ZIFL Volume 27, Issue 1
Barry Zalma
The Source for the Insurance Fraud Professional
Starting the 27th year of publication of Zalma’s Insurance Fraud Letter, ClaimSchool, Inc., Barry Zalma and the Zalma family wish you a happy and prosperous new year.
Read the full pdf version of ZIFL at http://zalma.com/blog/wp-content/uploads/2022/12/ZIFL-01-01-2023.pdf
Volume 27 Issue 1 contains articles including:
New Florida Statutes
The state of Florida proposed new statute to make insurance and insurance claims more fair is over 105 pages available at https://www.flsenate.gov/Session/Bill/2022A/2A/BillText/er/PDF.
Lawmakers in Florida passed legislation to abolish controversial assignments of benefits on property claims, eliminate the one-way attorney-fee recovery provision that is unique to Florida law, and require that binding appraisals included in a policy be stated in a separate endorsement and include a premium reduction. Bad-faith litigation for failure to settle a property claim also may not be filed until after a court determines the insurer breached the contract and a final judgment is rendered against the insurer. Other provisions include shortening the time period to file property claims from two years to one, and requiring insurers to reduce the period to pay or deny a claim from 90 days to 60. Anyone insured with the state’s Citizens Insurance must also carry flood insurance. The provisions become law when signed by the Governor, which is expected as early as today. For those wishing more information on the new law, Coalition Against Insurance Fraud law firm member Greenberg Traurig has provided a detailed summary.
Read the full pdf version of ZIFL at http://zalma.com/blog/wp-content/uploads/2022/12/ZIFL-01-01-2023.pdf
Report From the California Department of Insurance About New Law Relating to Fraud
A press release from the California Department of Insurance edited to report only new laws relating to insurance fraud:
Beginning January 1, 2023, Californians will benefit from newly created consumer protections as eleven new state laws sponsored by Insurance Commissioner Ricardo Lara this past legislative session take effect. The new laws address climate change, expand health access and reproductive care, preserve health protections, protect against fraud, and ensure public safety.
“Protecting consumers is my number one priority,” said Commissioner Lara. “Partnership with the Legislature and Governor Newsom is essential to my Department’s mission of bringing fairness for all in our oversight of the nation’s largest insurance market. I look forward to putting these eleven new laws into effect while taking further actions that benefit California consumers.”
Read the full pdf version of ZIFL at http://zalma.com/blog/wp-content/uploads/2022/12/ZIFL-01-01-2023.pdf
How to Add to the Professionalism of Insurance Claims Professionals
Scot Strems Disbarred & Public Adjuster Facing Loss of License
Florida Lawyer Who Used Cappers & Runners to Build a Practice Failed to Serve the Clients
The Supreme Court of Florida on December 22, 2022, disbarred attorney Scott Strems who it found guilty of professional misconduct. You can read the full opinion here. The court’s reasoning included:
Strems was the sole partner and owner of the Strems Law Firm, P.A. (SLF), and the firm’s caseload grew significantly from its inception. By 2016, the firm had only three litigation attorneys, with each managing approximately 700 cases. SLF’s inadequate staffing and lack of sufficient office procedures resulted in client neglect, case dismissals, frustrated judges, and costly sanctions on a near weekly basis.
Read the full pdf version of ZIFL at http://zalma.com/blog/wp-content/uploads/2022/12/ZIFL-01-01-2023.pdf
Health Insurance Fraud Convictions
Woman Sentenced In Death Of 86-Year-Old
Letticia Martinez, 28, pleaded guilty to neglect in the death of a resident at the Cappella Assisted Living and Memory Care facility in Grand Junction. She was sentenced to three years’ probation, 100 hours of community service and 30 days in jail.
An investigation by the Medicaid Fraud Control Unit of the Colorado Department of Law and the Grand Junction Police Department found that Martinez, Jamie Johnston, 31, and Jenny Logan, 52, were responsible for the death of Hazel Place on June 14, 2021, after she was left outside alone in the heat for six hours.
Martinez pleaded guilty to one count of caretaker neglect, a class 1 misdemeanor, and to a deferred sentence of negligent homicide, a class 5 felony. Johnston and Logan’s cases are ongoing.
This is followed by dozens more reports of health insurance fraud convictions.
Read the full pdf version of ZIFL at http://zalma.com/blog/wp-content/uploads/2022/12/ZIFL-01-01-2023.pdf
The Genuine Dispute & Fairly Debatable Doctrines
Defenses to the Tort of Bad Faith
Insurers in states where the tort of bad faith exists (almost every state) who deny fraudulent insurance claims with fear and trembling. The specter of punitive damages has worked to make multi-millionaires of many insurance criminals who convince insurers to settle rather than take a chance on a trial of a suit alleging the insurer acted in bad faith. Every person working on a potential fraudulent claim must understand this important defense to the tort of bad faith.
Read the full pdf version of ZIFL at http://zalma.com/blog/wp-content/uploads/2022/12/ZIFL-01-01-2023.pdf
Other Insurance Fraud Convictions
Buffalo Bus Driver Gets 5 Years Probation for Workers’ Compensation Claims Fraud
Antoinette Laney of Kenmore, New York, a former bus driver for the Niagara Frontier Transportation Authority (NFTA) was sentenced to five years of probation for fraudulently obtaining workers’ compensation benefits by misrepresenting her injuries. She must also pay full restitution to the NFTA for money she was paid through workers’ compensation.
Laney claimed that she was unable to perform her work as a bus driver at the NFTA and fraudulently obtained $30,212.69 in pay between September 2018 and February 2020 through workers’ compensation benefits. The defendant initially claimed that she was unable to work due to a right knee injury, but later amended the claim to a lower back and left knee injury.
