ZIFL Volume 28, Issue 16
Read the full article at https://lnkd.in/g8egXQAr, see the full video at https://lnkd.in/g3xXbkM2 and at https://lnkd.in/gceh-EhF, and at https://zalma.com/blog plus more than 4850 posts.
“It Is Better To Be A Mouse In A Cat’s Mouth Than A Man In A Lawyer’s Hands.” – Spanish Proverb
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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:
Fraud Doesn’t Pay but Keeps Trying
Fraud Perpetrators Fail in Attempt to Get Around Settlement
“Operation Back Cracker” (a joint state and federal criminal investigation) exposed a ring of Minnesota healthcare providers (mostly chiropractors) who were recruiting car accident victims and fraudulently billing auto insurers for their treatment. In related civil settlements, several providers agreed not to bill some of the insurance companies for any treatment provided to their insureds.
The chiropractors sued seeking to void the no-bill agreements used to reduce the insurers losses, by claiming the settlements violated the Minnesota No-Fault Automobile Insurance Act. The district court enjoined Illinois Farmers Insurance Company and others (together, Farmers) from entering into or enforcing the no bill agreements.
Read the full article and the entire issue of ZIFL at https://lnkd.in/gTg3nbAr.
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty third 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.
August 5, 2024
In Martin v. United Fire & Indem. Co., Civil Action 22-4850 (E.D. La. Aug 05, 2024) the resulted after damage to Mr. Martin’s property as a result of Hurricane Ida. The law firm McClenny, Moseley & Associates (MMA) filed the present action on behalf of Mr. Martin on December 4, 2022.
Read the full article and the entire issue of ZIFL at https://lnkd.in/gTg3nbAr.
North Haven Counselor Admits Defrauding Medicaid of More Than $1.6 Million
RACHEL COLLINS, 44, of Hamden, Connecticut waived her right to be indicted and pleaded guilty before U.S. District Judge Sarala V. Nagala in Hartford to health care fraud.
According to court documents and statements made in court, Collins was a state-licensed professional counselor and owner of Rachel Collins, LPC Counseling Services LLC, located in North Haven. Collins provided psychotherapy to children, adolescents, and adults, but particularly children and adolescents with a variety of behavioral and mental health issues. She was enrolled individually as a Behavioral Health Clinician provider in the Connecticut Medicaid Program (“Medicaid”).
Read the full article and the entire issue of ZIFL at https://lnkd.in/gTg3nbAr.
Convictions of Other Than Health Insurance Fraud
When it Rains it Pours on Lindberg
Federal Court Says Lindberg and Firms Must Pay $167M to Defunct Dutch Insurer
Greg Lindberg, the former insurance executive, now awaiting sentencing for a North Carolina bribery conviction, and his companies must pay almost $167 million to an insolvent life insurance company in the Netherlands.
Read the full article and the entire issue of ZIFL at https://lnkd.in/gTg3nbAr.
Defendant Gambled & Lost – He Turned Down a Favorable Plea & Went To Trial
When You Do the Crime You Must Do the Time
Thomas Sher was convicted of health care fraud and conspiracy to commit the same. The District Court sentenced him to ninety-six months’ imprisonment. Sher appealed his sentence, arguing that the court erred in its loss calculation and in its application of a sophisticated means enhancement.
In United States Of America v. Thomas Sher, No. 23-2337, United States Court of Appeals, Third Circuit (August 1, 2024) the Third Circuit dealt with the felon’s claims for a shorter sentence.
Read the full article and the entire issue of ZIFL at https://lnkd.in/gTg3nbAr.
Timing of Submission to the EUO
In Buongiovanni v. Allstate Insurance Co., 240 App. Div. 2d 455, 658 N.Y.S. 2d 431 (1997), a New York court affirmed a summary judgment in favor of the insurer, because the plaintiffs failed “to timely provide the requested tax returns, credit history, or authorizations for those documents, as a material breach of the policy.”
