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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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June 20, 2024
Arsonist Must Serve Full Sentence

Chutzpah: Serial Arsonist & Insurance Fraudster Requests Shortened Sentence

Read the full article at https://lnkd.in/gDiEdMAn, see the full video at https://lnkd.in/gzu2Sj4R and at https://lnkd.in/gf7ufCbr and at https://zalma.com/blog plus more than 4800 blog posts.

Post 4827

Arson-for-Profit is the most evil form of insurance fraud where people may be injured or die. Defendant Michael Thomas set fire to many properties in a mobile home park and then used the mail to collect insurance money. He was charged with four counts of mail fraud, went to trial and the jury convicted him on all counts. The Court sentenced him to a below-guidelines sentence of ninety months of imprisonment. His sentence is set to expire on February 11, 2025. Mr. Thomas is currently under home confinement under the CARES Act.

In United States Of America v. Michael Thomas, No. 3:18-CR-45 JD, United States District Court, N.D. Indiana, South Bend Division (June 6, 2024) Proceeding pro se, Mr. Thomas moved for a reduction in his sentence and the court considered his claims and rejected them.

BACKGROUND

After serving time in prison, Mr. Thomas was released by the Bureau of Prisons (“BOP”) to home confinement under the CARES Act to finish the rest of his sentence, which is expected to end next February. Mr. Thomas claims that the BOP is prohibiting him from securing employment as a pilot, a job which he held before being convicted of the fraud offenses. He states that he needs this job to maximize his income in order to repay restitution, support his family, and repay student debts. Mr. Thomas insists that his inability to work because of home confinement constitutes atypical circumstances warranting compassionate release.

LEGAL STANDARD

A court generally cannot modify a sentence once the sentence has been imposed. An exception to that general rule allows a court to modify a sentence, after considering if “extraordinary and compelling reasons warrant such a reduction,” the reduction is consistent with policy statements issued by the Sentencing Commission.

This analysis proceeds in two steps. At the first step the defendant must identify an extraordinary and compelling reason warranting a sentence reduction. If the defendant establishes such a reason, the district court, in the discretion conferred by the statute. The defendant’s rehabilitation is not, by itself, an extraordinary and compelling reason.

DISCUSSION

For four years, Mr. Thomas was engaged in mail fraud schemes against insurance companies. As part of those schemes, he and an associate caused seven fires at various dwellings in North Judson, Indiana. After the fires, he filed for and collected insurance payments on four properties that were damaged or destroyed by these fires.

Of the seven fires, two of them were at vacant properties, set to deflect suspicion from Mr. Thomas’s insurance fraud. By setting fires to residences, Mr. Thomas displayed no regard for the welfare and safety of those who lived nearby. While the dwellings he burned may have been unoccupied, his actions put first responders directly in harm’s way and there was no guarantee that the fires would not spread to nearby, occupied homes. The nature of Mr. Thomas’s criminal conduct, the need to reflect the seriousness of the offense, to promote respect for the law, and to provide just punishment for the offense, as well as the importance of deterring insurance fraud – among other factors – outweigh any mitigating circumstances in favor of early release.

The court concluded that Mr. Thomas did not establish an extraordinary and compelling reason for modifying his sentence. That Mr. Thomas has a limited ability to do other jobs rather than his preferred one due to his home detention status does not convert his situation into an extraordinary one. There’s no compelling reason to modify his sentence.

Therefore, Mr. Thomas’ motion for compassionate release or reduction in sentence was denied.

ZALMA OPINION

A professional pilot acted as a serial arsonist and insurance fraudster. He was convicted of the violent and dangerous crime of arson for profit and served time. He was lucky and allowed to serve the remainder of his sentence at home and then, with unmitigated gall, complained that the home confinement prevented him from making more money as a pilot and asked for his sentence to be reduced. The Court had no empathy and required him to fulfill his entire sentence.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:08:39
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14 hours ago
Ambiguity in Insurance Contract Resolved by Jury

Jury’s Findings Interpreting Insurance Contract Affirmed
Post 5105

See the full video at https://lnkd.in/gPa6Vpg8 and at https://lnkd.in/ghgiZNBN, and at https://zalma.com/blog plus more than 5100 posts.

