Zalma’s Insurance Fraud Letter – October 1, 2022
Read the full article at https://lnkd.in/gb8WvSyH and see the full video at https://lnkd.in/g2iqwfTE and at https://lnkd.in/g7YWxZwC and at https://zalma.com/blog plus more than 4300 posts.
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Posted on September 30, 2022 by Barry Zalma
Insurer Proactive Against Fraud
CIGNA Obtains $14,371,384.95 Judgment Against Fraudulent Health Care Provider
Since police, prosecutors and state insurance fraud investigators are seldom willing to arrest or prosecute insurance fraud perpetrators it is necessary for insurers to be proactive and sue those who attempt or succeed in defrauding insurers.
In Connecticut General Life Insurance Company and CIGNA Health And Life Insurance Company v. Mike Ogbebor and Stafford Renal LLC, No. 3:21-cv-00954 (JAM), United States District Court, D. Connecticut (September 6, 2022) CIGNA successfully sued a fake provider and obtained a default judgment for almost $15 million against the corporate defendant and its alter ego individual.
Read the full story at https://lnkd.in/gC_ERGrP
Another Florida Insurer Is Insolvent
FedNat Insurance Co. is now insolvent and must be liquidated – the sixth Florida property insurer this year to throw in the towel.
The Florida Department of Financial Services filed a consent agreement with the Leon County Circuit Court, detailing the extent of FedNat’s financial troubles and asking the court to approve DFS as the receiver for the insurer.
The move was not unexpected, after FedNat agreed in May to cancel policies, transfer others to a sister company and wind down operations with what regulators hoped would be an orderly runoff. The Demotech financial rating firm also withdrew its stability rating for FedNat on August 1, 2022.
Read the full story at https://lnkd.in/gC_ERGrP
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.
He 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].
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
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.
See the more than 500 videos at https://www.rumble.com/zalma
Good News From the Coalition Against Insurance Fraud
In shock and her blood pressure rising, Sharon Beighton was stunned to learn Bruce Saunders fell into a woodchipper and was ground up while clearing trees on her property near Brisbane, Australia. A tragic accident, it seemed. Prosecutors allege he was murdered: In a complex love “quadrangle,” Sharon Graham had two lovers hit Saunders on the head with a crowbar and place his lifeless body into the chipper so she could claim his $750K (AU) life policy. Graham is a former boyfriend of Saunders and was policy beneficiary. Roser was clearing trees with Saunders and swung the death-dealing crowbar. Peter John Koenig helped Roser feed Sanders into the chipper. Roser then lied that a tree branch hit Saunders, making him woozy and bleeding. Seemingly confused, Saunders supposedly stood unsafely on top of the chipper and tumbled into the churning blades — head-first. Police photos show Saunders’ legs sticking out of the woodchipper horizontally. Graham plotted his murder for six months. Yet Saunders’ murder made no sense to Beighton. Far from woozy, he appeared perfectly alert and wasn’t bloody, she told investigators. Beighton’s granddaughter said Graham made a “big deal” about how much money Saunders had and that “he would die first, and she would get everything.” Graham called the life insurer just a few days after the murder to collect the money. Graham and Roser face trial. Koenig pled guilty.
Read the full list of convictions at https://lnkd.in/gC_ERGrP
A Resource for the Insurance Professional
After practicing insurance law for over five decades, Barry Zalma, an internationally recognized and award-winning insurance expert and author, is releasing multiple education books on Amazon.com. The publications are designed to inform claims people, special investigation unit investigators, coverage lawyers, plaintiffs’ bad faith lawyers, insurance management and the insurance buying public on insurance claims procedures and insurance fraud. Each resource leverages key insights and learnings from Zalma’s 55+ years of practical experience as a claims person and insurance coverage attorney.
To be an insurance professional requires continuous learning. That’s the motivation behind my writing; I have felt a need to share my experiences to help people in the industry learn how to properly handle claims and avoid accusations of the tort of bad faith.” See his latest interview for new adjusters at https://player.fm/series/daily-claims/episode-11-advice-for-new-and-aspiring-adjusters.
Visit Zalma’s Insurance Claims Library to view all publications that can be purchased through Amazon as Paperback and Kindle e-books.
Health Insurance Fraud Convictions
U.S. Attorney & Feds Increase Efforts to Prosecute Fraud Perpetrators
Durable Medical Equipment Company Health Care Fraud Sentenced to Seven Years in Federal Prison
Daniel Pintado Cazola, on September 9, was sentenced to 87 months in prison for his role in using a durable medical equipment company to commit Medicare and Medicaid fraud and trying to conceal his connection to the crime by listing a straw owner in corporate and bank records.
