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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Subscriber to ZIFL at https://lnkd.in/gfpn78FM
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.
Insurer’s Exclusion for Claims of Assault & Battery is Effective
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Read the full article at https://lnkd.in/gBzt2vw9, see the video at https://lnkd.in/gEBBE-e6 and at https://lnkd.in/gk7EcVn9, and at https://zalma.com/blog plus more than 5250 posts.
Bar Fight With Security is an Excluded Assault & Battery
In The Cincinnati Specialty Underwriters Insurance Company v. Mainline Private Security, LLC, et al., Civil Action No. 24-3871, United States District Court, E.D. Pennsylvania (December 16, 2025) two violent attacks occurred in Philadelphia involving young men, Eric Pope (who died) and Rishabh Abhyankar (who suffered catastrophic injuries). Both incidents involved security guards provided by Mainline Private Security, LLC (“Mainline”) at local bars. The estates of the victims sued the attackers, the bars, and Mainline for negligence and assault/battery. The insurer exhausted a special limit and then denied defense or indemnity to Mainline Private Security.
INSURANCE COVERAGE
Mainline had purchased a commercial ...
Marine Insurer May Dispose of Vessel to Avoid Waste
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Read the full article at https://lnkd.in/gfn_UHdp, see the video at https://lnkd.in/gDWVccnr and at https://lnkd.in/gv9nsBqk, and https://zalma.com/blog plus more than 5200 posts.
In Western World Insurance Company v. The Estate Of Shawn Arsenault, No. 25-cv-13413-PGL, United States District Court, D. Massachusetts (December 17, 2025) the USDC was asked to resolve a marine insurance dispute after the sinking of the F/V Seahorse, a commercial fishing vessel, off Cape Cod on June 8, 2025. The vessel’s owner and operator, Shawn Arsenault, died in the incident.
Western World Insurance Company issued a hull insurance policy for the vessel. With no personal representative yet appointed for the estate, the insurer cannot determine the proper payee for the insurance proceeds.
The insurer paid for the vessel’s recovery and removal, and the vessel is now with a salvage company, incurring substantial storage fees. The insurer determined the loss is covered under the ...
Marine Insurer May Dispose of Vessel to Avoid Waste
Post 5249
Read the full article at https://lnkd.in/gfn_UHdp, see the video at https://lnkd.in/gDWVccnr and at https://lnkd.in/gv9nsBqk, and https://zalma.com/blog plus more than 5200 posts.
In Western World Insurance Company v. The Estate Of Shawn Arsenault, No. 25-cv-13413-PGL, United States District Court, D. Massachusetts (December 17, 2025) the USDC was asked to resolve a marine insurance dispute after the sinking of the F/V Seahorse, a commercial fishing vessel, off Cape Cod on June 8, 2025. The vessel’s owner and operator, Shawn Arsenault, died in the incident.
Western World Insurance Company issued a hull insurance policy for the vessel. With no personal representative yet appointed for the estate, the insurer cannot determine the proper payee for the insurance proceeds.
The insurer paid for the vessel’s recovery and removal, and the vessel is now with a salvage company, incurring substantial storage fees. The insurer determined the loss is covered under the ...
Zalma’s Insurance Fraud Letter
Read the full article at https://lnkd.in/dG829BF6; see the video at https://lnkd.in/dyCggZMZ and at https://lnkd.in/d6a9QdDd.
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 ...