Madelaine Chocolate Novelties, Inc. (“Madelaine Chocolate”) appealed the district court’s judgment following a jury verdict in favor of Great Northern Insurance Company (“Great Northern”) concerning storm-surge damage caused by “Superstorm Sandy” to Madelaine Chocolate’s production facilities.

In Madelaine Chocolate Novelties, Inc., d.b.a. The Madelaine Chocolate Company v. Great Northern Insurance Company, No. 23-212, United States Court of Appeals, Second Circuit (June 20, 2025) affirmed the trial court ruling in favor of the insurer.

BACKGROUND

Great Northern refused to pay the full claim amount and paid Madelaine Chocolate only about $4 million. In disclaiming coverage, Great Northern invoked the Policy’s flood-exclusion provision, which excludes, in relevant part, “loss or damage caused by ....

00:07:02
June 23, 2025
The Clear Language Of The Insurance Contract Controls

Failure to Name a Party as an Additional Insured Defeats Claim
Post 5104

Read the full article at https://lnkd.in/gbcTYSNa, see the full video at https://lnkd.in/ggmDyTnT and at https://lnkd.in/gZ-uZPh7, and at https://zalma.com/blog plus more than 5100 posts.

Contract Interpretation is Based on the Clear and Unambiguous Language of the Policy

In Associated Industries Insurance Company, Inc. v. Sentinel Insurance Company, Ltd., No. 23-CV-10400 (MMG), United States District Court, S.D. New York (June 16, 2025) an insurance coverage dispute arising from a personal injury action in New York State Supreme Court.

The underlying action, Eduardo Molina v. Venchi 2, LLC, et al., concerned injuries allegedly resulting from a construction accident at premises owned by Central Area Equities Associates LLC (CAEA) and leased by Venchi 2 LLC with the USDC required to determine who was entitled to a defense from which insurer.
KEY POINTS

Parties Involved:

CAEA is insured by Associated Industries Insurance Company, Inc. ...

00:08:22
June 20, 2025
Four Corners of Suit Allows Refusal to Defend

Exclusion Establishes that There is No Duty to Defend Off Site Injuries

Post 5103

Read the full article at https://lnkd.in/geje73Gh, see the full video at https://lnkd.in/gnQp4X-f and at https://lnkd.in/gPPrB47p, and at https://zalma.com/blog plus more than 5100 posts.

Attack by Vicious Dog Excluded

In Foremost Insurance Company, Grand Rapids, Michigan v. Michael B. Steele and Sarah Brown and Kevin Lee Price, Civil Action No. 3:24-CV-00684, United States District Court, M.D. Pennsylvania (June 16, 2025)

Foremost Insurance Company (“Foremost”) sued Michael B. Steele (“Steele”), Sarah Brown (“Brown”), and Kevin Lee Price (“Price”) (collectively, “Defendants”). Foremost sought declaratory relief in the form of a declaration that

1. it owes no insurance coverage to Steele and has no duty to defend or indemnify Steele in an underlying tort action and
2. defense counsel that Foremost has assigned to Steele in the underlying action may withdraw his appearance.

Presently before the Court are two ...

00:08:29
May 15, 2025
Zalma's Insurance Fraud Letter - May 15, 2025

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 ...

May 15, 2025
CGL Is Not a Medical Malpractice Policy

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 ...

April 30, 2025
The Devil’s in The Details

A Heads I Win, Tails You Lose Story
Post 5062

Posted on April 30, 2025 by Barry Zalma

"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ­­­Perpetrators than any Other Crime."

Immigrant Criminals Attempt to Profit From Insurance Fraud

People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.

The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...

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