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.

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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...

October 1, 1979 – 2024, Another Anniversary
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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....

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 ...