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;
Detail Charging Defendant for Fraud is Sufficient
Post 5242
Read the full article at https://lnkd.in/g_HVw36q, see the video at https://lnkd.in/gpBd-XTg and at https://lnkd.in/gzCnBjgQ and at https://zalma.com/blog plus more than 5200 posts.
Charges that Advises the Defendant of the Crime Cannot be Set Aside
In United States Of America v. Lourdes Navarro, AKA Lulu, No. 25-661, United States Court of Appeals, Ninth Circuit (December 4, 2025) Lourdes Navarro appealed the district court’s denial of her motion to dismiss the indictment and enter final judgment was in error.
FACTUAL BACKGROUND
The indictment alleged that insurers reimburse only for medically necessary services. Navarro performed unnecessary respiratory pathogen panel (RPP) tests on nasal swabs collected from asymptomatic individuals for COVID-19 screening.
Navarro billed over $455 million to insurers for those additional RPP tests that she knew to be medically unnecessary. These allegations constituted a plain, concise, and definite written ...
Louisiana Statute Prevents Enforcement of Contract Term Requiring Arbitration of Disputes
Post 5241
Read the full article at https://www.linkedin.com/pulse/international-convention-requiring-enforcement-award-barry-sttdc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
In Town of Vinton v. Indian Harbor Insurance Company, Nos. 24-30035, 24-30748, 24-30749, 24-30750, 24-30751, 24-30756, 24-30757, United States Court of Appeals, Fifth Circuit (December 8, 2025) municipal entities including the Town of Vinton, et al sued domestic insurers after dismissing foreign insurers with prejudice. The insurers sought arbitration under the Convention on the Recognition and Enforcement of Foreign Arbitral Awards (the “Convention”) but the court held Louisiana law — prohibiting arbitration clauses in such policies—controls, as the Convention does not apply absent foreign parties who ...
Refusal to Provide Workers’ Compensation is Expensive
Post 5240
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In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.
Company Overview:
USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...
Zalma’s Insurance Fraud Letter
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ZIFL Volume 29, Issue 24
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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/
Zalma’s Insurance Fraud Letter
Merry Christmas & Happy Hannukah
Read the following Articles from the December 15, 2025 issue:
Read the full 19 page issue of ZIFL at ...
The Professional Claims Handler
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Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
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This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
