Read the full article here and at https://www.linkedin.com/pulse/proof-loss-requirement-waived-barry-zalma-esq-cfe-ullec, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.
To Reject a Claim for Lack of a Proof of Loss the Insurer Must Continually Act to Enforce the Condition
Post 4925
The last time a 60 day limit to file a proof of loss was upheld was a case called White v. Home Mutual, 128 Cal. 131, 135, 60 P. 666, issued by the California Supreme Court in 1900. It was a Draconian decision with Mr. White only a few weeks late.
In Indiana, after a hailstorm damaged a condominium complex’s nine residential buildings, their insurer promptly investigated the claim, made three separate payments totaling nearly $30,000, and engaged in two years of ongoing negotiations. The insurer sought to deny coverage entirely because the insured failed to submit a sworn statement of loss within 60 days.
The ...
ZIFL – Volume 28 Number 21
Posted on November 1, 2024 by Barry Zalma
Post 4924
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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:
Pill Mill Doctor’s Conviction Affirmed
HEALTH CARE FRAUD CONVICTION AFFIRMED
ACTING AS A DR. FEEL GOOD...
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. ...
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 ...
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 ...
