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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 27, 2024
Damage While Fleeing Police Excluded

Exclusion Does Not Invalidate Policy

Read the full article at https://lnkd.in/gc4XEkP9, see the full video at https://lnkd.in/gnZwe9h6 and at https://lnkd.in/gT6-vh-d and at https://zalma.com/blog plus more than 4800 posts.

Post 4822

THE DISPUTE

Jerquavius Berry purchased a vehicle from Gerald Jones Ford, LLC. The Dealership sued General Security and Berry, seeking a declaratory judgment regarding General Security’s insurance coverage.

In General Security Indemnity Company Of Arizona v. Gerald Jones Ford, LLC. No. A24A0477, Court of Appeals of Georgia, Fifth Division (June 18, 2024) the Georgia Court of Appeals read the policy and ruled based on its wording.

Both moved for summary judgment. The trial court granted the Dealership’s motion and denied General Security’s motion. General Security appealed. The Court of Appeals decision turned on whether a denied claim renders an insurance policy “invalid.”

FACTS

In order to purchase the vehicle, Berry presented evidence of an insurance policy with Falls Lake National Insurance Company (“Falls Lake”) to the Dealership. Three days after he purchased the vehicle, while fleeing police in Virginia, Berry crashed the vehicle, causing a total loss. Berry was later found guilty of crimes.

Perhaps because Berry was in jail and did not respond to Exeter’s inquiry it rejected the note and returned it to the Dealership. The Dealership made a claim for the vehicle under Berry’s Falls Lake insurance policy. The Falls Lake policy provided that claims for Berry’s property damage were excluded from coverage because Berry was fleeing police when the vehicle sustained a total loss.

The Dealership submitted a claim for Berry’s vehicle to General Security, but General Security denied the claim, stating that the loss did not fall within the policy’s coverage. The Dealership filed the underlying declaratory judgment action against General Security. The Dealership’s insurance policy with General Security provided coverage for insured vehicles until the vehicle was sold or leased by the Dealership or if the buyer’s insurance proved to be invalid at the time of loss to the covered vehicle.

DISCUSSION

Since Berry provided evidence of insurance and the Dealership was not fully paid the only dispute at issue was whether Berry’s Falls Lake policy was invalid at the time of the loss.

The Court of Appeals undertook a three-step process in the construction of the contract:

1. The first of which is to determine if the instrument’s language is clear and unambiguous,
2. If the language is unambiguous, the court simply enforces the contract according to the terms and
3. Looks to the contract alone for the meaning.

When a contract term is not expressly defined, the court looks to the usual and common meaning of the term. A policy is invalid when coverage applies but becomes invalidated through the actions of the insured.

The Falls Lake insurance policy does not contain a coverage exclusion for fleeing police for a bodily or property injury to others only damage to the vehicle. Had Berry caused a bodily or property injury to another while fleeing the police, that third party’s claim would not have been excluded. The Falls Lake policy was in full force and effect at the time of the occurrence and coverage was not invalidated; it simply did not apply.

ZALMA OPINION

Where the language of an insurance policy unambiguously governs the factual scenario before the court, the court need only to apply the terms of the contract as written. The General Security policy language unambiguously does not cover such claims unless the purchaser’s insurance policy was invalid at the time of the loss. Since Berry’s policy with Falls Lake was not invalid at the time of the loss the trial court erred by granting summary judgment to the Dealership. Accordingly, the Court of Appeals reversed the trial court.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:08:07
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May 01, 2026
Zalma’s Insurance Fraud Letter – May 1, 2026

Happy Law Day

ZIFL – Volume 30, Issue 9 – May 1, 2026

Read the full article at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-may-1-2026-barry-zalma-esq-cfe-2tywc, see the video at at and at https://zalma.com/blog plus more than 5300 posts.

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL

ZIFL – Volume 30, Issue 9 – May 1, 2026

Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year and is written by Barry Zalma.

DOJ Creates National Fraud Enforcement Division

Will the Feds Take on Insurance Fraud? Possibly as Part of a National Anti-Fraud Effort

On April 7, 2026, the Acting Attorney General, Todd Blanche, issued a memorandum establishing the Department of Justice National Fraud Enforcement Division (NFED). The memo describes an ambitious, but perhaps redundant, vision for this ...

00:08:23
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April 30, 2026
The Efficient Proximate Cause Doctrine Saves a Claim

When Abalone Died As a Result of Multiple Causes The Efficient Proximate Cause Requires Payment

Post number 5345

Read the full article at https://www.linkedin.com/pulse/efficient-proximate-cause-doctrine-saves-claim-barry-zalma-esq-cfe-yndlc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.

