October 1, 1979 – 2024, Another Anniversary
Post 4901
Read the full article at https://lnkd.in/gCWa-Du7, see the full video at https://lnkd.in/gYBfBXp4 and at https://lnkd.in/gmwrV8qE and at https://zalma.com/blog; and https://lnkd.in/gWpS8p8H.
October 1, 2024
ZIFL – 10/1/2024 -Volume 28, Issue 19
Forty five years ago today I left the world of the employed and became an entrepreneur by opening my own law firm. The law practice was incorporated shortly thereafter as Barry Zalma, Inc. When I opened for business on October 1, 1979, I had no clients and no certainty that I would have any in the future. I had borrowed money from the bank to carry me through the first six months and was concerned about my ability to pay the loan with my third child about to be born. At 8:10 a.m. on October 1, 1979, Alan Warboys, called from London and provided me with my first case as an independent lawyer to represent Certain Underwriters at Lloyd’s, London. He, and the Lloyd’s Underwriters he represented, showed faith in me as a lawyer and insurance expert. Alan is now, and will forever be, my first client and a good friend.
https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
Lie on an Application About Primary Residence is Ground for Rescission
Plaintiff Homesite Insurance Company’s (Homesite) moved for Summary Judgment seeking a judicial declaration that it is entitled to rescission of Defendant Zhen Jiang’s homeowners’ insurance policy and enter summary judgment in its favor on Mr. Jiang’s bad faith counterclaims. In Homesite Insurance Company v. Zhen Jiang, No. CV-21-00554-TUC-JGZ, United States District Court, D. Arizona (September 16, 2024) the USDC explained an insurer’s right to rescission.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty sixth 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.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
World Wide Insurance Fraud
In an article by Kenneth Araullo on Sep 16, 2024 in ReinsuranceBusiness Mr. Araullo reports on the fact that fraud remains a top concern for insurers worldwide, according to the findings from the Reinsurance Group of America (RGA) 2024 Global Claims Fraud Survey. He notes: “The report highlights the ongoing challenges insurers face in managing fraud, with 74% of survey respondents indicating that the number of fraud cases is either holding steady or increasing compared to previous years.” He also notes that Reinsurance Group of America (RGA) 2024 Global Claims Fraud Survey. “35% of respondents said claims fraud had increased, while 39% reported no change. In underwriting fraud, 85% of respondents noted either no change or an increase in fraudulent activities, with 17% seeing an uptick.” You can read the full article here.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
Intentional Arson Even for Mental Health Assistance Requires Jail
Hunter Hipp pleaded guilty to first-degree arson after intentionally setting fires in the kitchen and living room of his apartment. He notified the district court in writing of his intent to move “for a dispositional and/or durational departure from the presumptive sentence,” and at sentencing he argued exclusively that he was particularly amenable to probation.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
Insurance Fraud is a Serious Crime
Why Insurance Fraud is Not Taken Seriously by Police & Prosecutors
State insurance departments near the turn of the century recognized that insurance fraud is a serious crime taking multiple billions of dollars from the insurance industry. Local police and prosecutors were not concerned, even after insurance fraud was made a felony, because no one suffered physical injury or death. Insurance fraud just cost a lot of money to insurers who were perceived as extremely wealthy and more victimizers than victim.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
Health Insurance Fraud Convictions
Behavioral Healthcare Company Executive Pleads Guilty to Healthcare Fraud
Miguel Saravia, 42, of Hanson, pleaded guilty to six counts of health care fraud. U.S. District Court Judge Allison D. Burroughs scheduled sentencing for Jan. 2, 2025.
Saravia, the Chief Executive Officer of Dana Group Associates, who is also the former Chief Operating Officer of Prime Behavioral Health, pleaded guilty to a scheme to defraud health care benefit programs by directing false billing for patient visits. From approximately 2017 to 2022, Saravia directed a group of individuals with no billing or medical training to enter Current Procedural Terminology codes (CPT) for therapy services that were not provided and to upcode CPT codes used for psychotherapy visits. Saravia submitted, or directed the submission of, false claims for treatment that was not provided or for more complex and expensive treatment than was provided.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
The Public Adjuster & Fraud
In Chubb & Son Inc. v. Consoli, 283 A.D. 2d 297, 726 N.Y.S. 2d 398 (N.Y. App. Div. 05/22/2001), a public adjuster was involved in a scheme with one of Chubb’s adjusters to intentionally inflate a claim and then pay Chubb’s adjuster to approve the claim. The insureds’ public adjuster was later convicted on charges of mail and tax fraud and Chubb’s representative was found guilty of defrauding Chubb.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
Ghost Broker Sentenced
Mohamed Choudhary, 33, who sold invalid insurance policies and tried to take out car insurance for himself by covering up his driving offences and using a fake no-claims discount certificate was sentenced to two years in prison, suspended for two years at Inner London Crown Court on 13 September 2024. He is subject to a six-month curfew, which runs daily from 9pm to 6am and is monitored by an electronic tag. He must also complete 150 hours of unpaid work and pay £1,630 in costs.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
Barry Zalma
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 full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-10-01-2024.pdf
Fraud Judgment for $45.657,401.01 Against Fraudster Seeks Bankruptcy Protection
Post 4904
Read the full article at https://www.linkedin.com/pulse/chutzpah-fraud-perpetrator-tries-use-court-avoid-zalma-esq-cfe-drswc, sSee the full video at and at and at https://zalma.com/blog.
