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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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August 14, 2024
Waiver of Two Very Specific Rights Does Not Infer a Waiver of all Rights

To Recover Appraisal Award Insured Must Actually Repair or Replace
Post 4855

Read the full article at https://lnkd.in/gfAhbDWD, see the full video at https://lnkd.in/gqwD6tSa and at https://lnkd.in/gHaWy4UM, and at https://zalma.com/blog and more than 4850 posts.

Cresthaven appealed the district court’s denial of its motion for relief from the court’s order dismissing without prejudice Cresthaven’s suit against Empire Indemnity Insurance Company (“Empire”) and for leave to file a supplemental complaint.

In Cresthaven Ashley Master Association, Inc. v. Empire Indemnity Insurance Company, No. 23-12761, United States Court of Appeals, Eleventh Circuit (August 7, 2024) the Eleventh Circuit resolved the dispute.

FACTS

Cresthaven, a condominium association, purchased a commercial property policy from Empire for a period covering March 17, 2017 to March 17, 2018 (the “Policy”). On September 10, 2017, Hurricane Irma struck the state of Florida. Cresthaven timely filed a claim with Empire for property damages sustained in the storm, which Empire denied on April 19, 2019.

Cresthaven’s Complaint, filed on July 15, 2019, sought a declaratory judgment that it did not breach its post loss duties, as well as the enforcement of the Policy’s appraisal provision and damages for breach of contract. Over the next three years, the parties conducted an appraisal and Cresthaven received two awards for property damages.

Empire a Motion to Dismiss for Lack of Subject-Matter Jurisdiction arguing that Cresthaven’s case no longer presented an actual Case or Controversy under Article III. The Court granted Empire’s motion on March 24, 2022.

March 24, 2022 Dismissal Order

Cresthaven needed to first identify an applicable law or ordinance that, if enforced, could result in a loss in value to the undamaged portion of the building or an increased cost to reconstruct any portion of the building, whether damaged or not. Second, the applicable law or ordinance needed to be enforced. Third, the applicable ordinance or law must have resulted in the aforementioned “loss in value” or “increased cost”. Cresthaven failed to satisfy any of the three preconditions.

The Court dismissed Cresthaven’s claims for failing to present an actual Case or Controversy.

Post-Dismissal Events

Cresthaven diligently commenced and completed repairs for several of its structures. Cresthaven never completed repairs or completed them timely to recover benefits under the Replacement Cost coverage under Empire’s Policy. Empire effectively invoked the five year statute of repose for property insurance claims under Fla. Stat. §95.11(2)(e).

DISCUSSION

Empire never waived its right to invoke the statute of repose. Without evidence that Empire represented that it would not invoke the statute of repose, the Eleventh Circuit could not conclude that the district court abused its discretion in declining to attribute bad faith to Empire’s communications about adjusting the claim with Cresthaven after the dismissal.

Empire’s written waiver was very specific and waived only the “as soon as reasonably possible” and the two-year deadline with respect to repairs, the temporal limitations that appeared in the Policy itself.

Empire’s July 8, 2022, letter invited Cresthaven to complete repairs and submit requests for payment. The fact that Empire did invoke the five-year statute of repose after its expiration merely indicates that Empire intended to exercise its rights under the Policy provisions and the law, which intention was apparent from the very inception of Cresthaven’s claim.

Empire’s waiver of two very specific rights is not a basis on which to infer a waiver of all rights.

The Policy provisions required Cresthaven to perform the work and identify the relevant ordinance before seeking reimbursement and the district court still would have granted the motion.

ZALMA OPINION

Waiver is a legal concept that allows parties to agree that certain conditions of a contract of insurance will not apply as long as it is knowingly made without coercion. Empire waived two rights provided to it in the policy. That was all it waived, nothing more, and it certainly did not waive the Statute of Repose, which, when it expired destroyed the entire lawsuit and arguments of Cresthaven. An insured should never sit on its rights.

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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00:08:50
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See the full video at https://lnkd.in/gPACkgWq and at https://lnkd.in/gsaxij7D, and at https://zalma.com/blog plus more than 5300 posts.

In Hassan Fayad v. Liberty Mutual Insurance Company, et al., No. 2:25-cv-10930, United States District Court, E.D. Michigan, Southern Division (March 24, 2026) Plaintiff Hassan Fayad, the owner of several businesses providing transportation, diagnostics, testing, and therapy services, regularly billed insurance companies for these services, was arrested and tried for fraud, convicted, had the conviction overruled and sued the insurers and prosecutors he found responsible.

