ZIFL Volume 28, Issue 11
https://lnkd.in/g4ZCBiis, See the full article at https://lnkd.in/g2VXQMY3, https://lnkd.in/g4ZCBiis, see the full video at https://lnkd.in/gga7T4QM and at https://lnkd.in/gADfWipg and https://zalma.com/blog plus more than 4800 posts.
Read the article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
The Source for the Insurance Fraud Professional
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/ This issue contains the following articles:
The Scope of Loss
When dealing with a potential fraudulent first party-property loss it is essential that the investigation into the claim is through and prompt. To do a thorough investigation of a property loss it is essential that the insured and the company’s adjuster agree to a complete scope of loss so that the investigation into the amount of the loss is prepared and agreed to in immediately.
In a loss to structures or contents the scope of loss is generated at the first meeting between the adjuster and the insured. The scope of loss is where both parties agree on the categories of property damaged.
Read the article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
More McClenny Moseley & Associates Issues
This is ZIFL’s twenty ninth 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.
April 26, 2024 – MMA Generated Lawsuits Dismissed
Read the article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
Insureds are Made More Equal Than Insurers
California Court of Appeals Extends Meaning of Statute to Make Insured More Powerful than Insurers at EUO
As George Orwell explained in his novel “Animal Farm” we are all equal, but some are more equal than others. In Vladimir Myasnyankin v. Nationwide Mutual Insurance Company, A166946, A167445, California Court of Appeals, First District, Fifth Division (January 30, 2024) the Court of Appeals decided, over the dissent of the Presiding Judge that the insured in a disputed claim is more equal than the insurer.
Read the article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
New Book
The Compact Book of Adjusting Property Claims – Fourth Edition
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 article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
Health Insurance Fraud Convictions
The federal prosecutors and courts have been busy prosecuting health insurance fraud.
Doctor, One of Top Prescribers of Opioids in Massachusetts, Is Sentenced
Dr. Olarewaju James Oladipo, of Canton, a Massachusetts, an orthopedic surgeon who prosecutors say was one of the top prescribers of opioid drugs in the state was sentenced in federal court in Boston for his role in a health care fraud scheme.
Oladipo was sentenced by U.S. District Court Judge Allison D. Burroughs to 16 months in prison, followed by one year of supervised release. In December 2023, Oladipo was convicted by a federal jury of 10 counts of health care fraud.
Read the article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
New Book Now Available from Barry Zalma
Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition
Read the article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
Other Insurance Fraud Convictions
Tennessee Man Sentenced to Over 3 Years in Federal Prison for Crop Insurance Fraud
David Garrett Manion, 61, of Lafayette, Tennessee, was sentenced to 3 years and 6 months in federal prison, followed by 3 years of supervised release, and was ordered to pay $3.5 million in restitution for defrauding the federal crop insurance program.
According to court documents, Manion was convicted for defrauding the federal crop insurance program between 2016 and 2022. Manion also has a prior 2016 conviction for defrauding the federal crop insurance program. As part of that 2016 case, Manion agreed to a five-year debarment from the federal crop insurance program administered by the United States Department of Agriculture Risk Management Agency.
While that case was being resolved, however, Manion devised a scheme under which other family members applied for and received crop insurance for tobacco that was farmed by and belonged to Manion. In addition to $3.5 million in criminal restitution, Manion agreed to pay the Risk Management Agency nearly $5.5 million to resolve other outstanding issues.
Read the article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
(c) 2024 Barry Zalma & ClaimSchool, Inc.
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Read the article and the full 26 page issue here in Adobe pdf format http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-06-01-2024.pdf.
Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.
Go to X @bzalma; Go to the Insurance Claims Library – https://lnkd.in/gwEYk
Read the article and the full 26 page issue here in Adobe pdf format https://lnkd.in/g2VXQMY3.
Interpleader Protects All Claimants Against Life Policy and the Insurer
Who’s on First to Get Life Insurance Proceeds
Post 5184
See the full video at https://lnkd.in/gyxQfnUz and at https://lnkd.in/gAd3wqWP, and at https://zalma.com/blog plus more than 5150 posts.
Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://lnkd.in/gRthzSnT; Go to Barry Zalma on YouTube- https://lnkd.in/g2hGv88; Go to the Insurance Claims Library – https://lnkd.in/gwEYk.
Interpleader Protects All Claimants Against Life Policy and the Insurer
In Metropolitan Life Insurance Company v. Selena Sanchez, et al, No. 2:24-cv-03278-TLN-CSK, United States District Court, E.D. California (September 3, 2025) the USDC applied interpleader law.
Case Overview
This case involves an interpleader action brought by the Metropolitan Life Insurance Company (Plaintiff-in-Interpleader) against Selena Sanchez and other defendants (Defendants-in-Interpleader).
Key Points
Plaintiff-in-Interpleader’s Application:
The Plaintiff-in-Interpleader...
