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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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January 03, 2025
Unhappy After Making Deal to Avoid Fraud Conviction

No Right to Change Plea Bargain Accepted by Judge

Post 4964

See the full video at https://rumble.com/v657cpg-unhappy-after-making-deal-to-avoid-fraud-conviction.html and at https://youtu.be/vgJnBIJ2QAM, and https://zalma.com/blog plus more than 4950 posts.

Defendant Got a Great Plea Deal and Tried to Set it Aside Without Success

Michele Seegars appealed from an order denying her motion for post-conviction relief (PCR) without an evidentiary hearing claiming ineffective assistance of counsel at a plea hearing resulting in her guilty plea to theft of services.

In State Of New Jersey v. Michele A. Seegars, No. A-3721-22, Superior Court of New Jersey, Appellate Division (December 30, 2024) Seegars tried to set aside a judgment rendered as part of a plea agreement to a crime less than the charged insurance fraud.

FACTS

In July 2018, defendant was involved in a two-car motor vehicle accident in Kearny. After the accident, defendant filed a property damage claim against the other driver, who was insured by York Risk Services Group, Inc. York denied responsibility for the accident on the part of its insured. Shortly before the accident occurred, defendant’s automobile insurance coverage provided by Progressive Insurance Company had lapsed. On the day after the accident, defendant contacted Progressive seeking to renew her automobile insurance policy. Defendant falsely represented to Progressive that she had not been involved in any car accidents during the short period of time coverage had lapsed. Progressive determined defendant was involved in the subject accident during the lapse period and advised her by letter that her automobile insurance would not be renewed. Progressive, as required by statute, also referred the matter to the Essex County Prosecutor’s Office for investigation for insurance fraud.

THE CHARGES

Defendant was later charged with third-degree insurance fraud arising from the alleged false information she provided to her auto insurance company. In January 2020 defendant pled guilty pursuant to a plea agreement to a lesser charge of theft of services a disorderly persons offense. The judge accepted the plea and imposed a sentence of one day jail credit and no probation was imposed.

Defendant filed a timely pro se PCR petition. In further support of her PCR application, defendant presented: (1) the two letters she received from York; and (2) an affidavit certifying she informed her trial attorney of her innocence before the plea. Defendant claimed she never had the opportunity to present evidence of her innocence to her trial attorney for review and investigation prior to the plea hearing. She stated she thought her guilty plea was for a “violation,” not a crime.

The State opposed the petition arguing the documents submitted by the defendant were not “exculpatory.” In addition, the State asserted that defendant’s affidavit was in “stark contrast” to her testimony at the plea hearing.

After oral argument, Judge Callahan concluded that defendant failed to present a prima facie case which would require an evidentiary hearing because she failed to raise any genuine issues of fact not already in the record.

ANALYSIS

A defendant is not entitled to an evidentiary hearing if the allegations are too vague, conclusory, or speculative to warrant an evidentiary hearing. The Appellate Division concurred with Judge Callahan’s finding that defendant’s claim of innocence was not based on exculpatory evidence and that no credible evidence exists supporting her position that the fault of the other driver excused her from disclosing the accident in response to the direct question from Progressive asking whether she was in any prior accidents before the date she applied for the policy renewal. The Appellate Division concluded, as the trial judge, that counsel’s failure to consider this evidence was not a mistake that would have impacted the likelihood of success at trial and did not make it less likely that defendant would have entered the guilty plea.

No evidence was presented by defendant that plea counsel affirmatively advised her that the guilty plea would have no effect concerning her future employment prospects. A review of the evidence considered by the trial judge as part of the PCR application revealed the evidence against her was strong and the likelihood that defendant would have been convicted on the original third-degree insurance fraud charge.

Therefore, the judge did not abuse his discretion by failing to hold an evidentiary hearing. Defendant failed to satisfy her burden to present a prima facie case requiring a hearing.

ZALMA OPINION

Every lawyer learns that it is important to be silent after you obtain a favorable ruling from a court. Seegars, facing a trial and with high potential for conviction and five year jail sentence agreed to conviction of a lesser crime, no jail time, no fine and no probation for which her counsel should have received a medal. She still obtained a criminal conviction that made it difficult to work in her profession. She was lucky the appellate division did not set aside the conviction where she could be tried and convicted of insurance fraud and sentenced to five years in jail since she clearly tried to defraud her insurer Progressive.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:08:39
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14 hours ago
Ambiguity in Insurance Contract Resolved by Jury

Jury’s Findings Interpreting Insurance Contract Affirmed
Post 5105

See the full video at https://lnkd.in/gPa6Vpg8 and at https://lnkd.in/ghgiZNBN, and at https://zalma.com/blog plus more than 5100 posts.

