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 14, 2024
Chutzpah – STOLI Fraudster Claims Hardship

Felon Seeks Release from Home Confinement in Luxury Apartment in New York City

Post 4931

Read the full article at https://www.linkedin.com/pulse/chutzpah-stoli-fraudster-claims-hardship-barry-zalma-esq-cfe-8jbhc, see the full video at and at and https://zalma.com/blog plus more than 4900 posts.

Insurance Fraud is a serious crime, especially when it takes advantage of the elderly to defraud insurers in a Stranger Originated Life Insurance (STOLI) scheme. In United States Of America v. Michael Binday, No. 12 CR 152 (CM), United States District Court, S.D. New York (November 4, 2024) the defendant continued to use the wealth he gained from his fraud to impose on the courts of the United States with frivolous and unfounded motions.

BACKGROUND

Michael Binday was sentenced to 144 months’ imprisonment after being found guilty of conspiracy to commit mail and wire fraud, as well as actual mail and wire fraud. The ...

00:09:12
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3 hours ago
Occam’s Razor

Exclusion for Work Performed by Insured Defeats Claim for Construction Defects
Post 4935

Read the full article at https://lnkd.in/gT_NsMHv, see the full video at https://lnkd.in/gqkPHYbp and at https://lnkd.in/gEEXkUe3, and at https://zalma.com/blog plus more than 4900 posts.

The question presented to the U.S. First Circuit Court of Appeals was whether a contractor’s CGL insurance policy covers general damage to a non-defective part of the contractor’s project resulting from a subcontractor’s defective work on a different part of that project.

APPLICATION OF OCCAM’S RAZOR

The analysis technique that proposes that the simplest of competing theories be preferred to the more complex.

FACTUAL BACKGROUND

Applying Massachusetts law, the district court concluded that Admiral had no duty to defend Tocci in Admiral Insurance Company, Starr Indemnity & Liability Company, Great American Assurance Company v. Tocci Building Corporation, Tocci Residential LLC, John L. Tocci, Sr., No. 22-1462, United States Court of Appeals,...

00:07:37
November 15, 2024
Zalma’s Insurance Fraud Letter September 15, 2024

Zalma’s Insurance Fraud Letter

A ClaimSchool™ Publication © 2024 Barry Zalma & ClaimSchool, Inc.

Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkycVolume 28, Issue 21 – November 15, 2024

“Honor, justice, and humanity, forbid us tamely to surrender that freedom which we received from our gallant ancestors, and which our innocent posterity have a right to receive from us. We cannot endure the infamy and guilt of resigning succeeding generations to that wretchedness which inevitably awaits them if we basely entail hereditary bondage on them.”

Thomas Jefferson

Insurance Fraud Requires Doctor to Lose his License

Sexual Misconduct, Fraud, Bribery & Unnecessary Surgery Revokes License

Louis Quartararo appealed from an August 22, 2022 final agency decision of the State Board of Medical Examiners (Board), revoking his license to practice medicine and surgery in New Jersey. The Superior Court of New Jersey, in In The Matter Of The Suspension Or Revocation Of The License Of Louis Quartararo, M.D. License No. ...

00:08:32
November 13, 2024
Bad Faith Set Up Fails

Read the full article at https://www.linkedin.com/pulse/bad-faith-set-up-fails-barry-zalma-esq-cfe-jllxc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.
Inadequate Information Made Refusal to Pay Policy Limits Not Bad Faith

INADEQUATE MEDICAL AUTHORIZATION USED TO CAUSE INSURER TO REFUSE SETTLEMENT DEMAND

Post 4930

Kara Flick appealed from the judgment after a jury rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. Flick contends the judgment should be reversed due to juror misconduct.

In KARA FLICK v. UNITED SERVICES AUTOMOBILE ASSOCIATION, B330507, California Court of Appeals, Second District, Sixth Division (November 5, 2024) the Court of Appeals resolved the dispute.

FACTUAL HISTORY

After sustaining injuries in an automobile accident caused by Francisco Reyes, Jr., Flick had her attorney send Reyes's insurer, the United Services ...

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November 07, 2024
Declaring a Policy Void

When a Policy Is Void

For Subscribers to Excellence in Claims Handling

You can Subscribe for only $5 a month to Excellence in Claims Handling at
https://barryzalma.substack.com/subscribe

A small portion of what was provided to subscribers.

In almost every policy of insurance, there is a clause declaring the policy void if the insured misrepresents or conceals material facts or commits fraud. For example:

We do not pay for bodily injury or property damage which is expected by, directed by, or intended by an insured. This exclusion does not apply to bodily injury that arises out of the use of reasonable force to protect people or property. (AAIS Form BP-200, (c) 1987 AAIS).

or:

This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other “insured,” at any time, intentionally conceal or misrepresent a material fact concerning: a. This Coverage Form; b. The covered “auto”; c. Your interest ...

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November 07, 2024
Declaring a Policy Void

When a Policy Is Void

For Subscribers to Excellence in Claims Handling

You can Subscribe for only $5 a month to Excellence in Claims Handling at
https://barryzalma.substack.com/subscribe

A small portion of what was provided to subscribers.

In almost every policy of insurance, there is a clause declaring the policy void if the insured misrepresents or conceals material facts or commits fraud. For example:

We do not pay for bodily injury or property damage which is expected by, directed by, or intended by an insured. This exclusion does not apply to bodily injury that arises out of the use of reasonable force to protect people or property. (AAIS Form BP-200, (c) 1987 AAIS).

or:

This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other “insured,” at any time, intentionally conceal or misrepresent a material fact concerning: a. This Coverage Form; b. The covered “auto”; c. Your interest ...

post photo preview
November 07, 2024

Declaring a Policy Void
When a Policy Is Void
For Subscribers to Excellence in Claims Handling
You can Subscribe for only $5 a month to Excellence in Claims Handling at
https://barryzalma.substack.com/subscribe
A small portion of what was provided to subscribers.
In almost every policy of insurance, there is a clause declaring the policy void if the insured misrepresents or conceals material facts or commits fraud. For example:
We do not pay for bodily injury or property damage which is expected by, directed by, or intended by an insured. This exclusion does not apply to bodily injury that arises out of the use of reasonable force to protect people or property. (AAIS Form BP-200, (c) 1987 AAIS).
or:
This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other “insured,” at any time, intentionally conceal or misrepresent a material fact concerning: a. This Coverage Form; b. The covered “auto”;...

post photo preview
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