In search of profit, insurers have decimated their professional claims staff. They laid off experienced personnel and replaced them with young, untrained, unprepared people. A virtual clerk replaced the old professional claims handler.
Process and computers replaced hands-on human skill and judgment. Money was saved on the expense side of the business by paying lower salaries. Within three months of firing the experienced claims people gross profit increased. The accountants were happy. The quarterly profits increased. None of the happy people were insurance professionals. None of them understood how a professional claims adjuster saves the insurer by establishing a fair amount of loss, avoiding payment for items not lost or overvalued, and by avoiding losses for which no coverage was provided by the policy.
The promises made by an insurance policy are kept by the professional claims person. Keeping a professional claims staff dedicated to excellence in claims handling is cost-effective over long periods of time. A professional and experienced adjuster will save the insurer millions by resolving disputes, paying claims owed promptly and fairly, and by so doing avoiding litigation and claims of breach of contract and breach of the covenant of good faith and fair dealing.
The professional claims person is an important part of the insurer’s defense against litigation by insureds against insurers for breach of contract and the tort of bad faith. Claims professionals resolve more claims for less money without the need for either party to involve counsel. A happy claimant satisfied with the results of his or her claim will never sue the insurer.
Incompetent or inadequate claims personnel force insureds and claimants to public insurance adjusters and lawyers. Every study performed on claims establishes that claims with an insured or claimant represented by counsel cost the insurer more than those where counsel is not involved.
Prompt, effective, professional claims handling saves money for both the insured and the insurer and fulfills the promises made when the insurer sold the policy.
Insurers who believe they can handle first or third party claims with young, inexpensive, inexperienced and untrained claims handlers should be accosted by angry stockholders whose dividends have plummeted, or will plummet, as a result. When an insurer compromises on claims staff, profits, thin as they may have been previously, will move rapidly into negative territory. Tort and punitive damages will deplete reserves. Insurers will quickly question why they are writing insurance. Those who stay in the business of insurance will either adopt a program requiring excellence in claims handling from every member of their claims staff, or they will fail.
Insurance is a business. It must change — this time for the better — if it is to survive. It must rethink the firing of experienced claims staff and reductions in training to save “expense.” Insurers should, if they wish to succeed, adopt a program to promote excellence in claims handling that can help insurers keep the promises made by the insurance policy and avoid charges of breach of contract and the tort bad faith in both first and third party claims.
The Largest Residential Burglary of All Time
Post 5407
Fraud & the Fear of Bad Faith Suits
Posted on July 22, 2026 by Barry Zalma
See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.
After ...
Chutzpah is not Enough
Post 5397
Posted on July 20, 2026 by Barry Zalma
See the video and at https://lnkd.in/gNUs2XzT and at https://lnkd.in/g2MawyzX
Magistrate Issues a Search Warrant if there is a Fair Probability that Contraband or Evidence of a Crime will be Found in a Particular Place.
In United States Of America v. Frank Suess, et al., CRIMINAL No. 3:24-308, United States District Court, M.D. Pennsylvania (July 16, 2026) a federal grand jury indicted Frank Suess, Melissa Driscoll, and others in a 55-count health care fraud and anti-kickback prosecution arising from an alleged scheme involving medically unnecessary prescription “foot baths.”
As part of the investigation, the FBI obtained an August 19, 2022 warrant to search Driscoll’s Sterling Pharmacy Yahoo email account for emails from January 1, 2018 through December 31, 2020. Driscoll moved to suppress the resulting evidence, arguing that the warrant lacked probable cause, was overbroad, and rested on material misstatements and omissions.
LAW:
The ...
Fraud Shouldn’t Pay
Post 5396
See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.
The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.
One month after the policy was ...
Statutory Benefits vs. Rights of an Indispensable Party
Posted on July 31, 2026 by Barry Zalma
Post 5415
In Yairi Vazquez De La Cruz v. Pennsylvania Financial Responsibility Assigned Claims Plan, No. 413 EDA 2025, No. J-A10037-26, Superior Court of Pennsylvania (July 29, 2026) the court was called upon to decide if Yairi Vazquez de la Cruz, who was injured in an April 16, 2019 motor vehicle accident in Pennsylvania while riding in a vehicle driven by Carol Castro was entitled to benefits from the Pennsylvania Assigned Claims Plan.
The vehicle was owned and insured by Wineska Navarro-Agosta through American Independent Insurance Company (AIIC), but Castro was not listed as a driver on the policy.
Appellee obtained a default judgment against the at-fault party, but no responsible party had insurance from which she could recover. She then, because there was no way to collect from the responsible party, he sought benefits from the Pennsylvania Financial Responsibility Assigned Claims Plan.
LAW
Under 75 Pa.C.S. § 1752(a), a ...
Missing Insurance Check Resulted in More than 200 Page Pro Se Complaint
Post 5414
Defendants Needed to Wade Through a Thicket Of Background Detail And Evidentiary Matter” To Identify Which Specific Claims Are Brought Against Them
In Keith P. Sequeira et al. v. Metropolitan Life Insurance Company et al., Civil Action No. 25-1929 (RK) (JTQ), United States District Court, D. New Jersey (July 20, 2026) this matter is before the Court upon pro se Plaintiffs Keith P. Sequeira and Helen D. Sequeira’s (“Plaintiffs”) First Amended Complaint. (“FAC”).
Plaintiffs alleged claims arising from a missing $17,558.32 insurance check issued after water damage to their New Jersey home and from a later sheriff’s sale/foreclosure concerning that property. Their First Amended Complaint asserted hundreds of counts against numerous defendants, including insurers, mortgage-related entities, banks, law firms, attorneys, and public officials.
BACKGROUND:
Plaintiffs originally filed suit in the District of Columbia, after ...
Missing Insurance Check Resulted in More than 200 Page Pro Se Complaint
Post 5414
Posted on July 30, 2026 by Barry Zalma
Defendants Needed to Wade Through a Thicket Of Background Detail And Evidentiary Matter” To Identify Which Specific Claims Are Brought Against Them
In Keith P. Sequeira et al. v. Metropolitan Life Insurance Company et al., Civil Action No. 25-1929 (RK) (JTQ), United States District Court, D. New Jersey (July 20, 2026) this matter is before the Court upon pro se Plaintiffs Keith P. Sequeira and Helen D. Sequeira’s (“Plaintiffs”) First Amended Complaint. (“FAC”).
Plaintiffs alleged claims arising from a missing $17,558.32 insurance check issued after water damage to their New Jersey home and from a later sheriff’s sale/foreclosure concerning that property. Their First Amended Complaint asserted hundreds of counts against numerous defendants, including insurers, mortgage-related entities, banks, law firms, attorneys, and public officials.
BACKGROUND:
Plaintiffs originally filed suit...
