Zalma on Insurance
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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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November 01, 2024
Zalma’s Insurance Fraud Letter – November 1, 2024

ZIFL – Volume 28 Number 21

Posted on November 1, 2024 by Barry Zalma

Post 4924

See the full video at and at

Subscribe to ZIFL at https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D

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:

Pill Mill Doctor’s Conviction Affirmed

HEALTH CARE FRAUD CONVICTION AFFIRMED

ACTING AS A DR. FEEL GOOD...

00:09:15
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October 31, 2024
Officer Caught Aiding Criminals for Cash

Police Officer who took Bribes from Insurance Fraudster Convicted

Post 4923

Read the full article at https://www.linkedin.com/pulse/officer-caught-aiding-criminals-cash-barry-zalma-esq-cfe-niboc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.

Demarkco Johnson (“Johnson”), appealed his convictions and claims the following errors:

1 The trial court abused its discretion in denying appellant’s request for a jury instruction on entrapment.
2 The trial court erred in failing to admonish and/or instruct the witness to stop answering questions with a legal conclusion after defense counsel had objected.
3 Appellant’s convictions are against the manifest weight of the evidence; therefore, his convictions are in violation of the Ohio state constitution and the Sixth and Fourteenth Amendments to the United States Constitution.

In State Of Ohio v. Demarkco Johnson, 2024-Ohio-5098, No. ...

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October 30, 2024
Man Bites Dog Story: Fraudsters Arbitration Attempts Stopped

Arbitration Stayed for Suspected Chiropractors’ Fraudulent No Fault Medical Claims

Post 4921

Read the full article at https://www.linkedin.com/pulse/man-bites-dog-story-fraudsters-arbitration-attempts-zalma-esq-cfe-5yw6c, see the full video at and at and at https://zalma.com/blog.

In Government Employees Insurance Company, (“GEICO”) v. Didier Demesmin, M.D., et al, No. 23-CV-6191 (ARR) (MMH), United States District Court, E.D. New York (October 23, 2024) GEICO sought to enjoin defendants Manuel A. Mendoza, D.C. and Mendoza Chiropractic Office PC (collectively the “Mendoza Defendants”) from pursuing certain “no-fault” insurance collection arbitrations or initiating new collections proceedings during the pendency of this lawsuit.

BACKGROUND

GEICO provides personal injury protection benefits on a “no-fault” basis, which means that, after an accident, insured drivers and their passengers ...

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October 29, 2024
Who’s on First & in What Percentage

Application of Diverse “Other Insurance” Clauses
Insurers Protected Insured and Litigated Their Differences

Post 4920

Two insurance companies- Gemini and Zurich- asked the Eleventh Circuit Court of Appeal to determine what share of a $2 million settlement each is required to pay. The district court entered judgment for Gemini, ordering that Zurich pay $500,000 plus prejudgment interest. Both parties appealed, with Gemini seeking another $500,000 and Zurich challenging the award of prejudgment interest.

In Gemini Insurance Company v. Zurich American Insurance Company, No. 22-13495, United States Court of Appeals, Eleventh Circuit (October 23, 2024) the competing “other insurance clauses” were resolved.
FACTS

After the death of Josue Vallejo, who was struck by a tractor-trailer operated by an employee of FSR Trucking, Inc two of three insurers disputed what proportion of the settlement each should pay. Zurich insured FSR, through its coverage of Commercial, for $1 million. Gemini also insured FSR for $3 million.

...

00:09:41
October 01, 2024
Failure to Pay a Premium Results in Cancellation

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 ...

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September 11, 2024

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."

August 30, 2024

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 ...

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