ZIFL – Volume 28 Number 14
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Zalma’s Insurance Fraud Letter – July 15, 2024
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The Source for the Insurance Fraud Professional
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The Source for the Insurance Fraud Professional
Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th 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/ This issue contains the following articles about insurance:
Present as Real a Free and Imaginary Oral Estimate as Proof of Claim is Fraud
False Swearing & Fraud in Claim Presentation Voids Policy
Never Lie To Your Insurer About The Extent Of Damage
Too many people believe that having a claim disputed by an insurance company is an invitation to get rich by suing an insurance company. People and some lawyers believe they can do anything to get money from an insurance company to profit from a claim and if they are caught, they will still recover the true amount of the loss. The USDC in Illinois put the lie to that assumption and an insured, trying to inflate a claim with what turned out to be a fake bid, was sufficient to make the insured take nothing and order it to pay back to the insurer what was paid before the dispute.
Read the full July 15, 2024 issue of ZIFL http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-07-15-2024.pdf
Criminal Investigation of Insurance Fraud Without Indictment Not Grounds for Stay of Civil Action
Fraud Bureau Investigates
Defendant Kith Furniture, LLC’s moved to stay the proceedings brought by Liberty Mutual in Liberty Mutual Fire Insurance Company v. Kith Furniture, LLC, No. 6:23-cv-01130-LSC, United States District Court, N.D. Alabama, Jasper Division (July 1, 2024) and the District Court resolved the dispute.
Read the full July 15, 2024 issue of ZIFL http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-07-15-2024.pdf
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty first installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
May 24, 2024
In David Wynn v. Southern Fidelity Insurance Co, No. 2:22-CV-04641, United States District Court, W.D. Louisiana, Lake Charles Division (May 24, 2024) alleged damage to plaintiff’s home in Sulphur, Louisiana, during Hurricanes Laura and Delta. Plaintiff, who was then represented by counsel from the law firm of McClenny Moseley & Associates, filed suit in this court against Southern Fidelity Insurance Company on August 25, 2022, raising claims of breach of insurance contract and bad faith.
Read the full July 15, 2024 issue of ZIFL http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-07-15-2024.pdf
Trucking Firm Owner’s Scheme to Lower Insurance Costs Guilty on Seven Counts
Tony Kirik, the owner of a New York trucking business who fabricated a supposedly independent Texas affiliate to circumvent his existing firm’s negative safety rating higher insurance costs was found guilty of conspiracy and fraud. On June 21, 2024 a jury in the U.S. District Court for the Western District of New York, following a three-week jury trial, found Kirik guilty on seven counts that include conspiracy, false documents, false statements, falsification of records, and concealment of material facts.
Read the full July 15, 2024 issue of ZIFL http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-07-15-2024.pdf
More Prosecution is Needed to Deter Insurance Fraud
Thomas Orville McLaughlin II was convicted of committing a fraudulent insurance act, making a false information, and interfering with law enforcement. He appealed claiming several of the State’s exhibits were improperly admitted and that a defense witness was improperly excluded.
In State of Kansas v. Thomas Orville McLaughlin II, No. 124,221, Court of Appeals of Kansas (June 21, 2024) McLaughlin sought relief from his conviction for insurance fraud.
Read the full July 15, 2024 issue of ZIFL http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-07-15-2024.pdf
Health Insurance Fraud Convictions
Pacific Toxicology Laboratories Agrees to Pay $1 Million to Resolve Allegations of Fraudulent Billing
Pacific Toxicology Laboratories (PacTox), has agreed to pay $1 million to resolve allegations that it submitted false claims for payment to Medicare for urine drug testing (UDT).
Read the full July 15, 2024 issue of ZIFL http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-07-15-2024.pdf and dozens more reports of convictions.
Convictions of Other Than Health Insurance Fraud
Iowa Woman Sentenced for Pet Insurance Fraud
Read the full July 15, 2024 issue of ZIFL http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-07-15-2024.pdf
Sarah Rahm, age 39, of Bondurant, Iowa made willful misrepresentations regarding her pet’s medical history and then falsified the onset date of a claimed medical condition in connection with an insurance claim, according to an investigation by the Iowa Insurance Division’s Fraud Bureau.
