Insurance Frauds Are Not Born, They Are Trained
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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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Jury’s Findings Interpreting Insurance Contract Affirmed
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Madelaine Chocolate Novelties, Inc. (“Madelaine Chocolate”) appealed the district court’s judgment following a jury verdict in favor of Great Northern Insurance Company (“Great Northern”) concerning storm-surge damage caused by “Superstorm Sandy” to Madelaine Chocolate’s production facilities.
In Madelaine Chocolate Novelties, Inc., d.b.a. The Madelaine Chocolate Company v. Great Northern Insurance Company, No. 23-212, United States Court of Appeals, Second Circuit (June 20, 2025) affirmed the trial court ruling in favor of the insurer.
BACKGROUND
Great Northern refused to pay the full claim amount and paid Madelaine Chocolate only about $4 million. In disclaiming coverage, Great Northern invoked the Policy’s flood-exclusion provision, which excludes, in relevant part, “loss or damage caused by ....
Failure to Name a Party as an Additional Insured Defeats Claim
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Contract Interpretation is Based on the Clear and Unambiguous Language of the Policy
In Associated Industries Insurance Company, Inc. v. Sentinel Insurance Company, Ltd., No. 23-CV-10400 (MMG), United States District Court, S.D. New York (June 16, 2025) an insurance coverage dispute arising from a personal injury action in New York State Supreme Court.
The underlying action, Eduardo Molina v. Venchi 2, LLC, et al., concerned injuries allegedly resulting from a construction accident at premises owned by Central Area Equities Associates LLC (CAEA) and leased by Venchi 2 LLC with the USDC required to determine who was entitled to a defense from which insurer.
KEY POINTS
Parties Involved:
CAEA is insured by Associated Industries Insurance Company, Inc. ...
Exclusion Establishes that There is No Duty to Defend Off Site Injuries
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Attack by Vicious Dog Excluded
In Foremost Insurance Company, Grand Rapids, Michigan v. Michael B. Steele and Sarah Brown and Kevin Lee Price, Civil Action No. 3:24-CV-00684, United States District Court, M.D. Pennsylvania (June 16, 2025)
Foremost Insurance Company (“Foremost”) sued Michael B. Steele (“Steele”), Sarah Brown (“Brown”), and Kevin Lee Price (“Price”) (collectively, “Defendants”). Foremost sought declaratory relief in the form of a declaration that
1. it owes no insurance coverage to Steele and has no duty to defend or indemnify Steele in an underlying tort action and
2. defense counsel that Foremost has assigned to Steele in the underlying action may withdraw his appearance.
Presently before the Court are two ...
ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional
See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.
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/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:
Health Care Fraud Trial Results in Murder for Hire of Witness
To Avoid Conviction for Insurance Fraud Defendants Murder Witness
In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...
Professional Health Care Services Exclusion Effective
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This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.
In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:
Insurance Coverage Dispute:
Travelers issued a Commercial General Liability ...
A Heads I Win, Tails You Lose Story
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Posted on April 30, 2025 by Barry Zalma
"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime."
Immigrant Criminals Attempt to Profit From Insurance Fraud
People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.
The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...
