ZIFL Volume 27 Number 5
Barry Zalma
Read the full article at https://lnkd.in/gXiVeBE2 and see the full video at https://lnkd.in/gdTK4Qmu and at https://lnkd.in/gEhvKF4p, and read the full 22 page ZIFL in pdf format at https://lnkd.in/gzErgazV and at https://zalma.com/blog plus more than 4450 posts.
McClenny Moseley & Associates & Insurance Fraud
The McClenny Moseley & Associates (MMA) series of lawsuits, court hearings and insurance department actions have brought about some very serious problems for MMA, including court orders, lawsuit dismissals, administrative cease and desist orders and litigation, all of which have created a poster child for Zalma’s Insurance Fraud Letter.
Since MMA has admitted that it reported a claim to various insurers, including Allied Insurance, that it was presenting claims against Allied and at least 856 claims to Allied and other insurers, that it represented the insured when, in truth and fact, it did not represent the insurer’s insureds, but, rather Apex Roofing who is not an insured of any of the insurers to whom MMA made claims, demanded appraisal and settled claims, cashed checks and took attorneys fees from people it did not represent the insurer is obligated to report each claim to the Louisiana Department of Insurance as a suspected insurance fraud effected or attempted.
Therefore, it appears, subject to the review of the Louisiana Attorney General and/or local prosecutors, MMA violated Louisiana fraud statutes, and each insurer who is a victim of one or more of the minimum of 856 fraudulent claims where MMA represented it was the attorney of the insurers’ insureds was a criminal fraudulent act.
Since the actions of Velawcity and Apex Roofing appear to meet the definition of a “runner” the prosecutors in the state of Louisiana should consider prosecution for their fraudulent activities.
In addition, the federal judges involved in these cases should consider reporting MMA, Velawcity and Apex Roofing to the U.S. Attorney for investigation of the potential crime of wire fraud.
There will be more hearings in March 2023 that will be reported in the March 15, 2023 issue of ZIFL.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
The Arson for Profit Defense
To prove the “arson for profit defense” the insurer must prove the three elements needed to establish arson plus proof that the insured violated the misrepresentation, concealment, or fraud condition, and/or that the act was an intentional act to defraud the insurer.
A successful “arson for profit defense” depends on a wide range of evidence, including expert testimony, knowledgeable and convincing witnesses, and effective counsel for the insurer. Where any of the evidence as to each element is non-existent, weak, or sufficiently rebutted by the insured’s experts and witnesses, the insurer’s “arson for profit defense” will likely fail.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Good News from the Coalition Against Insurance Fraud
A firm that administered health care claims stole $18M of funds intended for paying the claims. Anthony Riccardi started by administering third-party healthcare claims for a car dealership chain in New Canaan, Conn. Employee Benefit Solutions created invoices for the car dealership brand, which submitted payments and expected the funds to be paid to health care providers. EBS stole almost $18M of $26M the dealership paid. Most of this money was transferred into the EBS operating account and used for non-company expenses — mortgages, boats, golf and luxury cars. Riccardi only paid claims from health care providers he thought were likely to complain, or involved the car dealership execs. The scam also included inflated or bogus medical claims, including some by a phony company under Riccardi’s name. Unpaid financial obligations began to mount, prompting Riccardi to apply for millions in fraudulent bank loans and cash advances. They were used in part to pay financial obligations to the car dealership brand. To cover up the loan scheme, Riccardi forged invoices from a fake company that supposedly sold upgraded billing software to EBS. Ricardi pled federally guilty. He faces up to 30 years in prison when sentenced and agreed to repay $14.8M.
Read the full article plus many more reports of convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
How to Add to the Professionalism of Insurance Claims Professionals
Every insurer, insurance syndicate, insurance brokerage, insurance sales agency, insurer branch office, and vendors to the insurance industry should add to the libraries of their various offices or employees.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Health Insurance Fraud Convictions
Ronald A. Beasley II, 33, of Portsmouth, Florida was the pharmacist in charge at NH Pharma, a pharmacy located in Lake Mary, Florida. Through NH Pharma, Beasley and his co-conspirators billed Medicare for expensive compound drug creams that they never
actually purchased or dispensed, and instead provided Medicare patients an inexpensive compound drug cream not covered by Medicare.
Inventory records showed that NH Pharma did not buy enough of the expensive prescription drugs to fill all the prescriptions NH Pharma billed to Medicare. In total, Beasley and his co-conspirators received more than $1 million in fraudulent proceeds from Medicare.
A federal jury in the Middle District of Florida convicted Beasley, a Virginia man February 9, 2023 for his role in a scheme to defraud Medicare of over $1 million in prescription drug benefits.
Beasley was convicted of conspiracy to commit health care fraud and three counts of health care fraud. He is scheduled to be sentenced on April 25 and faces a maximum penalty of 10 years in prison on each count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Read the full article including more than a dozen convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
The Brothers Ben-Cohain
The story that follows is a fictionalized True Crime Story of Insurance Fraud from my 55 Years in Insurance that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. This is one of more than 80 stories in my book “Insurance Fraud Costs Everyone“ Available as a Kindle Book and Available as a Paperback from Amazon.com.
In 1990 Moshe Ben-Cohain and Menashe Ben-Cohain started a course of conduct that led to their arrest for insurance fraud. They failed to appear after posting bond and are, along with their co-conspirator, Raz Rosenberg, fugitives.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Other Insurance Fraud Convictions
Herbert Allen, age 38, and Dion Ridley, age 23, pleaded guilty to Conspiracy to Commit Mail Fraud in violation of Title 18, United States Code, Section 371 Allen was to 37 months in prison, followed by 3 years of supervised release and Ridley was sentenced to 6 months in prison, followed by 1 year of supervised release.