Court Refuses to Allow Procedural Rules To Enable Fraud Perpetrator Lupolover To Manipulate the Federal Court to Avoid Paying The Judgment
Before the USDC, ED, New York was the motion of Non-Debtor Respondents Michael Lupolover and NJTM Ventures, LLC seeking reconsideration of the Court’s July 29, 2024 Order establishing a temporary restraining order (TRO).
In Allstate Insurance Company, et al. v. Mark Mirvis, et al., No. 08-CV-4405 (PKC), United States District Court, E.D. New York (September 26, 2024) was compelled to continue jurisdiction of an October 2008 motion by Plaintiff Allstate Insurance Company after...
Insurance Fraud Exists at the Time the False Claim is Made Not Payment of the False Claim
Read the full article at https://www.linkedin.com/pulse/intentionally-presenting-false-claim-crime-barry-zalma-esq-cfe-lrp6c, see the full video at and and at https://zalma.com/blog plus more than 4900 posts.
Post 4903
A Knox County, Tennessee jury convicted John M. Fletcher of initiating a false report to a law enforcement officer and presenting a false or fraudulent insurance claim. The trial court imposed an effective sentence of four years.
In State Of Tennessee v. John M. Fletcher, No. E2022-01319-CCA-R3-CD, Court of Criminal Appeals of Tennessee, Knoxville (September 24, 2024) the court of appeals disposed of the false report to a law enforcement officer and dealt with the Insurance Frau charge.
FACTUAL BACKGROUND
On November 11, 2018, the Defendant purchased a 2006 black Hummer. The Defendant owned several other ...
Independent Adjuster Owes no Duty to Insured Absent Fraud
Post 4902
Read the full article at https://www.linkedin.com/pulse/adjuster-only-owes-duty-insurer-barry-zalma-esq-cfe-ouoqc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.
Defendant Applied Building Sciences, Inc. (“Applied”) moved the USDC to dismiss claims of negligence, intentional misrepresentation, and conspiracy brought by Plaintiff Hermes Health Alliance, LLC (“Hermes”).In Hermes Health Alliance, LLC v. Certain Underwriters At Lloyd’s, London, et al., Civil Action No. 23-2276, United States District Court, E.D. Louisiana (September 25, 2024) the USDC resolved the dispute.
BACKGROUND
Defendant Applied Building Sciences, Inc. (“Applied”) moved the USDC to dismiss claims of negligence, intentional misrepresentation, and conspiracy brought by Plaintiff Hermes Health Alliance, LLC (“Hermes”).
In Hermes...
No Coverage After Failure to Pay Premium Before Ten Days Notice to Cure Cancellation
Post 4900
Read the full article at https://www.linkedin.com/pulse/failure-pay-premium-results-cancellation-barry-zalma-esq-cfe-krlxc and see the full video at and at and at https://zalma.com/blog
Posted on September 27, 2024 by Barry Zalma
In a this first-party automobile negligence action, defendant, USA Underwriters (USAU), appealed the trial court’s order denying its motion for summary disposition even though policy had been cancelled six months before accident.
In Cynthia Jackso v. John Doe and Eddie Jennard Richardson, and USA Underwriters, No. 367269, Court of Appeals of Michigan (September 19, 2024) the Court of Appeals resolved the dispute by applying Michigan statutes.
FACTS
USAU provided auto insurance coverage to Willie Jackson to provide auto insurance, including uninsured motorist benefits ...
Intentional Acts, Insurance Claims & Exclusions
Insurance Requires a Fortuitous Act
Available only to subscribers to Excellence in Claims Handling at Subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.
It includes the following: "In 1978, the California Supreme Court in Clemmer v. Hartford Insurance Co.71 dealt with a shooting that resulted in the death of the victim.
Regardless, it still led to a finding by the Supreme Court of California of a need for defense and indemnity. The court concluded that Hartford had no duties with regard to Dr. Lovelace’s intentional acts in the killing of Dr. Clemmer but was obligated to defend him. If there was a finding of nonintentional conduct in the shooting, however, it would be obligated to defend and its refusal to do so was wrongful."
Go to my Interview on the Art of Adjusting Podcast
Barry Zalma, Esq., CFE
Insurance claims expert, consultant at Barry Zalma, Inc. and author/Publisher at ClaimSchool, Inc.
August 30, 2024
Posted on August 30, 2024 by Barry Zalma
See the video at:
In this episode, Chantal Roberts and William Auten welcome Barry Zalma, a seasoned insurance industry professional with over 56 years of experience. The trio discusses the changing role of insurance adjusters, their relationship with policyholders, and the current challenges faced by the industry.
Barry shares his journey from a military investigator to a trainee adjuster and recounts significant cases that shaped his career. Barry focuses on the critical importance of effective and fair claims handling for the profitability of insurance companies and the detrimental impact of poor handling practices. The team also grapple insurance fraud, the adversarial nature of the legal system, and the ...
