Zalma on Insurance
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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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July 18, 2025
Solomon Like Decision: No Duty to Defend – Potential Duty to Indemnify

Concurrent Cause Doctrine Does Not Apply When all Causes are Excluded
Post 5119

Death by Drug Overdose is Excluded

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

Southern Insurance Company Of Virginia v. Justin D. Mitchell, et al., No. 3:24-cv-00198, United States District Court, M.D. Tennessee, Nashville Division (October 10, 2024) Southern Insurance Company of Virginia sought a declaratory judgment regarding its duty to defend William Mitchell in a wrongful death case pending in California state court.

KEY POINTS

1. Motion for Judgment on the Pleadings: The Plaintiff moved for judgment on the pleadings, which was granted in part and denied in part.
2. Duty to Defend: The court found that the Plaintiff has no duty to defend William Mitchell in the California case due to a specific exclusion in the insurance policy.
3. Duty to Indemnify: The court could not determine at this stage whether the Plaintiff had a duty to ...

00:08:21
July 17, 2025
No Good Deed Goes Unpunished

GEICO Sued Fraudulent Health Care Providers Under RICO and Settled with the Defendants Who Failed to Pay Settlement

See the full video at https://lnkd.in/gDpGzdR9 and at https://lnkd.in/gbDfikRG, and at https://zalma.com/blog plus more than 5100 posts.

Post 5119

Default of Settlement Agreement Reduced to Judgment

In Government Employees Insurance Company, Geico Indemnity Company, Geico General Insurance Company, and Geico Casualty Company v. Dominic Emeka Onyema, M.D., DEO Medical Services, P.C., and Healthwise Medical Associates, P.C., No. 24-CV-5287 (PKC) (JAM), United States District Court, E.D. New York (July 9, 2025)

Plaintiffs Government Employees Insurance Company and other GEICO companies (“GEICO”) sued Defendants Dominic Emeka Onyema, M.D. (“Onyema”), et al (collectively, “Defendants”) alleging breach of a settlement agreement entered into by the parties to resolve a previous, fraud-related lawsuit (the “Settlement Agreement”). GEICO moved the court for default judgment against ...

00:07:38
July 15, 2025
Zalma’s Insurance Fraud Letter – July 15, 2025

ZIFL – Volume 29, Issue 14
Post 5118

See the full video at https://lnkd.in/geddcnHj and at https://lnkd.in/g_rB9_th, and at https://zalma.com/blog plus more than 5100 posts.

You can read the full 20 page issue of the July 15, 2025 issue at https://lnkd.in/giaSdH29

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL

This issue contains the following articles about insurance fraud:

The Historical Basis of Punitive Damages

It is axiomatic that when a claim is denied for fraud that the fraudster will sue for breach of contract and the tort of bad faith and seek punitive damages.

The award of punitive-type damages was common in early legal systems and was mentioned in religious law as early as the Book of Exodus. Punitive-type damages were provided for in Babylonian law nearly 4000 years ago in the Code of Hammurabi.

You can read this article and the full 20 page issue of the July 15, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-07-15-2025.pdf

Insurer Refuses to Submit to No Fault Insurance Fraud

...

00:08:27
July 16, 2025
There is no Tort of Negligent Claims handling in Alaska

Rulings on Motions Reduced the Issues to be Presented at Trial

Read the full article at https://lnkd.in/gwJKZnCP and at https://zalma/blog plus more than 5100 posts.

CASE OVERVIEW

In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.

FACTS

Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.

Prior to trial Bernier had three remaining claims against State Farm:

1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.

Both Bernier and State Farm dispositive motions before ...

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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 ...

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