The defendants admitted to being in a conspiracy to commit mail fraud in connection with a staged automobile collision. In the scheme, Allen falsely claimed that he was the driver of a car that was struck by a tractor-trailer on June 28, 2017. Ridley, a passenger in the car, falsely claimed that Allen was driving the car and they were struck by a tractor-trailer.
In fact, the government’s evidence showed that the defendants conspired with Damien Labeaud, Roderick Hickman, and others to intentionally collide Allen’s 2007 Chevrolet Impala with a tractor-trailer in the area of Tchoupitoulas Street and Calliope Street in New Orleans.
Read the full article and about many more insurance fraud convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
(c) 2023 Barry Zalma & ClaimSchool, Inc.
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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 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; 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
Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://lnkd.in/gfFKUaTf.
Go to substack at https://lnkd.in/gEEnV7Dd Consider subscribing to my publications at substack at https://lnkd.in/gEEnV7Dd
Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected]
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://lnkd.in/gWVSBde
Res Judicata Eliminates Second Suit
Post 5056
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Final Judgment Prohibits a Second Try
JC Robinson, Jr. (“JC”), pro se, appealed the trial court’s summary judgment decision in favor of defendant-appellee, Progressive Insurance Corporation (“Progressive”). In JC Robinson, Jr., et al. v. Progressive, 2025-Ohio-1370, No. 114348, Court of Appeals of Ohio, Eighth District, Cuyahoga (April 17, 2025) the Court of Appeals resolved the dispute.
FACTS
In May 2024, JC sued Progressive on behalf of himself and his minor daughter, E.R., (collectively “the Robinsons”). JC claimed that the Robinsons were involved in a “hit-and-skip,” rear-end, motor vehicle accident in November 2023 (“the MVA”) resulting in property damage, physical and mental injuries, medical expenses, lost income, and loss of enjoyment of life. JC claimed that the Robinsons’ presented to an emergency room after ...
No Response to Motion Guarantees Loss
Post 5055
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In Great Little Minds Academy, LLC v. Atlantic Casualty Insurance Company, Civil Action No. 4:23-CV-1875, United States District Court, S.D. Texas, Houston Division (April 17, 2025) Defendant Atlantic Casualty Insurance Company’s (“Atlantic”) moved for summary judgment.
BACKGROUND
Atlantic’s summary judgment evidence establishes that GLMA purchased a commercial lines insurance policy from Atlantic (“the policy”) that contained the following coverage exclusion (“the freeze exclusion”):
“2. We will not pay for loss or damage caused by or resulting from any of the following: …
"g. Water, other liquids, powder or molten material that leaks or flows from plumbing, heating, air conditioning or other equipment (except fire protective systems) caused by or ...
To Be Sued for Barratry in Texas the Court Must Have Jurisdiction
Post 5050
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A LAWYER WHO PAYS OR GIVES OR OFFERS TO PAY OR GIVE A PERSON MONEY OR ANYTHING OF VALUE TO SOLICIT EMPLOYMENT COMMITS BARRATRY IN TEXAS
A lawsuit that involved claims for alleged barratry and conspiracy to commit barratry filed by Appellants against the law firm McClenny Mosley & Associates, PLLC, Texas attorneys James McClenny and Zach Mosley, their Louisiana partner Richard William Huye, III, and Appellee Tort Network, LLC d/b/a Velawcity (“Velawcity”), an Arizona company that executed several Marketing Service Agreements with the law firm to provide advertising and marketing services. An appeal to the Court of Appeals of Texas involved the trial court’s order sustaining Velawcity’s special appearance and dismissing Appellants’ claims against Velawcity for lack of jurisdiction.
In Wayne J. Adams,...
Punitive Damages Must Be Added to Gross Income for Tax Purposes
See the full article at https://www.linkedin.com/pulse/punitive-damages-must-added-gross-income-tax-purposes-barry-n08yc and at https://zalma.com/blog plus subscribe at https://barryzalma.substack.com/subscribe.
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A TASTE OF EXCELLENCE IN CLAIMS HANDLING
The stated purpose of punitive damages is to punish a wrongdoer civilly to deter the wrongdoer and others from acting wrongfully. Insurance Bad Faith litigants dream of large punitive damage awards as a bonus and revenge upon the insurer that did not treat them fairly.
Punitive damages may be awarded where there is substantial harm and where there is none. [Restatement (First) of Torts § 908 cmt. c (Am. L. Inst. 1939); see also ...
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Duties and Liabilities of Insurance Brokers
Posted on March 12, 2025 by Barry Zalma
Excellence in Claims Handling
This blog post is just a taste of the full article that is only available to subscribers to Excellence in Claims Handling. Anyone can subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.
Cases in which insurance brokers’ liability is in question depend in part on whether brokers are seen to be serving a fiduciary role or simply acting as a conduit between the insured and the insurer.
A person or an entity is a fiduciary with respect to a plan to the extent:
he exercises any discretionary authority or discretionary control respecting management of such plan ...
Read the full article at https://www.linkedin.com/pulse/duties-liabilities-insurance-brokers-barry-zalma-esq-cfe-mmpbc, if you Subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.
Duties and Liabilities of Insurance Brokers
Posted on March 12, 2025 by Barry Zalma
Excellence in Claims Handling
This blog post is just a taste of the full article that is only available to subscribers to Excellence in Claims Handling. Anyone can subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.
Cases in which insurance brokers’ liability is in question depend in part on whether brokers are seen to be serving a fiduciary role or simply acting as a conduit between the insured and the insurer.
A person or an entity is a fiduciary with respect to a plan to the extent:
he exercises any discretionary authority or discretionary control respecting management of such plan ...
