Zalma’s Insurance Fraud Letter – July 1, 2022
ZIFL 7-1-2022
Read the full article at https://lnkd.in/gkTM34Qb, see the video explaining what is in the July 1, 2022 issue at https://lnkd.in/gi2jdegx and at https://lnkd.in/gb2hxnF9 and at https://zalma.com/blog plus more than 4250 posts.
ZIFL Volume 26 Number 13
ZIFL-07-01-2022 http://zalma.com/blog/wp-content/uploads/2022/06/ZIFL-07-01-2022.-1.pdf.
See the video explaining what is in the July 1, 2022 issue at https://rumble.com/v1al2t7-zalmas-insurance-fraud-letter-july-1-2022.html?mref=6zof&mrefc=3 and at
In the July 1, 2022 issue of Zalma’s Insurance Fraud Letter you will be able to read the full text of articles including:
Bases for Rescission
Rescission Is an Equitable Remedy First Created in The Ecclesiastical Courts of Elizabethan England.
When the United States was conceived in 1776 the founders were concerned with protecting their rights under British common law.
Common Law is a form of law developed by judges through tribunals and decisions of courts rather than executive branch action and legislative statutes.
Following the common law tradition, legal principles were referred to courts of equity to “mitigate the rigor” of the common law.
The new United States of America adopted British common law as the law once the U.S. Constitution was adopted in 1789. British common law was only modified by the limitations placed on the central government by the Constitution.
The viability and ability to enforce contracts was recognized as essential to commerce. Courts of law, following the British Common Law, were charged with enforcing legitimate contracts and rendering money judgments against the party who breached the contract.
Another Florida Insurer Goes Broke
Southern Fidelity Insurance Company has entered into receivership and is being liquidated, according to the Florida Office of Insurance Regulations (FLOIR).
Insurance fraud is rampant in Florida.
Lawyer Admits to Insurance Fraud & Theft from Clients
Convicted of Fraud & Theft Enough for Disbarment
On September 7, 2021, the Office of Disciplinary Counsel (ODC) requested this Court place Respondent Richard Alexander Murdaugh on interim suspension based upon information indicating Respondent had stolen funds from the law firm that employed him. Respondent consented to the relief and on September 8, 2021, the Supreme Court issued an order suspending Respondent from the practice of law. In re Murdaugh, 434 S.C. 233, 863 S.E.2d 335 (2021) and, in In the Matter of Richard Alexander Murdaugh, Supreme Court of South Carolina, June 16, 2022 the Supreme Court was faced with the obligation to render a final order re Murdaugh’s license to practice law.
Chutzpah: Murder for Insurance Money Life Sentences Affirmed
INSURANCE FRAUD IS A VIOLENT CRIME
When convicted of murder in the first degree and conspiracy to commit murder for life insurance money, the defendants require a great deal of chutzpah (unmitigated gall) to file multiple appeals to reduce or eliminate the life without parole sentences. In the latest effort, The People v. Leny Peterson Galafate, F081563, California Court of Appeals, Fifth District (June 9, 2022) the Court of Appeal wrote a detailed opinion discussing all of the arguments filed by the murderer expending more time and paper than a convicted murder who had already appealed unsuccessfully to different courts that was not deserved.
Good News From the Coalition Against Insurance Fraud
Health Insurance Fraud Convictions
Molina Healthcare Agrees to Pay Over $4.5 Million To Resolve False Claims Act Violations
Molina Healthcare, Inc. (Molina) and its previously owned subsidiary, Pathways of Massachusetts (Pathways), have agreed to pay $4.625 million to resolve allegations that it violated the False Claims Act by submitting reimbursement claims while violating several regulations related to the licensure and supervision of staff.
Molina is a managed care health services company that provides health care plans to various state and federal health care programs including MassHealth, the joint federal and state Medicaid program. Between November 2015 and March 2018, Molina owned and operated Pathways, a group of mental health centers located in Springfield and Worcester. During that period, the government contends that Molina and Pathways improperly submitted claims for reimbursement to MassHealth and care entities managed by MassHealth while failing to properly license and supervise mental health center staff, including social workers and psychological associates, and failing to provide and timely document the provision of adequate clinical supervision to clinicians requiring supervision.
Excellence in Claims Handling
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Become a Professional Claims Handler
In search of profit, insurers have decimated their professional claims staff. They laid off experienced personnel and replaced them with young, untrained, unprepared people. A virtual clerk replaced the old professional claims handler. Process and computers replaced hands-on human skill, empathy and judgment. Money was saved by paying lower salaries. Within three months of firing the experienced claims people gross profit increased.
Other Insurance Fraud Convictions
Ex-Surrey Banker Faked Cancer as Part Of £1.8m Fraud
Rajesh Ghedia, 42, said he would be dead in a year in a £1.2m insurance scam, Southwark Crown Court heard. He also swindled seven people – including a relative – out of huge sums of money by encouraging them to invest in non-existent financial products.
(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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See the last two issues of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/
Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com.
