Miscarriage Manipulation for Money
Read the full article at https://lnkd.in/gYQCAR39 and see the full video at https://lnkd.in/geBmJtia and at https://lnkd.in/gKibuU7X and at https://zalma.com/blog plus more than 4200 posts.
Posted on May 11, 2022 by Barry Zalma
Posted on May 11, 2022 by Barry Zalma
See the full video at https://rumble.com/v147vii-true-crime-of-insurance-fraud-video-number-71.html and at https://zalma.com/blog plus more than 4200 posts.
Rita was five months’ pregnant. Her entire family greeted her condition as an opportunity to make sufficient money for a happy Christmas in sunny Hawaii.
For four generations Rita’s family has lived luxuriously on insurance claims. Their last names changed more often than their underwear. Wherever they go, they carry a small plastic valve of soapy liquid and a small razor. Depending on the size of the town they are visiting, they stay a week, a month or a year. One member of the family will claim to have slipped and fallen in a restaurant or grocery store. With the razor they will induce bleeding at their hairline or on an arm or leg. They will be pleasant victims with no interest in profit. Grocers, and their insurers, rapidly and fairly settle their claims in fear that their injuries will increase.
Rita had been a professional claimant since she was eight. She fell in the most luxurious restaurants in Las Vegas, New York City, Baltimore, Washington, D.C., St. Louis, Missouri, and Beverly Hills, California. Shortly after she began to walk, her family taught her how to slip and look like she was hurt without actually causing any physical damage. By the time she was five she could limp on either leg, hold one arm limp, wince with pain when touched and give all the symptoms of a severely injured person.
By the time she was ten she had a clear knowledge of anatomy and knew all of the symptoms of soft tissue injury. Now, at 22, pregnant with the child of a sailor she met in San Diego whose name she does not remember, Rita is ready to move into major, profit making scams. Her brother Aaron would pose as her husband as they worked the major hotels and restaurants of Sacramento, California. At the Holiday Inn, she fell in a puddle of water in the lobby restroom where two innocent women ran to her assistance.
“Oh, my God!” Rita moaned. “Did I hurt the baby.”
Rita rode to the hospital with her “husband” sitting in the ambulance beside her, wringing his hands. They left their name, a mail drop address and a telephone number which connected to the family cellular telephone, with the hotel. She and the baby were found healthy and allowed to leave, although the doctor, because of the family history of miscarriage, noted on the hospital record that here condition was “guarded” and that she should cautiously watch for any spotting or other indication of a potential miscarriage.
In the next four days Rita fell in five hotels, two department stores and three restaurants in greater Sacramento. She rode to the hospital in an ambulance twice and visited a local chiropractor known to her family four times.
The family lived, and traveled, in three sixty-foot motor homes equipped with cellular telephones, a computer and all the comforts of a luxurious home. The family knew better than to be greedy. They never presented more than 10 claims each in any one city.
Rita and Aaron were reasonable people. They told the adjusters they did not wish to hire a lawyer. Although they were afraid they might lose the baby, the doctors had assured them that the baby was unhurt by the fall.
The adjusters, sensing an ability to settle the claim quickly before the baby was born, with possible extra damage, worked quickly to gain the confidence of Rita and Aaron. They wanted a release that would protect their clients.
They had no knowledge of Rita’s family history. Liability was clear. Independent witnesses observed a slick, soapy substance on the floor and on Rita after she fell.
Rita and Aaron were professional claims presenters. They played upon the innocence and good faith of the insurance adjusters. They would tell the adjusters:
“We don’t want money. We just can’t afford to pay the doctors’ bills. Please pay those for us and we’ll be happy.”
The adjusters, knowing the law and knowing that if litigation was filed Rita would be entitled to money for her pain and suffering, insisted that Rita take more money than the medical bills. Most of the claims were settled for between $6,000 and $25,000, depending on the generosity or gullibility of the individual adjusters.
Rita’s potential miscarriage brought her family over $100,000 for their stay in Sacramento. Her brothers, sisters, cousins and nephews falling all over the city generated another $100,000 in claims payments.
Their welcome in Sacramento worn thin, the family motor homes traveled west to San Francisco.
The motor homes were parked in a long term secure parking lot and the entire family boarded airplanes for a three week holiday in Maui.
ZALMA OPINION
The reason why a group of professional slip and fall claimants can succeed is due to the failure of insurers to conduct a full and thorough investigation of a claim presented. Had the adjuster’s investigated Rita’s claims and had they checked the All Claims Data Base the crime would have failed.
No alt text provided for this image
(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].
Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe.
Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com.
Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/
Detail Charging Defendant for Fraud is Sufficient
Post 5242
Read the full article at https://lnkd.in/g_HVw36q, see the video at https://lnkd.in/gpBd-XTg and at https://lnkd.in/gzCnBjgQ and at https://zalma.com/blog plus more than 5200 posts.
Charges that Advises the Defendant of the Crime Cannot be Set Aside
In United States Of America v. Lourdes Navarro, AKA Lulu, No. 25-661, United States Court of Appeals, Ninth Circuit (December 4, 2025) Lourdes Navarro appealed the district court’s denial of her motion to dismiss the indictment and enter final judgment was in error.
FACTUAL BACKGROUND
The indictment alleged that insurers reimburse only for medically necessary services. Navarro performed unnecessary respiratory pathogen panel (RPP) tests on nasal swabs collected from asymptomatic individuals for COVID-19 screening.
Navarro billed over $455 million to insurers for those additional RPP tests that she knew to be medically unnecessary. These allegations constituted a plain, concise, and definite written ...
Louisiana Statute Prevents Enforcement of Contract Term Requiring Arbitration of Disputes
Post 5241
Read the full article at https://www.linkedin.com/pulse/international-convention-requiring-enforcement-award-barry-sttdc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
In Town of Vinton v. Indian Harbor Insurance Company, Nos. 24-30035, 24-30748, 24-30749, 24-30750, 24-30751, 24-30756, 24-30757, United States Court of Appeals, Fifth Circuit (December 8, 2025) municipal entities including the Town of Vinton, et al sued domestic insurers after dismissing foreign insurers with prejudice. The insurers sought arbitration under the Convention on the Recognition and Enforcement of Foreign Arbitral Awards (the “Convention”) but the court held Louisiana law — prohibiting arbitration clauses in such policies—controls, as the Convention does not apply absent foreign parties who ...
Refusal to Provide Workers’ Compensation is Expensive
Post 5240
Read the full article at https://lnkd.in/guC9dnqA, see the video at https://lnkd.in/gVxz-qmk and at https://lnkd.in/gUTAnCZw, and at https://zalma.com/blog plus more than 5200 posts.
In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.
Company Overview:
USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...
The Professional Claims Handler
Post 5219
Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
