Insurance Should Never Apply to Indemnify Insured for its Intentional Acts
Post 4838
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Slyvia Melania Tejada de Tapia was injured at work and filed a workers’ compensation claim against her employer, 74 Industries, Inc. (74 Industries), which was settled pursuant to an order approving settlement with dismissal under statute called the Section 20 Settlement resulted in the dismissal of plaintiff’s workers’ compensation claims with prejudice. Workers’ Compensation is an exclusive remedy for an employee injured at work without fault.
In Sylvia Melania Tejada De Tapia v. 74 Industries, Inc. and Velcro USA, Inc., et al. v. New Jersey Manufacturers Insurance Company, No. A-2643-21, Superior Court of New Jersey, Appellate Division (July 12, 2024) the Appellate Division explained why workers’ compensation has no effect on tort law.
FACTS
Plaintiff suffered an injury after she was bitten or stung by an insect during the course of her employment as a sewing machine operator with 74 Industries. According to plaintiff, insects routinely infested the packages of fabric and materials that employees handled and frequently bit and stung employees. Plaintiff was hospitalized for treatment related to the infection she suffered as a result of the insect bite. The infection caused her right leg to swell and form green open sores.
New Jersey Manufacturers Insurance Company’s (NJM) had issued a standard workers’ compensation insurance policy (the Policy) to 74 Industries and recommended settlement of plaintiff’s workers’ compensation claim. Prior to the settlement, however, plaintiff had also filed a complaint in the Law Division alleging intentional torts against 74 Industries. 74 Industries filed a third-party complaint against NJM seeking coverage under the Policy for plaintiff’s claims of intentional wrong asserted against 74 Industries. NJM denied coverage citing policy exclusions for intentional torts and moved to dismiss 74 Industries’s third-party complaint. The Law Division judge granted NJM’s motion to dismiss 74 Industries’s third-party complaint for failure to state a claim.
NJM defended 74 Industries in workers’ compensation court and eventually recommended 74 Industries settle plaintiff’s case for a lump sum payment of $25,000 by way of an order approving settlement with dismissal.
Prior to the entry of the Section 20 settlement, however, plaintiff had filed an action in the Law Division alleging her injuries were caused by 74 Industries’s intentional misconduct under the principles explained by the Court in Laidlow v. Hariton Mach. Co., 170 N.J. 602, 14 (2002).
Plaintiff had filed a series of amended complaints, each of which included the same four counts against 74 Industries.
The court further found that plaintiff’s allegations fell squarely within the Policy’s C5 exclusion for “intentional wrongs” and rejected 74 Industries’s contention the Policy was ambiguous because the C7 exclusion and C7 endorsement provided coverage for “bodily injuries” under Part Two of the Policy.
DISCUSSION
The interpretation of an insurance policy, like any contract, is a question of law. In attempting to discern the meaning of a provision in an insurance contract, the plain language is ordinarily the most direct route. The plain and unambiguous language in the C5 endorsement clearly covers plaintiff’s intentional tort claims that result from a subjective intent to injure and those that are substantially certain to have caused injury.
As the motion court acknowledged, plaintiff asserts that she was threatened with adverse employment action if she left the jobsite for medical treatment, which based on a fair reading of the complaint suggests a cause of action for coercion. Defendant’s claim that it is entitled to coverage under the C7 exclusion fails because plaintiff’s causes of action are founded on intentional wrongs.
Lastly, the Appellate Division rejected 74 Industries’s argument that public policy supports coverage for intentional wrongs as New Jersey courts have consistently held that exclusions for intentional wrongs contained in insurance policies are legally valid.
Therefore there was no basis to support 74 Industries’s argument that public policy favors coverage for plaintiff’s intentional wrongs filed in Law Division. Therefore the court could discern no basis to conclude NJM had a duty to defend or indemnify 74 Industries against plaintiff’s intentional wrong claims made in the Law Division fourth-amended complaint.
ZALMA OPINION
Insurance, by definition, only insures against fortuitous conduct, an accident. Intentional acts, like those pleaded by Ms. Tejada de Tapia are not fortuitous but intentional and not insurable. The insurer, to be safe, added an exclusion for intentional acts which made clear its position and the requirement of fortuity.
(c) 2024 Barry Zalma & ClaimSchool, Inc.
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Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.
Posted on September 18, 2026 by Barry Zalma
See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html
In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.
The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.
Law
The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...
150 Months in Prison for Tax Fraud
Post 4846
Posted on September 17, 2026 by Barry Zalma
See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.
The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...
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Post 5489
Posted on September 14, 2026 by Barry Zalma
Fraudster Refuses to Answer Questions About His Alleged Fraud
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In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.
Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.
After Great American ...
Payment of Fines & Completion of Probation Reinstates Right to Vote
Post 4576
Posted on November 5, 2026 by Barry Zalma
To Restore Voting Rights The Felon Must Pay Fines of $546.00
In Florida Supreme Court Mediator Ethics Advisory Committee, ETH F-26-377, No. F-26-377 (October 29, 2026) citizen unnamed and to Ron Desantis Governor, Cord Byrd the Secretary of State Florida Division of Elections provided an advisory opinion to a convicted felon about his right to vote:
To: [redacted] We received your request for an advisory opinion. You indicate that you have one or more felony convictions and request whether you are eligible to vote, including whether you have any outstanding legal financial obligations under section 98.0751, Florida Statutes, and, if so, a statement of the amount that must be paid to make you eligible to vote, and an explanation of how the amount was calculated.
The Division hereby responds to your request pursuant to its legal authority under section 106.23(2), Florida Statutes, and Florida ...
Administrative Review Permits the Agency to Apply its Expertise
Post 4574
In Erwin Jordan Castro Valdez v. Warden, Otay Mesa Detention Center, No. 26-cv-06147-BAS-JLB, United States District Court, S.D. California (October 30, 2026) Castro Valdez, a Cuban national paroled into the United States, was arrested on June 23, 2026, for alleged insurance fraud, grand theft, and making a false report to law enforcement. In his first habeas action, the district court ordered a bond hearing within fourteen days to determine whether the changed circumstances justified revoking his parole.
An Immigration Judge subsequently denied bond because of his pending state criminal case. Castro Valdez filed a second petition under 28 U.S.C. § 2241, challenging that determination and requesting immediate release without first appealing to the Board of Immigration Appeals (BIA).
LAW
According to the supplied text, § 2241 does not expressly require administrative exhaustion, but courts impose exhaustion as a prudential requirement. ...
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Post 4573
Posted on November 3, 2026 by Barry Zalma
In The Prudential Insurance Company Of America v. Carol Gardina and George Gardina, No. 6:23-cv-1125-JSS-DCI, United States District Court, M.D. Florida, Orlando Division (October 22, 2026).
THE JURY TRIAL AND VERDICT
Plaintiff sued Defendants for numerous causes of action stemming from its allegations that Defendants fraudulently collected benefits under their long-term care insurance policies. Plaintiff's case proceeded to a nine-day jury trial, after which the jury found Defendants liable for fraudulent misrepresentation, fraudulent concealment, and civil conspiracy.
The jury also found Defendant Carol Gardina liable to Plaintiff for $1,930,129 in compensatory damages and Defendant George Gardina liable to Plaintiff for $12,496 in compensatory damages and $20 in punitive damages. Thereafter, the court entered judgment in Plaintiff's favor and awarded Plaintiff $1,930,129 in compensatory damages from...