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Happy Law Day
ZIFL – Volume 30, Issue 9 – May 1, 2026
Read the full article at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-may-1-2026-barry-zalma-esq-cfe-2tywc, see the video at at and at https://zalma.com/blog plus more than 5300 posts.
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
ZIFL – Volume 30, Issue 9 – May 1, 2026
Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year and is written by Barry Zalma.
DOJ Creates National Fraud Enforcement Division
Will the Feds Take on Insurance Fraud? Possibly as Part of a National Anti-Fraud Effort
On April 7, 2026, the Acting Attorney General, Todd Blanche, issued a memorandum establishing the Department of Justice National Fraud Enforcement Division (NFED). The memo describes an ambitious, but perhaps redundant, vision for this ...
When Abalone Died As a Result of Multiple Causes The Efficient Proximate Cause Requires Payment
Post number 5345
Read the full article at https://www.linkedin.com/pulse/efficient-proximate-cause-doctrine-saves-claim-barry-zalma-esq-cfe-yndlc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
In American Abalone Farms, LLC v. Star Insurance Company et al., H052643, California Court of Appeals, Sixth District (April 27, 2026) the Court of Appeals dealt with an insurance coverage issue that required application of the efficient proximate cause doctrine.
FACTS
American Abalone Farms, LLC ("American Abalone" ) operates an aquaculture farm in Santa Cruz County, California, raising abalone in tanks. In August 2020, the CZU Lightning Complex Fires led to a prolonged power outage and road closures near the farm. As a result, the farm’s water pumps failed, causing the death of most of the ...
Breach of a Specific Condition Precedent Is a Complete Defense
See the video at and at and at https://zalma.com/blog plus more than 5300 posts.
In United Services Automobile Association and State Farm Mutual Automobile Insurance Company v. Anthony Wenzell, 2026 CO 25 (Colo. Apr. 27, 2026) Anthony Wenzell was rear-ended in a car accident. He had a significant prior 2014 accident that required back surgery.
Wenzell claimed underinsured-motorist (UIM) benefits under three policies: (1) the tortfeasor’s liability policy, (2) his own primary UIM policy with State Farm, and (3) an excess UIM policy issued by USAA (under his brother’s policy, which contained an “other insurance” clause making USAA’s coverage excess over any collectible insurance).
After receiving the claims, both USAA and State Farm repeatedly requested that Wenzell execute comprehensive medical-release authorizations so they could obtain his full medical records and ...
It is Fraud to Make the Same Claim Twice
Read the full article at https://www.linkedin.com/pulse/fraud-make-same-claim-twice-barry-zalma-esq-cfe-c4g8c and at https://zalma.com/blog.
Chutzpah: After Being Paid for a New Roof Insured Makes Second Claim For Same Damages
Post number 5347
No One is Entitled to be Paid for the Same Loss Twice
In Mohammed Ali Khalili v. State Farm Lloyds, No. 14-25-00611-CV, Court of Appeals of Texas (April 30, 2026) Khalili maintained a State Farm Lloyds homeowners insurance policy for decades. In 2008 he filed a roof-damage claim; State Farm paid him to replace the entire roof (shingles and gutters). Khalili never replaced the roof and repeated his claim.
BACKGROUND
In 2021 he filed a second roof claim. State Farm’s inspectors found the roof “very old” with extensive non-storm-related damage. The claim was denied because (1) the damage did not exceed the deductible and (2) State Farm had already paid for a full roof replacement.
PROCEDURAL HISTORY
State Farm filed motion for summary...
It is Fraud to Make the Same Claim Twice
Read the full article at https://www.linkedin.com/pulse/fraud-make-same-claim-twice-barry-zalma-esq-cfe-c4g8c and at https://zalma.com/blog.
Chutzpah: After Being Paid for a New Roof Insured Makes Second Claim For Same Damages
Post number 5347
No One is Entitled to be Paid for the Same Loss Twice
In Mohammed Ali Khalili v. State Farm Lloyds, No. 14-25-00611-CV, Court of Appeals of Texas (April 30, 2026) Khalili maintained a State Farm Lloyds homeowners insurance policy for decades. In 2008 he filed a roof-damage claim; State Farm paid him to replace the entire roof (shingles and gutters). Khalili never replaced the roof and repeated his claim.
BACKGROUND
In 2021 he filed a second roof claim. State Farm’s inspectors found the roof “very old” with extensive non-storm-related damage. The claim was denied because (1) the damage did not exceed the deductible and (2) State Farm had already paid for a full roof replacement.
PROCEDURAL HISTORY
State Farm filed motion for summary...
What Must be Done after Notice of a Claim is Received by the Insurer
Read the full article at https://lnkd.in/gzvvdkMZ and at https://zalma.com/blog.
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A first party property policy does not insure property: it insures a person, partnership, corporation or other entity against the risk of loss of the property. Before an insured can make a claim for indemnity under a policy of first party property insurance the insured must prove that there was damage to property the risk of loss of which was insured by the policy. The obligation imposed on the insured ...
