ZIFL – Volume 26, Issue 15
Zalma’s Insurance Fraud Letter – August 1, 2022
Read the full article at https://lnkd.in/gU9w-nG4 and at https://lnkd.in/ggfYMGmz and at https://zalma.com/blog; and video at https://lnkd.in/gmutXXAR and at .
Posted on July 30, 2022 by Barry Zalma
Read the full 22 page Adobe .pdf Newsletter at http://zalma.com/blog/wp-content/uploads/2022/07/ZIFL-08-01-2022.pdf
See the full video at
and at https://rumble.com/v1e5zqf-zalmas-insurance-fraud-letter-august-1-2022.html
Read the full 22 page Adobe .pdf Newsletter at http://zalma.com/blog/wp-content/uploads/2022/07/ZIFL-08-01-2022.pdf
See the full video at
and at https://rumble.com/v1e5zqf-zalmas-insurance-fraud-letter-august-1-2022.html
Articles include:
“The Need to Understand the Mutability of Memory When Investigating a Fraud”
Very few people have a perfect eidetic (photographic) memory. Memory is a fluid and often unreliable human function.
During my time as a trainee investigator at the Army Intelligence School at Fort Holabird, Maryland, a classroom lecture on interviewing was interrupted by a man dressed in a clown mask, a tuxedo, swim fins, a cowboy hat, and a purple cummerbund. He ran into the room, screamed epithets, fired a weapon into the ceiling, and ran out. The teacher instructed each member of the class to write down a description of the intruder. None of our descriptions was accurate, and we were all shocked when the shooter was brought back into the class. The noise he made, the firing of a weapon, and the fear the incident engendered made it almost impossible to recall him accurately. Some even described him as having been female.
The professional recognizes that some EUO techniques can cause honest subjects — those who are innocent but “just trying to be helpful” — to “misremember” and provide unreliable, even false, information. It has long been known that false memories can be implanted by a process of suggestion, especially when used by skillful but unscrupulous attorneys or interviewers.
California Claims Regulations
Insurers licensed or operating in California must file their SIU annual reports by Wednesday, Sept. 28 and Insurers licensed or operating in California must ascertain that their entire claims staff has read, understood or be trained about the California Fair Claims Settlement Practices Regulations by September 1 of Each Year and be ready to swear under oath that the Regulation has been complied with by the insurer.
Insurance Agent Should not Sell Unregistered Securities
Unregistered Security Exclusion Eliminates Duty to Defend or Indemnify
William Saoud sells insurance-related products. Beginning in 2017, he offered some of his clients a new financial instrument: a Memorandum of Indebtedness issued by 1 Global Capital, LLC. The investment opportunity was too good to be true. William Saoud, Patricia Boland- Saoud, and Bill Saoud Financial, LLC v. Everest Indemnity Insurance Company, No. 21-1621, United States Court of Appeals, Sixth Circuit (July 14, 2022)
Free Insurance Videos
Barry Zalma, Esq., CFE has published five days a week videos on insurance claims, insurance claims law, insurance fraud and insurance coverage matters at https://www.rumble.com/zalma.https://rumble.com/c/c-262921
Intending Harm Caused is not Insurable
State Farm Fire and Casualty Company filed a motion for summary judgment, arguing that it owed no duty to defend or indemnify defendants, Hamdallah, L.L.C., et al. (“the LLCs”), against the claims asserted by plaintiff, Nixon Calix. The trial court granted for summary judgment and dismissed all claims against State Farm with prejudice.
In Nixon R. Calix v. Ideal Market # 6, Hamdallah, L.L.C., Kaki and Son, LLC, Hamdallah Hasan “Mario” Kaki, Muwafak “Mike” Kaki, Monadel “Cory” Elbarqa, Nofal “George” Haifa John Does 1-4, El Cortez Foods, LLC, And ABC & XYZ Insurance Company, No. 21-CA-555, Court of Appeals of Louisiana, Fifth Circuit (July 13, 2022) explained the right to rely on a clear and unambiguous exclusion.
