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 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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21 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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