Insurance Frauds Are Not Born, They Are Trained
Read the full article at https://www.linkedin.com/feed/update/urn:li:ugcPost:6921812566495150081?updateEntityUrn=urn%3Ali%3Afs_updateV2%3A%28urn%3Ali%3AugcPost%3A6921812566495150081%2CFEED_DETAIL%2CEMPTY%2CDEFAULT%2Cfalse%29 and see the full video at https://rumble.com/v11bte9-true-crime-of-insurance-fraud-video-number-56.html?mref=6zof&mrefc=2 and at
and at https://zalma.com/blog plus more than 4150 posts.
Wee Willy never intended to be a criminal. His ambition in life, from age three, was to be a meat cutter like his dad. Willy cruised through high school with a solid “C” average. He knew that as a meat cutter he only needed a steady hand. Literature and mathematics held no interest for him.
As a child he would visit the store where his father worked and watch sides of beef turn into chops, steaks and hamburger with rapt attention. His father, he believed, was an artist who turned ugly chunks of dead animals into beautiful and delicious food. His ambition was to be the Picasso of meat cutters.
When Willy graduated from high school his father helped him join the meat cutters local as an apprentice. He began his career at a neighborhood Piggy Wiggly market. As an apprentice Willy was ordered about by the journeyman meat cutter. The duties of an apprentice included sweeping up the cuttings, collecting the excess fat so that it could be sold to the renderer, and lifting and carrying carcasses for the journeyman.
On slow days the journeyman would let Willy practice on the giant band saw. Willy was happy. Even as an apprentice meat cutter he was doing what he always wanted to do. He was learning his trade. He also could bring a few cuts of filet mignon to his girlfriend’s father. When her father was happy with Willy, his girlfriend was even more loving.
Willy had outfitted his house from the local Goodwill store. By the time his house was rebuilt, he had a brand new house worth twice as much as when he bought it, completely furnished with new furniture from quality stores. He immediately put the house on the market and made a $100,000 profit. With the money, he traded in his car and bought a brand new Corvette, a gold and diamond ring and a Rolex President with a diamond face. He gave his old Rolex to his father.
Life was good. Willy decided to go into business for himself. He would become a builder. He attended the contractor’s license school for one day and learned enough to pass the test and become a licensed contractor. Willy was in business for himself. He really didn’t need to work. He was going to use the contractor’s license to make more money off of insurance. Any construction job he did would be paid for completely by the insurance company.
Willy’s two domestic insurers were members of the National Insurance Crime Bureau (NICB) and the ISO All Claims database; Lloyd’s was not.
When each insurer submitted their report of Willy’s robbery, the ISO and NICB advised both insurers of the other claim that appeared to be similar to their claim.Each insurer had in place a special fraud investigation unit (SIU). The SIU investigators contacted each other and found that the two claims were identical and based upon the same appraisals. Lloyd’s, through their independent investigators, also used the All Claims database and the adjusters for the three insurers shared information concerning Willy’s claim.
Within six months Willy fell off an oil tank and broke his leg in three places. Although it hurt a great deal, Willy was happy. He had workers’ compensation again and, with his disability insurance policies, his take home pay tripled.
He knew the leg would be slow to heal and he could enjoy a life of leisure paid for by all of the other stupid people who bought workers’ compensation insurance but did not benefit from it as did Willy.
(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 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].
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Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Proof of Highly Contaminated Water is Required for Extra Payments
Post number 5300
Read the full article at https://www.linkedin.com/pulse/acting-your-own-lawyer-foolish-barry-zalma-esq-cfe-mbg0c, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Acting as Your Own Lawyer is Foolish
Evidence of Breach of Contract Survives Dismissal of All Other Charges
In Lee Lifeng Hsu and Jane Yuchen Hsu v. State Farm Fire And Casualty Company, C. A. No. N24C-09-020 CLS, Superior Court of Delaware (February 27, 2026) a claim to State Farm who paid approximately $61,000 after assessments but denied coverage for additional items including ceramic tiles, the kitchen floor ceiling, underlayment plywood, and numerous personal property items resulted in suit by the Hsu’s acting in pro per.
Facts
Lee Lifeng Hsu and Jane Yuchen Hsu (“Plaintiffs”) purchased a homeowners’ insurance policy from State Farm Fire...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