In American Abalone Farms, LLC v. Star Insurance Company et al., H052643, California Court of Appeals, Sixth District (April 27, 2026) the Court of Appeals dealt with an insurance coverage issue that required application of the efficient proximate cause doctrine.

FACTS

American Abalone Farms, LLC ("American Abalone" ) operates an aquaculture farm in Santa Cruz County, California, raising abalone in tanks. In August 2020, the CZU Lightning Complex Fires led to a prolonged power outage and road closures near the farm. As a result, the farm’s water pumps failed, causing the death of most of the ...

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April 29, 2026
Breach of a Specific Condition Precedent Is a Complete Defense

Breach of a Specific Condition Precedent Is a Complete Defense

See the video at and at and at https://zalma.com/blog plus more than 5300 posts.

In United Services Automobile Association and State Farm Mutual Automobile Insurance Company v. Anthony Wenzell, 2026 CO 25 (Colo. Apr. 27, 2026) Anthony Wenzell was rear-ended in a car accident. He had a significant prior 2014 accident that required back surgery.

Wenzell claimed underinsured-motorist (UIM) benefits under three policies: (1) the tortfeasor’s liability policy, (2) his own primary UIM policy with State Farm, and (3) an excess UIM policy issued by USAA (under his brother’s policy, which contained an “other insurance” clause making USAA’s coverage excess over any collectible insurance).

After receiving the claims, both USAA and State Farm repeatedly requested that Wenzell execute comprehensive medical-release authorizations so they could obtain his full medical records and ...

00:11:27
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12 hours ago

It is Fraud to Make the Same Claim Twice

Read the full article at https://www.linkedin.com/pulse/fraud-make-same-claim-twice-barry-zalma-esq-cfe-c4g8c and at https://zalma.com/blog.

Chutzpah: After Being Paid for a New Roof Insured Makes Second Claim For Same Damages

Post number 5347

No One is Entitled to be Paid for the Same Loss Twice

In Mohammed Ali Khalili v. State Farm Lloyds, No. 14-25-00611-CV, Court of Appeals of Texas (April 30, 2026) Khalili maintained a State Farm Lloyds homeowners insurance policy for decades. In 2008 he filed a roof-damage claim; State Farm paid him to replace the entire roof (shingles and gutters). Khalili never replaced the roof and repeated his claim.

BACKGROUND

In 2021 he filed a second roof claim. State Farm’s inspectors found the roof “very old” with extensive non-storm-related damage. The claim was denied because (1) the damage did not exceed the deductible and (2) State Farm had already paid for a full roof replacement.

PROCEDURAL HISTORY

State Farm filed motion for summary...

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12 hours ago

It is Fraud to Make the Same Claim Twice

Read the full article at https://www.linkedin.com/pulse/fraud-make-same-claim-twice-barry-zalma-esq-cfe-c4g8c and at https://zalma.com/blog.

Chutzpah: After Being Paid for a New Roof Insured Makes Second Claim For Same Damages

Post number 5347

No One is Entitled to be Paid for the Same Loss Twice

In Mohammed Ali Khalili v. State Farm Lloyds, No. 14-25-00611-CV, Court of Appeals of Texas (April 30, 2026) Khalili maintained a State Farm Lloyds homeowners insurance policy for decades. In 2008 he filed a roof-damage claim; State Farm paid him to replace the entire roof (shingles and gutters). Khalili never replaced the roof and repeated his claim.

BACKGROUND

In 2021 he filed a second roof claim. State Farm’s inspectors found the roof “very old” with extensive non-storm-related damage. The claim was denied because (1) the damage did not exceed the deductible and (2) State Farm had already paid for a full roof replacement.

PROCEDURAL HISTORY

State Farm filed motion for summary...

post photo preview
April 30, 2026
Investigation of First Party Property Claims

What Must be Done after Notice of a Claim is Received by the Insurer

Read the full article at https://lnkd.in/gzvvdkMZ and at https://zalma.com/blog.

Below you will read from this post until you reach the the end of this blog post as the free part of an Excellence in Claims Handling post. To read the full article and receive all articles for members of Excellence in Claims Handling you should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the subscription link below.

A first party property policy does not insure property: it insures a person, partnership, corporation or other entity against the risk of loss of the property. Before an insured can make a claim for indemnity under a policy of first party property insurance the insured must prove that there was damage to property the risk of loss of which was insured by the policy. The obligation imposed on the insured ...

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