Earlier this year, Pintado Cazola pled guilty to one count of conspiracy to commit health care fraud, wire fraud, and mail fraud, and one count of aggravated identity theft.
Read the full list of convictions at https://lnkd.in/gC_ERGrP
Prosecutors Allow Arson-for-Profit to Succeed
Stupid Plea Bargain Destroys Insurer’s Right to Restitution
Intentionally burning a dwelling and the concomitant presentation of an insurance claims is an arson for profit and two serious felonies. However, in The People V. Damon Lawrence George, C095325, California Court of Appeals, Third District, Placer (September 12, 2022) Damon Lawrence George was allowed by the prosecution to plead guilty only to the unlawful burning of his house. The People, failing to understand the implications upon an insurer, allowed the insurance fraud to succeed by dismissing several related charges against defendant, including insurance fraud, without obtaining a People v. Harvey (1979) 25 Cal.3d 754 (Harvey). waiver, and allowing the defendant to keep the money paid.
Read the full story at https://lnkd.in/gC_ERGrP
Other Insurance Fraud Convictions
Salt of the Earth Michigan Farmer Will Pay $1.2 Million Settlement Over Crop Insurance Fraud
Gaylord D. Lincoln and G. Lincoln Farms, LLC, located in Springport, Michigan, agreed to pay $1,200,000 to resolve allegations that they violated the False Claims Act by causing the submission of fraudulent claims for federal crop insurance and federal farm benefit payments. The settlement amount was negotiated based on the defendants’ ability to pay.
This settlement resolves civil claims the United States brought against the defendants in a December 2021 lawsuit. In its complaint, the United States alleged that the defendants defrauded the U.S. Department of Agriculture’s (“USDA”) Farm Service Agency (“FSA”) by operating a scheme to avoid benefit program payment limitations. Specifically, the United States alleged that the defendants placed their farmland and crops in the names of their employees, who served as a facade for defendants but had no financial risk or interest in the crops and had them enroll in FSA benefit programs. These individuals then provided the FSA benefit payments to the defendants. The United States further alleged that defendants caused these individuals to take out fraudulent federal crop insurance policies for these crops, even though they had no insurable interest in these crops, and that the proceeds of the policies went to the defendants.
The complaint and other filings in this case can be found on the Court’s online docket under United States v. Lincoln, No. 1:21-cv-1089 (W.D. Mich.).
Read the full list of convictions at https://lnkd.in/gC_ERGrP
New Books:
“How to Acquire, Understand, and Make a Successful Claim on a Commercial Property Insurance Policy: Information Needed for Individuals and Insurance Pros to Deal With Commercial Property Insurance”
The New Book is now available as a Kindle book here, paperback here and as a hardcover here.
The Tort of Bad Faith
What Every Insurance Professional, Every Insurance Coverage Lawyer, Every Plaintiffs Bad Faith Lawyer, and Every Insurance Claims Person Must know About the Tort of Bad Faith
Available as a Hardcover, a paperback Available and as a Kindle Book
Insurance Fraudsters Deserve No Quarter
What every insurer should know about how it can be proactive in the efforts against insurance fraud by refusing to pay every fraudulent claim.
How Giving No Quarter Worked
Many years ago a client I represented was offended that an insured tried to defraud him and the people who were names in the syndicate he represented at Lloyd’s, London. I walked the Underwriter through the debris of the house that was burned, showed him some of the remains of the allegedly highly valuable fine arts, and then explained how he was deceived into issuing the policy. I was the attorney for Lloyd’s underwriters for the fine arts and Imperial Casualty for the homeowners policy.
Barry Zalma, Esq., CFE
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;
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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
Arsonist Tried To Represent Himself, Failed, and Sought Habeas Relief
Post number 5357
Read the full article at https://www.linkedin.com/pulse/he-who-acts-his-own-lawyer-has-idiot-client-barry-zalma-esq-cfe-d4bwc, See the full video at and at and at https://zalma.com/blog.
Karacson’s Arson for Profit Attempt Required Skill & Experience to Succeed
In Steve Ellis Karacson v. David Shaver, Warden, No. 25-1089, United States Court of Appeals, Sixth Circuit (May 20, 2026) Steve Karacson was convicted in Michigan state court of arson and insurance fraud after evidence showed he burned his own insured home. Investigators found multiple points of origin, gasoline odor, and evidence tying him to the scene, including cell-phone location data and a receipt showing he had purchased a gas can and gloves shortly before the fire.
FACTS
Karacson initially had appointed counsel, but his relationships with both appointed attorneys ...
Foolish to Repeatedly Disobey Court Orders
All That Remains For Trial Is Plaintiff’s Damages On Each Of These Claims And Establishing Proximate Causation Of Those Damages.
Post number 5348
See the full video at and at and at https://zalma.com/blog plus 5300 posts.