The court explained that: “while the plaintiffs refused to provide the defendant (Allstate) with the requested documents, they also demanded that the defendant give them a formal response on their insurance claim, under threat of litigation. Their attempts to cure the failure were made only in response to the defendant’s rejection of their claim. 658 N.Y.S. 2d at 431. A breach of the obligation to submit to an EUO is not cured by belated offers to provide records.”
Read the full article and the entire issue of ZIFL at https://lnkd.in/gTg3nbAr.
Dishonest Insurance Agents and Brokers
The most common kind of insurance fraud perpetrated on an insurance buyer is committed by insurance agents and brokers. They include, but are not limited to, the following:
Premium Diversion & Many Other Schemes
Many times, these agents represent well-known companies, making them more credible. However, these agents still steal money paid for premiums, often through a practice known as “premium diversion.” This tactic is as straightforward as agents taking the money paid for a premium for themselves instead of sending it to the company.
Agents will create a policy and let it lapse, or they cancel it without your knowledge or never create the policy to begin with. The worst part of this kind of embezzlement is that the insurance buyer will usually not find out about it until a claim is presented only to learn there is no policy.
Read the full article and the entire issue of ZIFL at https://lnkd.in/gTg3nbAr.
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected].
Read the full article and the entire issue of ZIFL at https://lnkd.in/gTg3nbAr.
When Harm is Inherent in the Nature of the Act it is Intentional
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No Coverage for Intentional Acts
Hitting a Person in the Face is an Intentional Act
In Unitrin Auto and Home Insurance Company v. Brian C. Sullivan, et al., George A. Ciminello, No. 2022-01607, Index No. 21632/14, Supreme Court of New York, Second Department (November 19, 2025) George A. Ciminello was injured when struck in the face by a cup filled with liquid, thrown from a moving vehicle operated by Brian C. Sullivan, with Robert Harford as the passenger who threw the cup. The vehicle approached Ciminello at about 30 mph, from 2 to 10 feet away, and Harford extended his arm to make contact. The cup splintered upon impact.
Sullivan and Harford later conceded liability on the intentional tort claim before a damages trial.
Insurance Policy:
Unitrin Auto and Home...
Obtaining Title to Church by Fraud Defeated
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Read the full article at https://www.linkedin.com/pulse/unmitigated-gall-abuse-elderly-bishop-his-church-zalma-esq-cfe-xcasc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
It is Villainous to Steal Church Property from Sick and Elderly Bishop
In Testimonial Cathedral Local Church of God in Christ v. EquityKey Real Estate Option, LLC et al. (Cal. Ct. App., 2d Dist., Div. 8, No. B331522 (Nov. 18, 2025) EquityKey (through broker Steven Sharpe and Frank Wheaton, a trusted advisor/friend of elderly Bishop Jimmy Hackworth) presented a deal supposedly for a $4 million life-insurance policy on Hackworth’s life with EquityKey as beneficiary. In exchange, EquityKey paid Hackworth $400,000 upfront.
Factual Background
To qualify Hackworth for the large policy, church real property on South Western Ave., Los Angeles was temporarily ...
Guilty of Money Laundering Scheme
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See the video at https://lnkd.in/gqh7V46x and at https://lnkd.in/gmE-zrDC and at https://zalma.com/blog plus more than 5200 posts.
Prison Sentence for Fraud Must be Limited to the Fraud in Which the Defendant Participated
In United States v. Stephen O. Anagor, No. 2:24-CR-00019-DCLC-CRW (E.D. Tenn., Nov. 26, 2025) by Judge Clifton L. Corker the government sought to increase the defendant’s sentence because his co-conspirators added a fraudulent FBI scam that resulted in the victim’s suicide. Anagor sought a lower sentence because he was only involved in part of the fraud.
Charges & Plea
Defendant, a U.S. Army soldier pled guilty on June 11, 2025 to Conspiracy to Commit Mail and Wire Fraud, Aiding and Abetting Aggravated Stalking Resulting in Death and Aiding and Abetting Aggravated Identity Theft that was part of a larger 38-count superseding indictment against Anagor and co-defendants Chinagorom Onwumere and Salma Abdalkareem for an international Nigerian-based ...
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 ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
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 ...
