ZIFL Volume 28 Issue 3
Barry Zalma
Feb 1, 2024
Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f; video at https://lnkd.in/gM-C-yif and at https://lnkd.in/gNPgmgqm, and go to https://zalma.com/blog plus more than 4700 posts.
See the full video at https://rumble.com/v4aircl-zalmas-insurance-fraud-letter... and at
Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th 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/
The current issue can be read in full at http://zalma.com/.../uploads/2024/01/ZIFL-02-01-2024.pdf and includes the following articles:
Fraudulently Submitting Fake Applications Violates Licensing Statutes
Insurance Producer Fraudulently Submits Applications to Insurer
Paul B. Kumar appealed a final agency decision of Commissioner of the Department of Banking and Insurance (Commissioner or Department) revoking his insurance producer license and imposing $60,774.25 in civil penalties, surcharge, attorney’s fees and costs of investigation, for violations of the New Jersey Insurance Producer Licensing Act of 2001 and the New Jersey Insurance Fraud Prevention Act (Fraud Act).
Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
More McClenny Moseley & Associates Issues
This is ZIFL’s twenty third installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
12/19/2023
$10,170,665.53 Default Judgment Against MMA (Including Interest)
Read this full article and the entire issue of ZIFL here.Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
Now Available The Compact Book of Adjusting Property Claims – Fourth Edition
On January 2, 2024, in Kindle, paperback and hardback formats, The Compact Book of Adjusting Property Claims, Fourth Edition is now available for purchase here.and here. The Fourth Edition contains updates and clarifications from the first three editions plus additional material for the working adjuster and the insurance coverage lawyer.
Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
Convictions From the Coalition Against Insurance Fraud
Dr. Michael Villarroel, working as a doctor in the US Navy, was sentenced in federal court to one year and one day in custody. Villarroel admitted that from 2012 to at least December 2015, he conspired with other members of the Navy to obtain money from the United States by making claims for life insurance payments based on exaggerated or fake injuries and disabilities. Villarroel certified that he reviewed the records and determined the injuries were legitimate when in fact he knew they were fake or exaggerated. At times, Villarroel falsely stated that he interviewed the claimant and provided other service members with actual medical records to be used in fabricating claims. Villarroel knew the claims were false, but he signed off on them to receive kickbacks once the fake injuries resulted in insurance payouts. In addition to prison time, Villarroel will have to pay $180K as criminal forfeiture.
Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
Health Insurance Fraud Convictions
Four Plead Guilty to Healthcare Offenses, Including Doctors and Lab Owners
Mark Rubin, 58, Renee Field, 44, Kelly Nelson, 52, and Carlos Hornedo, 61, were all charged via felony informations in December 2023. Mr. Rubin, on January 17th, and Mr. Hornedo, on January 10th, both pleaded guilty to one count of conspiracy to solicit and receive illegal kickbacks. On December 13th, Ms. Field and Ms. Nelson both pleaded guilty to one count of conspiracy to pay and receive health care kickbacks. The defendants each face a maximum penalty of not more than five years in federal prison, a $250,000 fine, and may be ordered to pay restitution.
Read this full article and the entire issue of ZIFL here.Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
Lawyer With Unfortunate Name & Advertising Asking that People Should ‘Hire A Dick’ Faces Six Figure Sanctions
Eric B. Dick, Esq, for the second time in three months has been ordered to reimburse an insurer more than $100,000 for filing a “frivolous, groundless” lawsuit made “solely for the purpose of harassment.”
Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
New Book Now Available from Barry Zalma
Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition
Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition provides detailed guidance and practical information on the four primary areas of any investigation of suspicious claims. The book also examines recent developments in areas such as arson investigation procedures, bad faith, extracontractual damages, The fake burglary, and Lawyers Deceiving Insurers, Courts & Their Clients During, Catastrophes—A New Type Of Fraud and the appendices includes the NAIC Insurance Information and Privacy Protection Model Act and usable forms for everyone involved in claims and will provide necessary information to the claims adjuster, SIU fraud investigator, claims manager, or coverage lawyer.
Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
Other Insurance Fraud Convictions
Life Insurance Fraud in South Africa
Onthatile Sebati and her co-accused and cousin Tumelo Mokone with Mokone’s brother Kagiso, were found guilty of killing her parents, sister and brother in 2016.
Sebati, 23, and her two cousins were found guilty in the Pretoria high court of murdering her father, mother, eight months pregnant sister and young brother. Sebati paid her cousins Tumelo and Kagiso Mokone R100,000 from life insurance payouts she received after the murders. She was 15 years old when she came up with the plot to kill her father, police constable Solomon Lucky Sebati, mother Mmatshepo, a nurse at an old-age home, her 19-year-old pregnant sister Tshegofatso and her young brother Quinton at their home at Mmakau near Brits in the North West in December 2016.
Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
(c) 2024 Barry Zalma & ClaimSchool, Inc.
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Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;
Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.
Subscribe to my substack at https://lnkd.in/giC2Kg4f
Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://lnkd.in/gV9QJYH; Go to the Insurance Claims Library – https://lnkd.in/gwEYkxD.
Who’s on First? State or Federal Court
Post 5222
Read the full article at https://lnkd.in/gWj97cFs, see the video at https://lnkd.in/gtS6CpUX and at https://lnkd.in/gQEAeyHc,
Conflict Between State & Federal Court Requires Abstention
See the video at https://lnkd.in/gtS6CpUX and at https://lnkd.in/gQEAeyHc,
Conflict Between State & Federal Court Requires Abstention
Hector David Campoverde was injured at a Brooklyn construction site in 2015. Campoverde was an employee of Vazquez Bro Restoration Inc., a subcontractor for C.C.C. Renovation Inc., which was itself a subcontractor for general contractor L&M Builders Group LLC. In Starr Indemnity & Liability Company v. Scottsdale Insurance Company, No. 24-CV-3309 (PKC) (TAM), United States District Court, E.D. New York (September 30, 2025) was asked to determine whether one or more of the involved insurers is obligated to indemnify Campoverde, and in what order Camporverde can receive indemnity, from one or more insurer.
Underlying Incident:
Campoverde sued the ...
National Flood Policy Bars Late Filed Suit
Post 5221
Read the full article at https://www.linkedin.com/pulse/one-year-suit-limitation-defeats-filed-two-years-zalma-esq-cfe-olr0c, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
No Excuse for Late Flood Suit After Claim Denial
In Domenico D’ambrosio, Michele D’ambrosio v. American Bankers Insurance Company Of Florida, No. 2:25-cv-155-KCD-NPM, United States District Court, M.D. Florida, Fort Myers Division (October 7, 2025) this is an insurance dispute stemming from Hurricane Ian. Plaintiffs Domenico and Michelle D’Ambrosio submitted a flood claim that Defendant American Bankers Insurance Company of Florida will not pay. To recover the funds allegedly owed, Plaintiffs sued for breach of contract.
Defendant’s moved to dismiss under Fed.R.Civ.P. 12(b)(6). Defendant presses one ...
ZIFL – Volume 29, Issue 21
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post 5220
Read the full article at https://lnkd.in/gRMJpi4s, see the video at https://lnkd.in/gwGSd6ZA & at https://lnkd.in/gbDiuFJy, and at https://zalma.com/blog plus more than 5200 posts.
See the video at & at https://rumble.com/v711hr0-zalmas-insurance-fraud-letter-november-1-2025.html
See the full 18 page issue of ZIFL at ZIFL-11-01-2025
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/
Conviction for Health Insurance Fraud Upheld
Physician Conspired with Bonavilla to Effect Health Insurance Fraud
Dennis Davin Bonavilla was involved in an insurance fraud scheme as an executive of Free Choice Healthcare. The scheme targeted indigent patients, often on ...
The Professional Claims Handler
Post 5219
Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