In Linh Wang v. Esurance Insurance Company, No. C24-0447-JCC, United States District Court, W.D. Washington, Seattle (May 1, 2026) John C. Coughenour, United States District Judge, found that throughout this case, culminating with its briefing on Plaintiff’s renewed motion and that Defendant has subjected Plaintiff to unnecessary motion practice for clearly discoverable information and made dubious representations (including to the Court).
FACTUAL BACKGROUND
This case involves an underinsured/uninsured motorist insurance bad faith claim arising from a 2017 motor vehicle collision. The plaintiff, Linh Wang, alleges that Esurance Insurance ...
The Right to Negotiate with Insurer is Not an Assignment of Claims
Post number 5347
Read the full article at https://www.linkedin.com/pulse/ambiguous-contract-repair-assignment-barry-zalma-esq-cfe-2xppc, see the full video at https://rumble.com/v79is1s-ambiguous-contract-to-repair-not-an-assignment.html and at and at https://zalma.com/blog plus more than 5300 posts.
Nebraska Requires an Actual Assignment to Allow Contractor to Sue Insurer
In Millard Gutter Company, a corporation doing business as Millard Roofing and Gutter v. Farmers Mutual Insurance Company of Nebraska, also known as Farmers Mutual Insurance, also known as Farmers Mutual, No. A-24-818, Court of Appeals of Nebraska (May 5, 2026) Millard sued Farmers as an assignee of Jane Anzalone who had hired Millard Gutter to repair the roof of her home and agreed to allow Millard Gutter to coordinate with her insurer, Farmers Mutual, concerning reimbursement for repairs authorized under her insurance policy.
FACTUAL BACKGROUND
In ...
Court Allows itself to be Abused by Convicted Murderer and Insurance Fraudster
A Prisoner Has a Limited Right to file a Habeas Petition but Must do so Properly
Post number 5387
Posted on July 6, 2026 by Barry Zalma
Court Allows itself to be Abused by Convicted Murderer and Insurance Fraudster
A Prisoner Has a Limited Right to file a Habeas Petition but Must do so Properly
Post number 5387
In Tami Duvall v. State Of Indiana, No. 1:25-cv-01239-SEB-TAB, United States District Court, S.D. Indiana, Indianapolis Division (July 1, 2026) Indiana prisoner Tami Duvall filed a habeas petition under 28 U.S.C. § 2254 challenging her 2011 Indiana convictions for murder, insurance fraud, and obstruction of justice.
Law:
Federal Rule of Civil Procedure 15(a) governs amendment of pleadings, allowing amendment as of course within specified time limits and otherwise permitting amendment with leave of court when justice so requires.
Federal Rule of Civil Procedure 12(f) permits the Court to strike redundant matter. Rule 5 of the Rules ...
It is a Crime to Lie to Your Insurer That Accident Happened After Policy Inception
Post number 5386
Posted on July 3, 2026 by Barry Zalma
Conviction for Fraud Affirmed Because Evidence Overwhelming
In State Of Washington v. Saleem Mumin Robinson, No. 87244-3-I, Court of Appeals of Washington, Division 1 (June 29, 2026) Saleem Robinson was involved in an automobile collision on May 18, 2021. The other driver, Mohamed Waggeh, photographed Robinson’s documents and later reported the collision to GEICO, identifying the time as approximately 12:40 p.m.
That same day, at 6:06 p.m., more than five hours after the accident, Robinson purchased Progressive insurance for the vehicle involved in the collision.
The next morning, Robinson called Progressive to report the claim and stated that the accident occurred around 6:15 p.m. Progressive recorded that call without advising Robinson that it was being recorded. Progressive later conducted a special investigative unit investigation the claim because it was submitted shortly ...
Deprive Insurer of the Ability to Properly and Timely Investigate Claim & Recover Nothing
Posted on July 2, 2026 by Barry Zalma
Post number 5385
No Contract Claim No Bad Faith Claim
In South Alexander Development I, LLC v.Markel American Insurance Co., Civil Action No. 23-1436-JWD-SDJ, United States District Court, M.D. Louisiana (June 24, 2026) South Alexander Development I, LLC (SADI) owned and operated a solar farm in Springfield, Louisiana that allegedly sustained significant Hurricane Ida damage.
After SADI submitted a claim, MAIC ultimately paid $1,099,614.02 for undisputed physical damage plus the $210,000 income-loss policy limit. SADI later sued for breach of contract and statutory bad faith, contending MAIC failed to fully investigate and adjust the claim; MAIC sought summary judgment, arguing SADI failed to cooperate and withheld material repair-cost information.
LAW:
Louisiana insurance policies are interpreted as contracts according to their plain meaning, and the insured bears the burden ...
