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.
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Proof of Highly Contaminated Water is Required for Extra Payments
Post number 5300
Read the full article at https://www.linkedin.com/pulse/acting-your-own-lawyer-foolish-barry-zalma-esq-cfe-mbg0c, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Acting as Your Own Lawyer is Foolish
Evidence of Breach of Contract Survives Dismissal of All Other Charges
In Lee Lifeng Hsu and Jane Yuchen Hsu v. State Farm Fire And Casualty Company, C. A. No. N24C-09-020 CLS, Superior Court of Delaware (February 27, 2026) a claim to State Farm who paid approximately $61,000 after assessments but denied coverage for additional items including ceramic tiles, the kitchen floor ceiling, underlayment plywood, and numerous personal property items resulted in suit by the Hsu’s acting in pro per.
Facts
Lee Lifeng Hsu and Jane Yuchen Hsu (“Plaintiffs”) purchased a homeowners’ insurance policy from State Farm Fire...
Chutzpah of Fraud Perpetrator Still Gets 36 years in Prison
Post number 5303
Read the full article at https://www.linkedin.com/pulse/fraudster-fails-jail-house-lawyer-barry-zalma-esq-cfe-araye and at https://zalma.com/blog plus more than 5200 posts.
Prisoner Should Know Better Than Representing Himself
In The People v. Roderick Nathaniel Washington, B330868, California Court of Appeals, Second District, Eighth Division (March 5, 2026) Roderick Nathaniel Washington was convicted by a jury on numerous counts related to credit card and unemployment insurance fraud.
The investigation revealed that Washington orchestrated two main types of fraud. The first involved credit cards: police searches at the residences of Washington’s girlfriend and his daughter uncovered hundreds of credit profiles, personal identifying information, mail addressed to Washington, fraudulent licenses and credit cards, and forged reports.
FACTUAL BACKGROUND
Bank Fraud
Washington opened multiple accounts in the names of others, including deceased ...
Denying a Claim in the State Gives Court Standing
Post number 5302
Posted on March 12, 2026 by Barry Zalma
In 5th LLC v. Kemah Capital Holdings, LLC d/b/a Kemah Marine and Clear Spring Property and Casualty Company, No. CIV-25-364-D, United States District Court, W.D. Oklahoma (March 10, 20260
FACTUAL BACKGROUND
Plaintiff 5th LLC purchased an insurance policy for its Moonen 83 yacht, covering the period from October 27, 2022, to October 27, 2023. On December 24, 2022, the yacht sustained damage due to seawater intrusion, which Plaintiff alleges should be covered under the policy. Plaintiff filed a claim that was denied three times, each denial referencing Kemah Capital Holdings and signed by a Kemah representative acting on behalf of Clear Spring Property & Casualty Company.
Kemah asserted it had an agreement with Clear Spring to market, broker, and underwrite insurance on Clear Spring’s behalf.
LEGAL ISSUES
Defendant Kemah Capital sought dismissal on three grounds: lack of personal jurisdiction, lack of subject matter ...
Rescission of a Life Insurance Policy
Misrepresenting the Use Of Drugs Makes Policy Void from its Inception
Post number 5299
Posted on March 9, 2026 by Barry Zalma
In Primerica Life Insurance Company v. Rosalia Castillo Bucio, an individual; Hipolito Castillo Bucio, an individual No. 3:24-cv-01567-RBM-KSC, United States District Court, S.D. California (March 2, 2026) Primerica Life Insurance Company sued Rosalia Castillo Bucio and Hipolito Castillo Bucio, seeking to rescind a term life insurance policy issued to Gilberto Castillo.
FACTUAL BACKGROUND
. The policy, valued at $614,000, named the defendants as co-beneficiaries. Castillo submitted an application on January 15, 2020, in which he denied any history of drug or alcohol abuse in the past ten years. However, after Castillo’s death on March 28, 2021, medical records revealed that he had used methamphetamine and cocaine prior to the application date, contradicting his representations. Both defendants subsequently filed claims for the death benefit, prompting...
