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.
Subscribe to my publications at substack at substack.com/refer/barryzalma
Go to substack at substack.com/refer/barryzalma
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
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; and @Zalma on Truth Social.
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.
Concurrent Cause Doctrine Does Not Apply When all Causes are Excluded
Post 5119
Death by Drug Overdose is Excluded
See the full video at https://lnkd.in/geQtybUJ and at https://lnkd.in/g_WNfMCZ, and at https://zalma.com/blog plus more than 5100 posts.
Southern Insurance Company Of Virginia v. Justin D. Mitchell, et al., No. 3:24-cv-00198, United States District Court, M.D. Tennessee, Nashville Division (October 10, 2024) Southern Insurance Company of Virginia sought a declaratory judgment regarding its duty to defend William Mitchell in a wrongful death case pending in California state court.
KEY POINTS
1. Motion for Judgment on the Pleadings: The Plaintiff moved for judgment on the pleadings, which was granted in part and denied in part.
2. Duty to Defend: The court found that the Plaintiff has no duty to defend William Mitchell in the California case due to a specific exclusion in the insurance policy.
3. Duty to Indemnify: The court could not determine at this stage whether the Plaintiff had a duty to ...
GEICO Sued Fraudulent Health Care Providers Under RICO and Settled with the Defendants Who Failed to Pay Settlement
See the full video at https://lnkd.in/gDpGzdR9 and at https://lnkd.in/gbDfikRG, and at https://zalma.com/blog plus more than 5100 posts.
Post 5119
Default of Settlement Agreement Reduced to Judgment
In Government Employees Insurance Company, Geico Indemnity Company, Geico General Insurance Company, and Geico Casualty Company v. Dominic Emeka Onyema, M.D., DEO Medical Services, P.C., and Healthwise Medical Associates, P.C., No. 24-CV-5287 (PKC) (JAM), United States District Court, E.D. New York (July 9, 2025)
Plaintiffs Government Employees Insurance Company and other GEICO companies (“GEICO”) sued Defendants Dominic Emeka Onyema, M.D. (“Onyema”), et al (collectively, “Defendants”) alleging breach of a settlement agreement entered into by the parties to resolve a previous, fraud-related lawsuit (the “Settlement Agreement”). GEICO moved the court for default judgment against ...
ZIFL – Volume 29, Issue 14
Post 5118
See the full video at https://lnkd.in/geddcnHj and at https://lnkd.in/g_rB9_th, and at https://zalma.com/blog plus more than 5100 posts.
You can read the full 20 page issue of the July 15, 2025 issue at https://lnkd.in/giaSdH29
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
This issue contains the following articles about insurance fraud:
The Historical Basis of Punitive Damages
It is axiomatic that when a claim is denied for fraud that the fraudster will sue for breach of contract and the tort of bad faith and seek punitive damages.
The award of punitive-type damages was common in early legal systems and was mentioned in religious law as early as the Book of Exodus. Punitive-type damages were provided for in Babylonian law nearly 4000 years ago in the Code of Hammurabi.
You can read this article and the full 20 page issue of the July 15, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-07-15-2025.pdf
Insurer Refuses to Submit to No Fault Insurance Fraud
...
Rulings on Motions Reduced the Issues to be Presented at Trial
Read the full article at https://lnkd.in/gwJKZnCP and at https://zalma/blog plus more than 5100 posts.
CASE OVERVIEW
In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.
FACTS
Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.
Prior to trial Bernier had three remaining claims against State Farm:
1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.
Both Bernier and State Farm dispositive motions before ...
ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional
See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.
Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:
Health Care Fraud Trial Results in Murder for Hire of Witness
To Avoid Conviction for Insurance Fraud Defendants Murder Witness
In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...
Professional Health Care Services Exclusion Effective
Post 5073
See the full video at https://lnkd.in/g-f6Tjm5 and at https://lnkd.in/gx3agRzi, and at https://zalma.com/blog plus more than 5050 posts.
This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.
In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:
Insurance Coverage Dispute:
Travelers issued a Commercial General Liability ...