Read the full July 15, 2024 issue of ZIFL here.
UK Convicts Motorcycle Fraud Claims
Matthew Shaw lost his claim in the UK in a case called Shaw v Wilde, Case No: F90NlA2-1 a case that arose from a motorcycle accident that left Mr. Shaw with injuries to all four limbs. After receiving an interim payment of £150,000 from Hastings Direct, Mr Shaw pursued a £6.6 million claim, citing expenses for luxury vehicles and business class travel.
Hastings Direct and Keoghs achieved what is said to be the largest fundamental dishonesty verdict ever recorded in the UK, with £6.6 million saved by the insurance provider.
Read the full July 15, 2024 issue of ZIFL http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-07-15-2024.pdf.
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455; Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog.
He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.
Go to Zalma’s Insurance Fraud Letter at https://zalma.com/zalmas-insurance-fraud-letter-2/ ; Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ and GTTR at https://gettr.com/@zalma
ZIFL-07-15-2024.pdf
Read the full July 15, 2024 issue of ZIFL at https://lnkd.in/gj6gmEHf
Barry Zalma, Inc., 310-390-4455;
Chutzpah: After Criminal Prosecution Defendant Sues USA
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Dr. Segun Patrick Adeoye, a medical doctor, filed a lawsuit against the United States of America, seeking damages for alleged violations during his criminal prosecution. He was acquitted by a jury but claims to have suffered significant harm, including financial losses, damage to his professional reputation, and personal distress.
In Dr. Segun Patrick Adeoye v. The United States Of America, Civil Action No. 4:25-cv-83, United States District Court, E.D. Texas, Sherman Division (July 23, 2025) the USDC dismissed Adeoye’s suit.
FACTUAL BACKGROUND
Dr. Adeoye was indicted on charges of conspiracy to commit wire fraud and money laundering. The indictment alleged that he and his co-conspirators obtained at least seventeen million dollars through various fraudulent schemes. Despite being acquitted, Dr. Adeoye claims that his ...
Payment of Appraisal Award Defeats Claim of Bad Faith
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Hurricane Damage to Dwelling Established by Appraisal Award
In Homeowners Of America Insurance Company v. Emilio Menchaca, No. 01-23-00633-CV, Court of Appeals of Texas, First District (July 31, 2025) after a hurricane Homeowners of America Insurance Company (“HAIC”) estimated that the cost of covered repair to Menchaca’s house was $3,688.54, which was less than his deductible, and therefore no payment would be made.
FACTS
After Menchaca retained counsel HAIC advised that, under the terms of the policy, Menchaca was required to first invoke the appraisal process prior to filing suit, and that HAIC reserved the right to request that Menchaca and any adjuster hired on his behalf submit to an Examination Under Oath (“EUO”).
On August 23, 2018, Menchaca’s counsel ...
Payment of Appraisal Award Defeats Claim of Bad Faith
Post 5163
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Hurricane Damage to Dwelling Established by Appraisal Award
In Homeowners Of America Insurance Company v. Emilio Menchaca, No. 01-23-00633-CV, Court of Appeals of Texas, First District (July 31, 2025) after a hurricane Homeowners of America Insurance Company (“HAIC”) estimated that the cost of covered repair to Menchaca’s house was $3,688.54, which was less than his deductible, and therefore no payment would be made.
FACTS
After Menchaca retained counsel HAIC advised that, under the terms of the policy, Menchaca was required to first invoke the appraisal process prior to filing suit, and that HAIC reserved the right to request that Menchaca and any adjuster hired on his behalf submit to an Examination Under Oath (“EUO”).
On August 23, 2018, Menchaca’s counsel ...
Rulings on Motions Reduced the Issues to be Presented at Trial
Read the full article at https://lnkd.in/gwJKZnCP and at https://zalma/blog plus more than 5100 posts.
CASE OVERVIEW
In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.
FACTS
Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.
Prior to trial Bernier had three remaining claims against State Farm:
1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.
Both Bernier and State Farm dispositive motions before ...
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 ...
Professional Health Care Services Exclusion Effective
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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 ...
