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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 21, 2024
Never Delay Responding to Requests for Admission in Arizona

Requests for Admission Deemed Admitted in Arizona if Not Responded to Within 30 Days

Read the full article at https://lnkd.in/gFaFwFTY, see the full video at https://lnkd.in/gPvzTw_3 and at https://lnkd.in/gy6u9uGk and at https://zalma.com/blog plus more than 4800 posts.

Post 4828

Rose Karam, an insured, appealed from the superior court’s grant of summary judgment in favor of her residential property insurer, Mercury Casualty Co. In Rose A. Karam v. Mercury Casualty Company, No. 2 CA-CV 2023-0112, Court of Appeals of Arizona, Second Division (May 31, 2024) her suit against Mercury was defeated by admission that she had no case because she responded late to requests.

FACTUAL BACKGROUND

Karam was an insured under a Mercury homeowner’s policy. After suffering a fire at her home, Karam filed a property loss and damage claim under the policy, citing damage to a piano and a wall mirror. Following receipt of payments by Mercury Karam complained to Mercury that she was underpaid for personal property losses.

Two years later, Karam sued Mercury for insurance fraud, consumer fraud, and breach of contract. Thereafter, on August 30, 2022, Mercury served Karam with a set of discovery requests including interrogatories and requests for admission. Karam’s response to the requests for admission were due within thirty days of service she provided her responses months later on December 1, 2022.

Mercury moved for summary judgment. By its motion, Mercury asserted, in part, that because Karam’s responses to the requests for admission were untimely, the requests were deemed admitted. Due to those admissions-including that Karam had been fully and fairly paid for her losses, that Mercury had not breached the insurance policy, and that Karam had suffered no damages-Mercury claimed it was entitled to judgment as a matter of law on Karam’s breach of contract claim.

The court further determined that, even considering her actual, albeit untimely, responses to the requests for admission, Karam “failed to produce admissible evidence creating a genuine issue of fact for trial.”

DISCUSSION

The Court of Appeals will only affirm a grant of summary judgment if the evidence produced in support of the defense or claim has so little probative value that no reasonable person could find for its proponent.

Admissions

Arizona Rule 36(a)(1) provides that “[a] party may serve on any other party a written request to admit . . . the truth of any matters . . . relating to . . . facts, the application of law to fact, or opinions about either; and . . . the genuineness of any described documents.” The purpose of requests for admission is to expedite the trial and to relieve parties of unnecessary costs in proving facts.

Once a party is served with requests for admission, failure to respond within 30 days the rule provides “[a] matter admitted under this rule is conclusively established unless the court, on motion, permits the admission to be withdrawn or amended.”

Karam conceded on appeal that she did not respond to Mercury’s requests for admission within the required thirty-day period. Therefore the superior court did not abuse its discretion in deeming the statements in the requests for admission admitted.

Karam effectively admitted that she had been fully and fairly compensated for the claims she submitted, that Mercury did not breach the insurance policy, and that she did not otherwise have damages. Those admissions – even each standing alone – defeat a claim for breach of the insurance policy.

Given the allegations in Karam’s complaint and her admissions made by operation of law, there remained no material issue in dispute and Karam can no longer carry her burden of proof in this action.

Mercury was entitled to summary judgment and the court did not err in granting Mercury’s motion.

ZALMA OPINION

A lawyer practicing in Arizona that does not comply with the rules concerning Requests for Admission will always lose because his opponent will always send a Request including the ultimate facts about the case. Mercury’s counsel took advantage of the Arizona rule and obtained admissions that resulted in the resolution of the case in its favor. Karam is not without a remedy, she has a cause of action against her lawyer.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:06:29
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20 hours ago
Allegations That Establish Breach of a Condition Defeats Suit

Notice of Claim Later than 60 Days After Expiration is Too Late

Post 5089

Injury at Massage Causes Suit Against Therapist

Read the full article at https://lnkd.in/gziRzFV8, see the full video at https://lnkd.in/gF4aYrQ2 and at https://lnkd.in/gqShuGs9, and at https://zalma.com/blog plus more than 5050 posts.

Hiscox Insurance Company (“Hiscox”) moved the USDC to Dismiss a suit for failure to state a claim because the insured reported its claim more than 60 days after expiration of the policy.

In Mluxe Williamsburg, LLC v. Hiscox Insurance Company, Inc., et al., No. 4:25-cv-00002, United States District Court, E.D. Missouri, Eastern Division (May 22, 2025) the trial court’s judgment was affirmed.

FACTUAL BACKGROUND

Plaintiff, the operator of a massage spa franchise, entered into a commercial insurance agreement with Hiscox that provided liability insurance coverage from July 25, 2019, to July 25, 2020. On or about June 03, 2019, a customer alleged that one of Plaintiff’s employees engaged in tortious ...

00:08:31
June 02, 2025
Zalma’s Insurance Fraud Letter – June 1, 2025

ZIFL – Volume 29, Issue 11
The Source for the Insurance Fraud Professional
Posted on June 2, 2025 by Barry Zalma

Post 5087

See the full video at and at

Read the full article and the full issue of ZIFL June 1, 2025 at https://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-06-01-2025.pdf

Zalma’s Insurance Fraud Letter – June 1, 2025

See the full video at https://lnkd.in/gw-Hgww9 and at https://lnkd.in/gF8QAq4d, and at https://zalma.com/blog plus more than 5050 posts.

ZIFL – Volume 29, Issue 11

The Source for the Insurance Fraud Professional

Read the full article and the full issue of ZIFL June 1, 2025 at https://lnkd.in/gTWZUnnF

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 ...

00:08:42
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May 30, 2025
Plain Language of Policy Enforced

No Coverage if Home Vacant for More Than 60 Days

Failure to Respond To Counterclaim is an Admission of All Allegations

Post 5085

See the full video at https://lnkd.in/gbWPjHub and at https://lnkd.in/gZ9ztA-P, and at https://zalma.com/blog plus more than 5050 posts.

In Nationwide Mutual Insurance Company v. Rebecca Massey, Civil Action No. 2:25-cv-00124, United States District Court, S.D. West Virginia, Charleston Division (May 22, 2025) Defendant Nationwide Mutual Insurance Company's (“Nationwide”) motion for Default Judgment against Plaintiff Rebecca Massey (“Plaintiff”) for failure to respond to a counterclaim and because the claim was excluded by the policy.

BACKGROUND

On February 26, 2022, Plaintiff's home was destroyed by a fire. At the time of this accident, Plaintiff had a home insurance policy with Nationwide. Plaintiff reported the fire loss to Nationwide, which refused to pay for the damages under the policy because the home had been vacant for more than 60 days.

Plaintiff filed suit ...

00:06:50
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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