Never Lie or Conceal Potential Claims From Insurer
Read the full article at https://lnkd.in/gJkzeXBc, shttps://lnkd.in/gJkzeXBc and at https://zalma.com/blog plus more than 4800 posts.
Post 4823
Plaintiff CMGK, LLC, doing business as Massage Envy, appealed from an order granting summary-judgment to defendant Certain Underwriters at Lloyd’s, London Subscribing to Policy Number ME10XXXX, and dismissing with prejudice plaintiff’s claims. Plaintiff sought coverage under a Sexual Acts Liability Endorsement of a claims-made-and-reported policy issued by Lloyd’s to plaintiff. The court found plaintiff was not entitled to coverage and granted the motion.
In CMGK, LLC d/b/a Massage Envy v. Certain Underwriters At Lloyd’s, London Subscribing To Policy Number ME10XXXX, No. A-1836-22, Superior Court of New Jersey, Appellate Division (June 13, 2024) the appeal was considered based on the facts established by the motions.
FACTS
CMGK operated a Massage Envy Spa franchise located in Mays Landing. Emad Gus Khalifa was the sole member of plaintiff and was familiar with its operations. In 2013, plaintiff hired April Pippin as a general manager to assist Khalifa with the day-to-day management of the facility. Pippin and Khalifa performed management functions for plaintiff.
The Application for Insurance
Khalifa executed on behalf of plaintiff an application for the policy at issue. “This Claims Made policy applies only to those claims arising from covered incidents which occur on or after the stated retroactive date. In addition, the claim must first be made and reported to the company during the policy period or applicable extended reporting period.” (Emphasis in the policy).
The Policy
Defendant issued its Specified Medical Professions Professional Liability Insurance Policy to plaintiff for the policy period March 9, 2018, to March 9, 2019, and subject to a Retroactive Date of March 9, 2014. The policy included a Sexual Acts Liability Endorsement.
The Sexual Acts Liability Endorsement. Prior to the effective date of the policy, the Insured represented that it had no knowledge of a Sexual Act or any fact, circumstance, situation or incident involving a Sexual Act which may result in a Claim under this policy.
In 2016, plaintiff hired Steffon Davis as a massage therapist. According to plaintiff’s client M.N., Davis sexually assaulted her during a massage he performed on her on September 23, 2017. Two days later, M.N. reported the alleged assault to Pippin. On September 26, 2017, M.N. went to the Township of Hamilton police station and told a police officer about the incident. According to the officer, M.N. told her “[Davis had] placed his finger between her vagina lips and cupped her breast during a massage.”
M.N. eventually sued. On September 5, 2018, plaintiff tendered the suit to defendant for coverage who refused to defend or indemnify the Plaintiff who sued Lloyd’s claiming Lloyd’s had breached the policy and seeking a judgment declaring M.N.’s claims fell within the coverage provided by Lloyd’s.
Finding the language of the prior-knowledge clause to be “clear and unambiguous,” the trial court rejected plaintiff’s attempt to interpret it in a manner where an honest belief in the futility of a claim negates actual knowledge of allegations of wrongdoing. The court found the police decision not to file criminal charges does not support a reasonable belief that M.N. would not file a civil lawsuit.
Khalifa’s assumption or hope, purportedly based on the officer’s decision not to file a criminal complaint or M.N.’s decision not to file a civil complaint sooner, that M.N. wouldn’t file a claim is not enough to defeat summary judgment. Adopting plaintiff’s interpretation of the policy language would have the effect of rendering meaningless the prior-knowledge clause. To avoid the application of the clause, an insured could simply assert it did not believe – in the face of all evidence to the contrary – a claim might be filed.
The reasonableness of excluding claims based on prior conduct that the insured could reasonably have foreseen might serve as the basis for a future claim was apparent to the appellate court as it would be to anyone involved in the business of insurance. The Appellate Division, therefore, affirmed the order granting defendant’s summary-judgment motion.
ZALMA OPINION
An application for insurance is a request to an insurer to make an offer of insurance. The insurer relies on the good faith of the proposed insured to accurately respond to all the inquires including any information available to the insured at the time the application is presented, of any acts that could result in a claim. Such an act, sexual abuse of a customer by a massage therapist, known to the insured but not yet grown into an actual suit must be disclosed to allow the insurer to make a well reasoned decision to offer to insure the proposed insured.
(c) 2024 Barry Zalma & ClaimSchool, Inc.
Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.
Subscribe to my substack at https://barryzalma.substack.com/subscribe, & Subscribe to my substack at https://lnkd.in/gmmzUVBy.
Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg.
Go to X @bzalma; Go to the Insurance Claims Library – https://lnkd.in/gwEYk
Arsonist Tried To Represent Himself, Failed, and Sought Habeas Relief
Post number 5357
Read the full article at https://www.linkedin.com/pulse/he-who-acts-his-own-lawyer-has-idiot-client-barry-zalma-esq-cfe-d4bwc, See the full video at and at and at https://zalma.com/blog.
Karacson’s Arson for Profit Attempt Required Skill & Experience to Succeed
In Steve Ellis Karacson v. David Shaver, Warden, No. 25-1089, United States Court of Appeals, Sixth Circuit (May 20, 2026) Steve Karacson was convicted in Michigan state court of arson and insurance fraud after evidence showed he burned his own insured home. Investigators found multiple points of origin, gasoline odor, and evidence tying him to the scene, including cell-phone location data and a receipt showing he had purchased a gas can and gloves shortly before the fire.