Madelaine Chocolate Novelties, Inc. (“Madelaine Chocolate”) appealed the district court’s judgment following a jury verdict in favor of Great Northern Insurance Company (“Great Northern”) concerning storm-surge damage caused by “Superstorm Sandy” to Madelaine Chocolate’s production facilities.

In Madelaine Chocolate Novelties, Inc., d.b.a. The Madelaine Chocolate Company v. Great Northern Insurance Company, No. 23-212, United States Court of Appeals, Second Circuit (June 20, 2025) affirmed the trial court ruling in favor of the insurer.

BACKGROUND

Great Northern refused to pay the full claim amount and paid Madelaine Chocolate only about $4 million. In disclaiming coverage, Great Northern invoked the Policy’s flood-exclusion provision, which excludes, in relevant part, “loss or damage caused by ....

00:07:02
June 23, 2025
The Clear Language Of The Insurance Contract Controls

Failure to Name a Party as an Additional Insured Defeats Claim
Post 5104

Read the full article at https://lnkd.in/gbcTYSNa, see the full video at https://lnkd.in/ggmDyTnT and at https://lnkd.in/gZ-uZPh7, and at https://zalma.com/blog plus more than 5100 posts.

Contract Interpretation is Based on the Clear and Unambiguous Language of the Policy

In Associated Industries Insurance Company, Inc. v. Sentinel Insurance Company, Ltd., No. 23-CV-10400 (MMG), United States District Court, S.D. New York (June 16, 2025) an insurance coverage dispute arising from a personal injury action in New York State Supreme Court.

The underlying action, Eduardo Molina v. Venchi 2, LLC, et al., concerned injuries allegedly resulting from a construction accident at premises owned by Central Area Equities Associates LLC (CAEA) and leased by Venchi 2 LLC with the USDC required to determine who was entitled to a defense from which insurer.
KEY POINTS

Parties Involved:

CAEA is insured by Associated Industries Insurance Company, Inc. ...

00:08:22
June 20, 2025
Four Corners of Suit Allows Refusal to Defend

Exclusion Establishes that There is No Duty to Defend Off Site Injuries

Post 5103

Read the full article at https://lnkd.in/geje73Gh, see the full video at https://lnkd.in/gnQp4X-f and at https://lnkd.in/gPPrB47p, and at https://zalma.com/blog plus more than 5100 posts.

Attack by Vicious Dog Excluded

In Foremost Insurance Company, Grand Rapids, Michigan v. Michael B. Steele and Sarah Brown and Kevin Lee Price, Civil Action No. 3:24-CV-00684, United States District Court, M.D. Pennsylvania (June 16, 2025)

Foremost Insurance Company (“Foremost”) sued Michael B. Steele (“Steele”), Sarah Brown (“Brown”), and Kevin Lee Price (“Price”) (collectively, “Defendants”). Foremost sought declaratory relief in the form of a declaration that

1. it owes no insurance coverage to Steele and has no duty to defend or indemnify Steele in an underlying tort action and
2. defense counsel that Foremost has assigned to Steele in the underlying action may withdraw his appearance.

Presently before the Court are two ...

00:08:29
May 15, 2025
Zalma's Insurance Fraud Letter - May 15, 2025

ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional

See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.

Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th 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/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:

Health Care Fraud Trial Results in Murder for Hire of Witness

To Avoid Conviction for Insurance Fraud Defendants Murder Witness

In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...

May 15, 2025
CGL Is Not a Medical Malpractice Policy

Professional Health Care Services Exclusion Effective

Post 5073

See the full video at https://lnkd.in/g-f6Tjm5 and at https://lnkd.in/gx3agRzi, and at https://zalma.com/blog plus more than 5050 posts.

This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.

In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:

Insurance Coverage Dispute:

Travelers issued a Commercial General Liability ...

April 30, 2025
The Devil’s in The Details

A Heads I Win, Tails You Lose Story
Post 5062

Posted on April 30, 2025 by Barry Zalma

"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ­­­Perpetrators than any Other Crime."

Immigrant Criminals Attempt to Profit From Insurance Fraud

People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.

The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...

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