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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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October 31, 2025
The Zalma Philosophy of Claims Handling – Part 8

The Professional Claims Handler

Post 5218

Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-8-barry-zalma-esq-cfe-zdwsc, see the full video at https://rumble.com/v70zl4s-the-zalma-philosophy-of-claims-handling-part-8.html and at https://youtu.be/MIYcF71ffRQ, and at https://zalma.com/blog plus more than 5200 posts.

Claims Commandment X – Thou Shall Not Pretend to be a Lawyer

Some experienced and professional claims people know the law in their area of expertise better than most lawyers.

Adjusters should be adjusters and leave lawyering to lawyers. Similarly, lawyers should be lawyers and never try to be adjusters.

Claims Commandment XI – Thou Shall Empathize With the Claimant

Everyone presenting a claim is unhappy, disturbed, shocked, injured and needs help.

Empathy is identification with and understanding of another’s situation, feelings, and motives. It is the ability to understand another person’s circumstances, point of view, thoughts, and feelings....

00:11:08
October 28, 2025
The Zalma Philosophy of Claims Handling – Part 6

HOW TO CREATE AN EXCELLENCE IN CLAIMS HANDLING PROGRAM

See the full video at https://rumble.com/v70wb2i-the-zalma-philosophy-of-claims-handling-part-6.html and at https://youtu.be/tL5nDKPEs40 and at https://zalma.com/blog plus more than 5200 posts.

Post 5217

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry.

An Excellence in Claims Handling program begins with a statement in the insurer’s claims manual or statement of professionalism that it is dedicated to providing excellence in claims handling to every insured who presents a claim.

The excellence in claims handling program should include, at a minimum:

A series of lectures supported by text materials explaining:
A definition of insurance.
How to read and understand an insurance policy.
How to interview an insured, witness, or claimant.
How to assist an insured in the insured’s obligation to ...

00:08:40
October 27, 2025
The Zalma Philosophy of Claims Handling – Part 5

The Professional Claims Handler

Post 5216

Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-5-barry-zalma-esq-cfe-jde8c, see the full video at https://rumble.com/v70q4x8-the-zalma-philosophy-of-claims-handling-part-5.html and at https://youtu.be/6b9tZQsEkB4, and at https://zalma.com/blog plus more than 5200 posts.

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry.
Standards to be a Professional Claims Adjuster

The Insurance claims professional should be a person who:

1. Can read and understand the insurance policies issued by the insurer.
2. Understands the promises made by the policy.
3. Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
4. Are competent investigators.
5. Have empathy and recognize the difference between empathy and sympathy.
6. ...

00:08:18
October 31, 2025
The Zalma Philosophy of Claims Handling – Part 9

The Professional Claims Handler
Post 5219

Posted on October 31, 2025 by Barry Zalma

An Insurance claims professionals should be a person who:

Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.

How to Create Claims Professionals

To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...

post photo preview
October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

post photo preview
October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail

Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.

My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

post photo preview
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