FACTS
Karacson initially had appointed counsel, but his relationships with both appointed attorneys ...
Foolish to Repeatedly Disobey Court Orders
All That Remains For Trial Is Plaintiff’s Damages On Each Of These Claims And Establishing Proximate Causation Of Those Damages.
Post number 5348
See the full video at and at and at https://zalma.com/blog plus 5300 posts.
In Linh Wang v. Esurance Insurance Company, No. C24-0447-JCC, United States District Court, W.D. Washington, Seattle (May 1, 2026) John C. Coughenour, United States District Judge, found that throughout this case, culminating with its briefing on Plaintiff’s renewed motion and that Defendant has subjected Plaintiff to unnecessary motion practice for clearly discoverable information and made dubious representations (including to the Court).
FACTUAL BACKGROUND
This case involves an underinsured/uninsured motorist insurance bad faith claim arising from a 2017 motor vehicle collision. The plaintiff, Linh Wang, alleges that Esurance Insurance ...
The Right to Negotiate with Insurer is Not an Assignment of Claims
Post number 5347
Read the full article at https://www.linkedin.com/pulse/ambiguous-contract-repair-assignment-barry-zalma-esq-cfe-2xppc, see the full video at https://rumble.com/v79is1s-ambiguous-contract-to-repair-not-an-assignment.html and at and at https://zalma.com/blog plus more than 5300 posts.
Nebraska Requires an Actual Assignment to Allow Contractor to Sue Insurer
In Millard Gutter Company, a corporation doing business as Millard Roofing and Gutter v. Farmers Mutual Insurance Company of Nebraska, also known as Farmers Mutual Insurance, also known as Farmers Mutual, No. A-24-818, Court of Appeals of Nebraska (May 5, 2026) Millard sued Farmers as an assignee of Jane Anzalone who had hired Millard Gutter to repair the roof of her home and agreed to allow Millard Gutter to coordinate with her insurer, Farmers Mutual, concerning reimbursement for repairs authorized under her insurance policy.
FACTUAL BACKGROUND
In ...
Attempt at Intervention Fails
Post number 5366
GEICO Requires Commendation and Emulation for its Action Against Fraud Perpetrators
Read the full article at https://www.linkedin.com/pulse/insurer-sued-defendants-submitting-thousands-claims-zalma-esq-cfe-k4mdc and at https://zalma.com/blog plus more than 5350 posts.
In Government Employees Insurance Co., et. al. v. Tarakchyan D.C., et al., Civil No. 24-cv-6952 (ZNQ)(JTQ), United States District Court, D. New Jersey (May 29, 2026) GEICO sued medical-provider defendants for allegedly submitting thousands of fraudulent insurance charges for unnecessary treatment.
FACTS:
Air Wolf, a non-party defendant in a separate New York auto-accident case involving one of the same claimants, moved to intervene in order to access discovery and settlement materials and oppose confidentiality restrictions.
ISSUE:
Whether Air Wolf was entitled to intervene in GEICO’s federal fraud action under Rule 24, either as of right or permissively.
LEGAL STANDARD
Intervention is ...
Police Chief’s Guilty Verdict Affirmed
Post number 5365
Cumulative Evidence Sufficient to Prove Fraud
Read the full article at https://www.linkedin.com/pulse/conspiring-burn-vehicle-insurance-money-crime-barry-zalma-esq-cfe-raisc and at https://zalma.com/blog plus more than 5350 posts.
In United States of America v. Christopher Filline, No. 25-50049, United States Court of Appeals, Fifth Circuit (June 1, 2026) Christopher Filline, the police chief of Castroville, Texas, reported that his wife’s Lincoln Navigator had been stolen.
In truth, the vehicle had actually been burned on a remote road two days earlier. The government presented evidence that Filline was under serious financial strain, that the Navigator needed expensive repairs, and that Filline repeatedly said he wanted someone to “get rid of” it. According to witness testimony, Filline enlisted Ambrose Rymers, who in turn recruited his cousin Oscar Hernandez to take the vehicle and burn it.
After the vehicle was destroyed, Filline filed a false police report and ...
Arsonist Who Tried to Defraud Insurer Failed to Avoid Jail
Post number 5364
Posted on June 3, 2026 by Barry Zalma
Arson is a Violent and Dangerous Crime Deserving Serious Punishment
The People of the State of New York v. Zef Gjurashaj, 2026 NY Slip Op 03320, No. 2023-03675, Ind. No. 70463/21, Supreme Court of New York, Second Department (May 27, 2026) the defendant owned a restaurant that was destroyed by fire on September 6, 2017. Prosecutors alleged that he and a codefendant conspired to intentionally set the fire in order to obtain financial benefit.
At the time of the fire, the defendant’s wife was present in the restaurant, and the indictment alleged that she was not a participant in the crime. After a jury trial, the defendant was convicted of first-degree arson, second-degree conspiracy, two counts of first-degree reckless endangerment, second-degree insurance fraud, and fifth-degree criminal tax fraud.
LAW
The appellate court applied several key legal principles:
1. Preservation doctrine (CPL ...