The district attorney’s office said its investigation also revealed that Laney performed work through Instacart and Ebay while continuing to collect workers’ compensation pay.
Laney pleaded guilty to one count of grand larceny on September 26, 2022. She was sentenced this week before Erie County Court Judge Kenneth Case.
Followed by many more other than health insurance fraud convictions.
Read the full pdf version of ZIFL at http://zalma.com/blog/wp-content/uploads/2022/12/ZIFL-01-01-2023.pdf
It’s Time to Subscribe to Locals or Substack
For Subscribers Only I Have Published Special Insurance Videos
I have published on Locals.com more than 25 videos and two webinars to subscribers and more than 400 free videos. I also published on Substack.com hundreds of free videos and webinars of the Excellence in Claims Handling Program available only to Subscribers. The subscribers have access to all the videos and a webinar on “The Examination Under Oath A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud” among others.
The videos start with the history of insurance and work their way through various types of insurance and how to obtain and deal with insurance claims.
Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe.
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Read the full issue of ZIFL at
http://zalma.com/blog/wp-content/uploads/2022/12/ZIFL-01-01-2023.pdf
(c) 2023 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]
Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at
Zalma on Insurance
Insurance, insurance claims, insurance law, and insurance fraud .
By Barry Zalma
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Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected]
Go to the Insurance Claims Library – https://lnkd.in/gWVSBde; and @Zalma on Truth Social.
Convicted Criminal Seeks to Compel Receiver to Protect his Assets
Post number 5291
See the video at and at and at https://www.zalma.com/blog plus more than 5250 posts.
The Work of a Court Appointed Receiver is Constitutionally Protected
In Simon Semaan et al. v. Robert P. Mosier et al., G064385, California Court of Appeals, Fourth District, Third Division (February 6, 2026) the Court of Appeals applied the California anti-SLAPP statute which protects defendants from meritless lawsuits arising from constitutionally protected activities, including those performed in official capacities. The court also considered the doctrine of quasi-judicial immunity, which shields court-appointed receivers from liability for discretionary acts performed within their official duties.
Facts
In September 2021, the State of California filed felony charges against Simon Semaan, alleging violations of Insurance Code section 11760(a) for making...
When There are Two Different Other Insurance Clauses They Eliminate Each Other and Both Insurers Owe Indemnity Equally
Post number 5289
In Great West Casualty Co. v. Nationwide Agribusiness Insurance Co., and Conserv FS, Inc., and Timothy A. Brennan, as Administrator of the Estate of Pat- rick J. Brennan, deceased, Nos. 24-1258, 24-1259, United States Court of Appeals, Seventh Circuit (February 11, 2026) the USCA was required to resolve a dispute that arose when a tractor-trailer operated by Robert D. Fisher (agent of Deerpass Farms Trucking, LLC-II) was involved in a side-impact collision with an SUV driven by Patrick J. Brennan, resulting in Brennan’s death.
Facts
Deerpass Trucking, an interstate motor carrier, leased the tractor from Deerpass Farms Services, LLC, and hauled cargo for Conserv FS, Inc. under a trailer interchange agreement. The tractor was insured by Great West Casualty Company with a $1 million policy limit, while the trailer was insured by Nationwide Agribusiness Insurance Company with a $2 million ...
Opiod Producer Seeks Indemnity from CGL Insurers
Post number 5288
Read the full article at https://lnkd.in/guNhStN2, see the full video at https://lnkd.in/gYqkk-n3 and at https://lnkd.in/g8U3ehuc, and at https://zalma.com/blog plus more than 5250 posts.
Insurers Exclude Damages Due to Insured’s Products
In Matthew Dundon, As The Trustee Of The Endo General Unsecured Creditors’ Trust v. ACE Property And Casualty Insurance Company, et al., Civil Action No. 24-4221, United States District Court, E.D. Pennsylvania (February 10, 2026) Matthew Dundon, trustee of the Endo General Unsecured Creditors’ Trust, sued multiple commercial general liability (CGL) insurers for coverage of opioid-related litigation involving Endo International PLC a pharmaceutical manufacturer.
KEY FACTS
Beginning as early as 2014, thousands of opioid suits were filed by governments, third parties, and individuals alleging harms tied to opioid manufacturing and marketing.
Bankruptcy & Settlements
Endo filed Chapter 11 in August 2022; before bankruptcy it ...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lost the ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah. Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and wonder how did all these wonderful things come into being. Jews believe the force we call G_d created the entire universe and everything in it. Jews feel G_d is all seeing and knowing and although we can’t see Him, He is everywhere and in everyone.We understand...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
Read the full article at https://www.linkedin.com/pulse/passover-americans-barry-zalma-esq-cfe-5vgkc.
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lostthe ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah.
Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and ...
You Get What You Pay For – Less Coverage Means Lower Premium
Post number 5275
Posted on January 30, 2026 by Barry Zalma
See the video at and at
When Experts for Both Sides Agree That Two Causes Concur to Cause a Wall to Collapse Exclusion Applies
In Lido Hospitality, Inc. v. AIX Specialty Insurance Company, No. 1-24-1465, 2026 IL App (1st) 241465-U, Court of Appeals of Illinois (January 27, 2026) resolved the effect of an anti-concurrent cause exclusion to a loss with more than one cause.
Facts and Background
Lido Hospitality, Inc. operates the Lido Motel in Franklin Park, Illinois. In November 2020, a windstorm caused one of the motel’s brick veneer walls to collapse. At the time, Lido was insured under a policy issued by AIX Specialty Insurance Company which provided coverage for windstorm damage. However, the policy contained an exclusion for any loss or damage directly or indirectly resulting from ...