Good News From The Coalition Against Insurance Fraud
For example: Dr. Jose Santeiro lured patients for medically unneeded rehab in a $112M fleecing of private insurers in South Florida. Recruiters paid kickbacks to con addicted patients into attending Santeiro’s detox facilities, then plied them with illegal drugs to ensure they were admitted. Santeiro made false claims for excessive urinalysis drug tests that weren’t even used in treatment. Santeiro then readmitted a core group of addicted patients he shuffled between Compass Detox and another facility to fraudulently bill for as much bogus drug treatment as possible. Santeiro also prescribed Compass Detox patients an addictive “comfort drink” to sedate them so they’d stay at the facility and keep returning. And he let cohorts use his log-in at the detox facilities to sign electronic medical files to make it falsely appear he provided treatment. Santeiro was given 4 1/2 years in federal prison.
Convicted of Wire & Insurance Fraud
After being convicted of multiple counts of fraud Ejaz Shreef was sentenced to a term of imprisonment for 48 months on each count, concurrent, followed by two years of supervised release.
In Ejaz Shreef v. United States of America, Nos. 3:18-cr-157-RJC-DCK-2, 3:22-cv-78-RJC, United States District Court, W.D. North Carolina, Charlotte Division (July 8, 2022) resolved his motion to reduce his sentence in favor of the government.
Health Insurance Fraud Convictions
Including a story why a Jury Convicts Man of $600 Million Health Care Fraud, Wire Fraud, and ID Theft Scheme. Mathew James, 54, of East Northport, was convicted by a federal jury. James, a New York man was convicted over $600 million health care fraud, wire fraud, and identity theft scheme.
Zalma on Insurance at Locals.com
Create a Staff of Professional Claims Handlers
Click Here to Subscribe to the Excellence in Claims Handling Programs for Each of Your Claims Personnel for Only $5 A Month Or $50 A Year by Subscribing to Zalma on Insurance at Locals.
Barry Zalma has created at Locals.com a series of insurance educational materials most of which are free to anyone. The free materials include more than 441 videos and more than 4200 digests of recent appellate court opinions and more than 81 videos dealing with true crime stories of insurance fraud.
Another Complaint Surfaces on Strems Over Settlement & Fee Deal
Scot Strems, the pain in the bank accounts of Florida insurers could see his two-year suspension completed in July 2022. But allegations by the state Bar could result in new sanctions or even a permanent disbarment.
A 25-page complaint, separate from previous allegations, charges that Miami attorney Strems and his law firm, in 2018 informed a client of a settlement with a property insurance company but then secretly settled with the insurer for twice as much and attempted to pocket a large, unauthorized fee.
In Addition, Another Strems Law Firm Attorney Suspended by Florida Supreme Court
Fallout from the infamous Strems Law Firm’s litigation practices in Florida continues. Two years after Coral Gables plaintiffs’ attorney Scot Strems was suspended from practice for filing thousands of unnecessary lawsuits against property insurers and violating other Bar rules, and two years after the Florida Bar filed a complaint against another attorney with the firm, the state Supreme Court has suspended the lawyer for 91 days.
Other Insurance Fraud Convictions
Insurance Fraud is a Violent Crime – Two Guilty in Sweetie Pie’s Murder-For-Hire Plot
For example: Terica Ellis and Waiel Rebhi Yaghnam charged with the murder-for-hire plot that led to the death of Andre Montgomery in 2016 pleaded guilty July 22, 2022.
In 2020, the two were charged with conspiracy to commit wire and mail fraud. Yaghnam was charged with five counts of aggravated identify theft. Montgomery, the grandson of original Sweetie Pie’s owner Robbie Montgomery, was shot and killed near Fairground Park on March 14, 2016. James Timothy Norman, Montgomery’s uncle, has been charged with conspiracy to use a cellphone in the “commission” of a murder-for-hire that resulted in death. Charging documents revealed that Norman took out a $450,000 life insurance policy on his nephew in 2014 and Norman was the sole beneficiary.
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 also serves as an arbitrator or mediator for insurance related disputes. 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].
Over the last 54 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455;
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; I publish daily articles 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
Concealing a Weapon Used in a Murder is an Intentional & Criminal Act
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In Howard I. Rosenberg; Kimberly L. Rosenberg v. Chubb Indemnity Insurance Company Howard I. Rosenberg; Kimberly L. Rosenberg; Kimberly L. Rosenberg; Howard I. Rosenberg v. Hudson Insurance Company, No. 22-3275, United States Court of Appeals, Third Circuit (February 11, 2025) the Third Circuit resolved whether the insurers owed a defense for murder and acts performed to hide the fact of a murder and the murder weapon.
