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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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May 22, 2024
No Post Conviction Help

Unrelated Witness Misconduct no Help to Convicted Shooter

Read the full article at https://lnkd.in/gD3GMuDC, see the full video at https://lnkd.in/gyf488DC and at https://lnkd.in/gUpxQCCz and https://zalma.com/blog plus more than 4800 posts.

Post 4806

Luis M. Soto (“Soto”) appealed pro se from the order dismissing his second petition for relief filed pursuant to the Post Conviction Relief Act (“PCRA”).

In Commonwealth Of Pennsylvania v. Luis M. Soto, Nos. 831 EDA 2023, 832 EDA 2023, 833 EDA 2023, 834 EDA 2023, No. J-S04035-24, Superior Court of Pennsylvania (May 14, 2024) the appellate court gave consideration to all the pro se claims only to see them quashed.
FACTS

In 2013, Soto discharged a firearm into a large crowd of people in Philadelphia, killing one person and injuring three others, including Larry Robinson. Madeline Soberal, a witness to the shooting, was initially reluctant to speak with police, but after interacting with Officer Carmen Sanchez, identified Soto as the shooter from a photo array. The matter proceeded to a consolidated jury trial at which Soberal testified that she was a few feet away from Soto when he pulled out a firearm and began shooting into the crowd. Officer Sanchez testified that Soberal feared for her safety if she provided a statement to police and had to be convinced that police would ensure her safety if she agreed to provide testimony against Soto.

After Soto was convicted, in May 2022, the Philadelphia District Attorney’s Office sent correspondence to Soto that revealed that each of the officers who testified with regard to his trial and conviction had been involved in various forms of misconduct unrelated to Soto’s criminal case. For example, Officer Sanchez received a fifteen-day suspension after being found guilty of insurance fraud, Officer Cartegena was disciplined for using excessive force in an unrelated criminal matter, and Detective Crone was disciplined for both a domestic violence incident and for authoring a racially offensive letter. None of the misconduct had anything to do with the shooting.

Soto claimed that he was entitled to a new trial on the basis that, “had the jury been aware of the officers’ history of, and propensity for misconduct at the time of his trial, the outcome would have been different.”

The PCRA court entered an order dismissing the petition. The appellate court reviews an order dismissing a petition under the PCRA in the light most favorable to the prevailing party at the PCRA level.

ANALYSIS

The PCRA court concluded that Soto’s claims lacked merit. The PCRA court observed that the evidence of misconduct by the officers was completely unrelated to Soto’s criminal case. The appellate court concluded that the PCRA court’s determination, that the after-discovered evidence presented by Soto had no other use than to impeach the credibility of the officers’ testimony at trial, is supported by the record and free of legal error.

In his PCRA petition, Soto identified only one witness who would testify at an evidentiary hearing, that is, Assistant District Attorney Shoshana Silverstein, to confirm that she provided Soto with the police misconduct disclosure packet that is the basis for his claims.

No witnesses at trial claimed that they were coerced by police, and the only evidence offered by Soto to the contrary was the isolated instances of unrelated police misconduct included in the police disclosure packet. Soto’s claims were entirely speculative.

The Superior Court concluded that the PCRA court’s decision to deny Soto’s request for leave to amend his petition is supported by the record and free from legal error. Soto’s issues merits no relief.

ZALMA OPINION

The essence of this case is that Soto must stay in jail. The fact that one of the officers who testified against Soto was convicted of Insurance Fraud and other officers were disciplined for unrelated issues had no bearing on the fact that Soto shot many bullets into a group of people and killed someone did not change and he was not entitled to post conviction relief.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:06:47
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12 hours ago
$455 Million for Unnecessary Covid Tests is a Crime

Detail Charging Defendant for Fraud is Sufficient
Post 5242

Read the full article at https://lnkd.in/g_HVw36q, see the video at https://lnkd.in/gpBd-XTg and at https://lnkd.in/gzCnBjgQ and at https://zalma.com/blog plus more than 5200 posts.

Charges that Advises the Defendant of the Crime Cannot be Set Aside

In United States Of America v. Lourdes Navarro, AKA Lulu, No. 25-661, United States Court of Appeals, Ninth Circuit (December 4, 2025) Lourdes Navarro appealed the district court’s denial of her motion to dismiss the indictment and enter final judgment was in error.

FACTUAL BACKGROUND

The indictment alleged that insurers reimburse only for medically necessary services. Navarro performed unnecessary respiratory pathogen panel (RPP) tests on nasal swabs collected from asymptomatic individuals for COVID-19 screening.

Navarro billed over $455 million to insurers for those additional RPP tests that she knew to be medically unnecessary. These allegations constituted a plain, concise, and definite written ...

00:07:41
December 11, 2025
An International Convention Requiring Enforcement of Foreign Arbitration Award Doesn’t Apply

Louisiana Statute Prevents Enforcement of Contract Term Requiring Arbitration of Disputes

Post 5241

Read the full article at https://www.linkedin.com/pulse/international-convention-requiring-enforcement-award-barry-sttdc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.

In Town of Vinton v. Indian Harbor Insurance Company, Nos. 24-30035, 24-30748, 24-30749, 24-30750, 24-30751, 24-30756, 24-30757, United States Court of Appeals, Fifth Circuit (December 8, 2025) municipal entities including the Town of Vinton, et al sued domestic insurers after dismissing foreign insurers with prejudice. The insurers sought arbitration under the Convention on the Recognition and Enforcement of Foreign Arbitral Awards (the “Convention”) but the court held Louisiana law — prohibiting arbitration clauses in such policies—controls, as the Convention does not apply absent foreign parties who ...

00:08:06
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December 10, 2025
$500 a Day Penalty if no Workers’ Compensation Insurance

Refusal to Provide Workers’ Compensation is Expensive
Post 5240

Read the full article at https://lnkd.in/guC9dnqA, see the video at https://lnkd.in/gVxz-qmk and at https://lnkd.in/gUTAnCZw, and at https://zalma.com/blog plus more than 5200 posts.

In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.

Company Overview:

USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...

00:09:22
October 31, 2025
The Zalma Philosophy of Claims Handling – Part 9

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 ...

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October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

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 ...

post photo preview
October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

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 ...

post photo preview
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