ZIFL – Volume 28 Number 14
Read the full article at https://lnkd.in/gbj6c5R5; https://lnkd.in/gj6gmEHf, See the full video at https://lnkd.in/gF3WAQVQ and at https://lnkd.in/gtShaQNc and at https://zalma.com/blog plus more than 4800 posts.
Zalma’s Insurance Fraud Letter – July 15, 2024
Post 4834
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;
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
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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...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
