The workers’ compensation insurance industry in New York should be ashamed for only filing 1,118 fraud complaints, almost 500 of which were unsubstantiated. Since New York releases violent criminals with no bail to offend again ZIFL shouldn’t be surprised at the weak results.
Free Insurance Videos

Barry Zalma, Esq., CFE has published five days a week videos on insurance claims, insurance claims law, insurance fraud and insurance coverage matters at

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 52 years in the insurance business. He is available at

http://www.zalma.com

and [email protected].

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 53 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

See the more than 388 videos at https://www.rumble.com/zalma
“Insurance Fraud – Volume I & Volume II, Second Edition” Now Available

Insurance fraud continually takes more money each year than it did the last from the insurance buying public. No one knows the actual amount with any certainty because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year. Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance criminals is endemic. Most insurance fraud criminals are not detected. Those that are detected do so because they became greedy, sloppy and unprofessional so that the attempted fraud becomes so obvious it cannot be ignored.

No one will ever be able to place an exact number on the amount lost to insurance fraud. Everyone who has looked at the issue knows – whether based on their heart, their gut or empirical fact determined from convictions for the crime of insurance fraud – that the number is enormous. When insurers and governments put on a serious effort to reduce the amount of insurance fraud the number of claims presented to insurers and the pseudo-government-based or funded insurers drops logarithmically.

When insurers and governments put on a serious effort to reduce the amount of insurance fraud the number of claims presented to insurers and the pseudo-government-based or funded insurers drops logarithmically. The effort to stop insurance fraud against Medicare and Medicaid has increased in recent years. This book contains appellate decisions regarding insurance fraud from federal and state appellate courts across the country and full text of many insurance fraud statutes. It is available as both a legal research tool and a product to assist insurers, insurance company personnel, independent insurance adjusters, special investigation unit investigators, state fraud investigators and insurance lawyers to become effective persons involved in the attempt to defeat or reduce the effect of insurance fraud.

See the full issue of ZIFL at

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Videos
Posts
February 21, 2025
No Coverage for Criminal Acts

Concealing a Weapon Used in a Murder is an Intentional & Criminal Act

Post 5002

Read the full article at https://lnkd.in/gmacf4DK, see the full video at https://lnkd.in/gav3GAA2 and at https://lnkd.in/ggxP49GF and at https://zalma.com/blog plus more than 5000 posts.

In Howard I. Rosenberg; Kimberly L. Rosenberg v. Chubb Indemnity Insurance Company Howard I. Rosenberg; Kimberly L. Rosenberg; Kimberly L. Rosenberg; Howard I. Rosenberg v. Hudson Insurance Company, No. 22-3275, United States Court of Appeals, Third Circuit (February 11, 2025) the Third Circuit resolved whether the insurers owed a defense for murder and acts performed to hide the fact of a murder and the murder weapon.

FACTUAL BACKGROUND

Adam Rosenberg and Christian Moore-Rouse befriended one another while they were students at the Community College of Allegheny County. On December 21, 2019, however, while at his parents’ house, Adam shot twenty-two-year-old Christian in the back of the head with a nine-millimeter Ruger SR9C handgun. Adam then dragged...

00:08:09
February 20, 2025
Electronic Notice of Renewal Sufficient

Renewal Notices Sent Electronically Are Legal, Approved by the State and Effective
Post 5000

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Washington state law allows insurers to deliver insurance notices and documents electronically if the party has affirmatively consented to that method of delivery and has not withdrawn the consent. The Plaintiffs argued that the terms and conditions statement was not “conspicuous” because it was hidden behind a hyperlink included in a single line of small text. The court found that the statement was sufficiently conspicuous as it was bolded and set off from the surrounding text in bright blue text.

In James Hughes et al. v. American Strategic Insurance Corp et al., No. 3:24-cv-05114-DGE, United States District Court (February 14, 2025) the USDC resolved the dispute.

The court’s reasoning focused on two main points:

1 whether the ...