FACTUAL BACKGROUND

By January 2020, Liberty Mutual, Progressive, Allstate, and Esurance suspected fraudulent activity and filed a complaint with the Michigan Department of Attorney General (MDAG). The insurers alleged that Fayad and others billed Michigan auto insurance policies for profit without actually providing medically ...

00:08:00
April 09, 2026
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In Beth Mayhew and Matthew Mayhew v. Vladimir Sadovyh, et al., No. 2:26-CV-04029-WJE, United States District Court, W.D. Missouri (April 6, 2026) Mayhew was involved in a trailer-truck accident with Vladimir Sadovyh, who was employed by Nova First, LLC and Globex Transport, Inc. Both companies owned the tractor-trailer involved.

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Chubb and Mohave Transportation Insurance Company jointly issued an insurance policy covering Nova First, Globex, and Sadovyh, with EMA Risk Services acting as a third-party administrator.

Beth Mayhew sued Nova First, Globex, and Sadovyh for negligence in Missouri state court, and following a jury trial, a nuclear judgment was awarded to the Mayhews totaling ...

00:04:01
April 09, 2026
IVF is not Excluded Sexual Conduct

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See the full video at https://lnkd.in/gxKjDztW and at https://lnkd.in/gnxkxS42, and at https://zalma.com/blog plus more than 5300 posts.

Sexual Conduct Exclusion Doesn’t Apply When Doctor Negligently Uses His Own Sperm

In Integris Insurance Company v. Narendra B. Tohan, No. AC 47222, Court of Appeals of Connecticut (April 7, 2026) Integris Insurance Company, a medical professional liability insurer, initiated a declaratory action to determine its duty to defend and indemnify Narendra B. Tohan, a physician licensed in Connecticut, in a separate negligence action alleging medical misconduct.

FACTUAL BACKGROUND

In 2019, Kayla Suprynowicz and Reilly Flaherty (civil action plaintiffs), who were strangers for most of their lives, discovered through a genetic testing company that they are half siblings.

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00:07:58
April 02, 2026
Zalma’s Insurance Fraud Letter – April 1, 2026

ZIFL – Volume 30, Issue 7 – April 1, 2026

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post number 5314

Posted on April 1, 2026 by Barry Zalma

Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th 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 fraud:

No One is Above the Law – Not Even a Police Officer

Police Officer Convicted for Fraud in Reporting an Accident Affirmed
Police Officer Should never Lie about Results of Chase

In State Of Ohio v. Anthony Holmes, No. 115123, 2026-Ohio-736, Court of Appeals of Ohio, Eighth District, Cuyahoga (March 5, 2026) a police officer appealed criminal conviction as a result of lies about a high speed chase.

Read the following article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-04-01-2026-1.pdf...

April 01, 2026
Zalma’s Insurance Fraud Letter – April 1, 2026

ZIFL – Volume 30, Issue 7 – April 1, 2026

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post number 5314

Posted on April 1, 2026 by Barry Zalma

Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th 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 fraud:

No One is Above the Law – Not Even a Police Officer

Police Officer Convicted for Fraud in Reporting an Accident Affirmed
Police Officer Should never Lie about Results of Chase

In State Of Ohio v. Anthony Holmes, No. 115123, 2026-Ohio-736, Court of Appeals of Ohio, Eighth District, Cuyahoga (March 5, 2026) a police officer appealed criminal conviction as a result of lies about a high speed chase.

Read the following article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-04-01-2026-1.pdf...

March 31, 2026
Insurance Fraud Costs Everyone

Posted on March 30, 2026 by Barry Zalma

Insurance Fraud, a Way to Reduce Violent Crime
Post number 5313

A Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story helps to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ­­­Perpetrators than any Other Crime.

She Taught Her Customers The Swoop And Squat:

Recently the California Insurance Department’s Fraud Division arrested a young woman in Los Angeles County for operating an insurance fraud school. She advertised her classes in the “Penny Saver” an advertising sheet distributed free to the public and a print version of Facebook, X Craig’s list. She had operated for several years teaching methods of committing automobile insurance fraud. Only after a police officer enrolled in one of her classes was she arrested.

Her defense ...

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