Don’t Drive Off a Cliff, It May Not Be Covered
Read the full article at https://www.linkedin.com/feed/update/urn:li:ugcPost:6924706215813951488?updateEntityUrn=urn%3Ali%3Afs_updateV2%3A%28urn%3Ali%3AugcPost%3A6924706215813951488%2CFEED_DETAIL%2CEMPTY%2CDEFAULT%2Cfalse%29 and see the full video at https://rumble.com/v12cg12-true-crime-of-insurance-fraud-video-no.-61.html and at
and at https://zalma.com/blog plus more than 4200 posts.
Jimmy wanted a new pickup truck in the worst way. He decided to deliberately wreck his old car, make a claim against his insurance policy and use the proceeds to buy a new F150.
Jimmy disclosed his plan to his best friend, Winifred. She agreed to help — as a lookout for oncoming traffic —on the night they chose to destroy the car.
Jimmy, with his friend Winifred as a passenger, intentionally drove his pickup off the road and over a small cliff at 35 mph. He did not let her out of the truck to be his “look out” as planned. He thought it would be more realistic a claim — one that would not be questioned by his insurance company, if Winifred was in the car with him.
As planned, the car did not survive the crash. Unfortunately, neither did Winifred.
The heirs argued they were entitled to Under Insured Motorists (UIM) benefits under the Farmers and County Mutual policy because Jimmy was under insured. Furthermore, they claimed Winifred’s death was “accidental.”
Farmers and County Mutual’s response was, translated from the lawyerese:
“Give us a break.”
The heirs argued that Jimmy and Winifred intended to destroy the truck, not Winifred. The death was accidental.
In the Winifred’s Heirs v. Farmers & County Mutual arbitration, Farmers and County argued that interpretation of “accident” in liability policies is hyper-technical and legalistic and should not apply to the same term in UIM policies. The arbitrator ruled in favor of the insurer.
The heirs sued, lost at the trial court, that adopted the ruling of the Arbitrator. The heirs appealed and a Court of Appeals agreed, saying that, for UIM purposes, an “accident” is an “event” that, from the insured’s and the underinsured motorist’s perspective, is “unforeseen, unintended unexpected or the like.”
An injury is not accidental, the appellate court explained, if the injury-producing event was intended or expected. It is not necessary that the insured intend or expect the injury.
People who do wrong should not profit from it. Paying Winifred’s heirs for her death while admitting that she was intentionally a part of a criminal act is the same as the police paying the heirs of an armed robber who is shot to death by the police in the course of his armed robbery.
If our courts continue to honor criminals, and their heirs, for causing their own injuries the system will destroy itself. If insurers continue to pay to settle this type of fraudulent claim because it is less expensive than fighting to a conclusion all of us who buy insurance will suffer.
Every person who buys insurance should shout to their insurers – GIVE US A BREAK!
(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
Post 5105
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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
Post 5104
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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
Post 5103
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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
Post 5073
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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
Post 5062
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...