00:09:18
February 19, 2025
Post Procurement Fraud Prevents Rescission

Rescission in Michigan Requires Preprocurement Fraud
Post 4999

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Lie About Where Vehicle Was Garaged After Policy Inception Not Basis for Rescission

This appeal turns on whether fraud occurred in relation to an April 26, 2018 renewal contract for a policy of insurance under the no-fault act issued by plaintiff, Encompass Indemnity Company (“Encompass”).

In Samuel Tourkow, by David Tourkow v. Michael Thomas Fox, and Sweet Insurance Agency, formerly known as Verbiest Insurance Agency, Inc., Third-Party Defendant-Appellee. Encompass Indemnity Company, et al, Nos. 367494, 367512, Court of Appeals of Michigan (February 12, 2025) resolved the claims.

The plaintiff, Encompass Indemnity Company, issued a no-fault insurance policy to Jon and Joyce Fox, with Michael Fox added as an additional insured. The dispute centers on whether fraud occurred in...

00:07:58
February 07, 2025
From Insurance Fraud to Human Trafficking

Insurance Fraud Leads to Violent Crime
Post 4990

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CRIMINAL CONDUCT NEVER GETS BETTER

In The People v. Dennis Lee Givens, B330497, California Court of Appeals, Second District, Eighth Division (February 3, 2025) Givens appealed to reverse his conviction for human trafficking and sought an order for a new trial.

FACTS

In September 2020, Givens matched with J.C. on the dating app “Tagged.” J.C., who was 20 years old at the time, had known Givens since childhood because their mothers were best friends. After matching, J.C. and Givens saw each other daily, and J.C. began working as a prostitute under Givens’s direction.

Givens set quotas for J.C., took her earnings, and threatened her when she failed to meet his demands. In February 2022, J.C. confided in her mother who then contacted the Los Angeles Police Department. The police ...

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February 06, 2025
No Mercy for Crooked Police Officer

Police Officer’s Involvement in Insurance Fraud Results in Jail
Post 4989

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Von Harris was convicted of bribery, forgery, and insurance fraud. He appealed his conviction and sentence. His appeal was denied, and the Court of Appeals upheld the conviction.

In State Of Ohio v. Von Harris, 2025-Ohio-279, No. 113618, Court of Appeals of Ohio, Eighth District (January 30, 2025) the Court of Appeals affirmed the conviction.

FACTUAL BACKGROUND

On January 23, 2024, the trial court sentenced Harris. The trial court sentenced Harris to six months in the county jail on Count 15; 12 months in prison on Counts 6, 8, 11, and 13; and 24 months in prison on Counts 5 and 10, with all counts running concurrent to one another for a total of 24 months in prison. The jury found Harris guilty based on his involvement in facilitating payments to an East Cleveland ...

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February 05, 2025
EXCUSABLE NEGLECT SUFFICIENT TO DISPUTE ARBITRATION LATE

Read the full article at https://lnkd.in/gRyw5QKG, see the full video at https://lnkd.in/gtNWJs95 and at https://lnkd.in/g4c9QCu3, and at https://zalma.com/blog.

To Dispute an Arbitration Finding Party Must File Dispute Within 20 Days
Post 4988

EXCUSABLE NEGLECT SUFFICIENT TO DISPUTE ARBITRATION LATE

In Howard Roy Housen and Valerie Housen v. Universal Property & Casualty Insurance Company, No. 4D2023-2720, Florida Court of Appeals, Fourth District (January 22, 2025) the Housens appealed a final judgment in their breach of contract action.

FACTS

The Housens filed an insurance claim with Universal, which was denied, leading them to file a breach of contract action. The parties agreed to non-binding arbitration which resulted in an award not

favorable to the Housens. However, the Housens failed to file a notice of rejection of the arbitration decision within the required 20 days. Instead, they filed a motion for a new trial 29 days after the arbitrator’s decision, citing a clerical error for the delay.

The circuit court ...

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