FACTUAL BACKGROUND
Adam Rosenberg and Christian Moore-Rouse befriended one another while they were students at the Community College of Allegheny County. On December 21, 2019, however, while at his parents’ house, Adam shot twenty-two-year-old Christian in the back of the head with a nine-millimeter Ruger SR9C handgun. Adam then dragged...
Renewal Notices Sent Electronically Are Legal, Approved by the State and Effective
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Washington state law allows insurers to deliver insurance notices and documents electronically if the party has affirmatively consented to that method of delivery and has not withdrawn the consent. The Plaintiffs argued that the terms and conditions statement was not “conspicuous” because it was hidden behind a hyperlink included in a single line of small text. The court found that the statement was sufficiently conspicuous as it was bolded and set off from the surrounding text in bright blue text.
In James Hughes et al. v. American Strategic Insurance Corp et al., No. 3:24-cv-05114-DGE, United States District Court (February 14, 2025) the USDC resolved the dispute.
The court’s reasoning focused on two main points:
1 whether the ...
Rescission in Michigan Requires Preprocurement Fraud
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Lie About Where Vehicle Was Garaged After Policy Inception Not Basis for Rescission
This appeal turns on whether fraud occurred in relation to an April 26, 2018 renewal contract for a policy of insurance under the no-fault act issued by plaintiff, Encompass Indemnity Company (“Encompass”).
In Samuel Tourkow, by David Tourkow v. Michael Thomas Fox, and Sweet Insurance Agency, formerly known as Verbiest Insurance Agency, Inc., Third-Party Defendant-Appellee. Encompass Indemnity Company, et al, Nos. 367494, 367512, Court of Appeals of Michigan (February 12, 2025) resolved the claims.
The plaintiff, Encompass Indemnity Company, issued a no-fault insurance policy to Jon and Joyce Fox, with Michael Fox added as an additional insured. The dispute centers on whether fraud occurred in...
Insurance Fraud Leads to Violent Crime
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CRIMINAL CONDUCT NEVER GETS BETTER
In The People v. Dennis Lee Givens, B330497, California Court of Appeals, Second District, Eighth Division (February 3, 2025) Givens appealed to reverse his conviction for human trafficking and sought an order for a new trial.
FACTS
In September 2020, Givens matched with J.C. on the dating app “Tagged.” J.C., who was 20 years old at the time, had known Givens since childhood because their mothers were best friends. After matching, J.C. and Givens saw each other daily, and J.C. began working as a prostitute under Givens’s direction.
Givens set quotas for J.C., took her earnings, and threatened her when she failed to meet his demands. In February 2022, J.C. confided in her mother who then contacted the Los Angeles Police Department. The police ...
Police Officer’s Involvement in Insurance Fraud Results in Jail
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Von Harris was convicted of bribery, forgery, and insurance fraud. He appealed his conviction and sentence. His appeal was denied, and the Court of Appeals upheld the conviction.
In State Of Ohio v. Von Harris, 2025-Ohio-279, No. 113618, Court of Appeals of Ohio, Eighth District (January 30, 2025) the Court of Appeals affirmed the conviction.
FACTUAL BACKGROUND
On January 23, 2024, the trial court sentenced Harris. The trial court sentenced Harris to six months in the county jail on Count 15; 12 months in prison on Counts 6, 8, 11, and 13; and 24 months in prison on Counts 5 and 10, with all counts running concurrent to one another for a total of 24 months in prison. The jury found Harris guilty based on his involvement in facilitating payments to an East Cleveland ...
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To Dispute an Arbitration Finding Party Must File Dispute Within 20 Days
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EXCUSABLE NEGLECT SUFFICIENT TO DISPUTE ARBITRATION LATE
In Howard Roy Housen and Valerie Housen v. Universal Property & Casualty Insurance Company, No. 4D2023-2720, Florida Court of Appeals, Fourth District (January 22, 2025) the Housens appealed a final judgment in their breach of contract action.
FACTS
The Housens filed an insurance claim with Universal, which was denied, leading them to file a breach of contract action. The parties agreed to non-binding arbitration which resulted in an award not
favorable to the Housens. However, the Housens failed to file a notice of rejection of the arbitration decision within the required 20 days. Instead, they filed a motion for a new trial 29 days after the arbitrator’s decision, citing a clerical error for the delay.
The circuit court ...