A Claim by Any Other Name is not a Claim
Post 5182
It is Imperative that Insured Report Potential Claim to Insurers
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In Jeffrey B. Scott v. Certain Underwriters At Lloyd’s, London, Subscribing To Policy No. B0901li1837279, RLI Insurance Company, Certain Underwriters At Lloyds, London And The Insurance Company, Subscribing To Policy No. B0180fn2102430, No. 24-12441, United States Court of Appeals, Eleventh Circuit (August 25, 2025) the court explained the need for a claim to obtain coverage.
Case Background:
This appeal arises from a coverage dispute under a Directors & Officers (D&O) insurance policy. Jeffrey B. Scott, the plaintiff-appellant, was terminated from his role as CEO, President, and Secretary of Gemini Financial Holdings, LLC in October 2019. Following his termination, Scott threatened legal action against Gemini, and ...
A Claim by Any Other Name is not a Claim
Post 5182
It is Imperative that Insured Report Potential Claim to Insurers
Read the full article at https://lnkd.in/gfbwAsxw, See the full video at https://lnkd.in/gea_hgB3 and at https://lnkd.in/ghZ7gjxy, and at https://zalma.com/blog plus more than 5150 posts.
In Jeffrey B. Scott v. Certain Underwriters At Lloyd’s, London, Subscribing To Policy No. B0901li1837279, RLI Insurance Company, Certain Underwriters At Lloyds, London And The Insurance Company, Subscribing To Policy No. B0180fn2102430, No. 24-12441, United States Court of Appeals, Eleventh Circuit (August 25, 2025) the court explained the need for a claim to obtain coverage.
Case Background:
This appeal arises from a coverage dispute under a Directors & Officers (D&O) insurance policy. Jeffrey B. Scott, the plaintiff-appellant, was terminated from his role as CEO, President, and Secretary of Gemini Financial Holdings, LLC in October 2019. Following his termination, Scott threatened legal action against Gemini, and ...
Barry Zalma: Insurance Claims Expert Witness
Posted on September 3, 2025 by Barry Zalma
The Need for a Claims Handling Expert to Defend or Prove a Tort of Bad Faith Suit
© 2025 Barry Zalma, Esq., CFE
When I finished my three year enlistment in the US Army as a Special Agent of US Army Intelligence in 1967, I sought employment where I could use the investigative skills I learned in the Army. After some searching I was hired as a claims trainee by the Fireman’s Fund American Insurance Company. For five years, while attending law school at night while working full time as an insurance adjuster I became familiar with every aspect of the commercial insurance industry.
On January 2, 1972 I was admitted to the California Bar. I practiced law, specializing in insurance claims, insurance coverage and defense of claims against people insured and defense of insurance companies sued for breach of contract and breach of the implied covenant of good faith and fair dealing. After 45 years as an active lawyer, I asked that my license to practice law be declared inactive ...
The Need for a Claims Handling Expert to Defend or Prove a Tort of Bad Faith Suit
© 2025 Barry Zalma, Esq., CFE
When I finished my three year enlistment in the US Army as a Special Agent of US Army Intelligence in 1967, I sought employment where I could use the investigative skills I learned in the Army. After some searching I was hired as a claims trainee by the Fireman’s Fund American Insurance Company. For five years, while attending law school at night while working full time as an insurance adjuster I became familiar with every aspect of the commercial insurance industry.
On January 2, 1972 I was admitted to the California Bar. I practiced law, specializing in insurance claims, insurance coverage and defense of claims against people insured and defense of insurance companies sued for breach of contract and breach of the implied covenant of good faith and fair dealing. After 45 years as an active lawyer, I asked that my license to practice law be declared inactive and became a consultant and expert witness for lawyers representing insurers and lawyers ...
APPRAISAL AWARD SETS AMOUNT OF DAMAGES RECOVERED FROM INSURER
Post 5180
See the full video at https://rumble.com/v6yd2z0-evidence-required-to-prove-breach-of-contract.html and at https://youtu.be/2ywEjs3hZsw, and at https://zalma.com/blog plus more than 5150 posts.
It’s a Waste of Time to Sue Your Insurer if You Don’t Have Evidence
Evidence Required to Prove Breach of Contract
Read the full article at https://www.linkedin.com/pulse/evidence-required-prove-breach-contract-barry-zalma-esq-cfe-rfelc, see the full video at https://rumble.com/v6yd2z0-evidence-required-to-prove-breach-of-contract.html and at https://youtu.be/2ywEjs3hZsw, and at https://zalma.com/blog plus more than 5150 posts.
It’s a Waste of Time to Sue Your Insurer if You Don’t Have Evidence
In Debbie Beaty and Jonathan Hayes v. Homeowners Of America Insurance Company, No. 01-23-00844-CV, Court of Appeals of Texas, First District (August 26, 2025) Debbie Beaty and Jonathan Hayes filed a claim under their homeowner’s insurance policy with Homeowners of ...
