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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 17, 2025
Failure to Plead Breach of Contract Requires Dismissal

Breach of Contract Required to Sue for Bad Faith
Post 4975

Read the full article at https://lnkd.in/g6znKECB, see the full video at https://lnkd.in/gzUBQqcj and at https://lnkd.in/gnHHbZbp and at https://zalma.com/blog plus more than 4950 posts.

Foremost Insurance Company Grand Rapids, Michigan (“Foremost”) moved the court to dismiss in C & S Properties – I, LLC v. Foremost Insurance Company Grand Rapids, Michigan, Civil Action No. 24-462, United States District Court, E.D. Louisiana (January 10, 2025)

FACTUAL BACKGROUND

Damages from Hurricane Ida caused insurance claims concerning three properties owned by Plaintiff. The properties were each covered by separate insurance policies issued by Foremost when they were damaged by Hurricane Ida in August 2021.

Plaintiff alleged that, while Foremost has been in possession of sufficient evidence of the losses or had the opportunity to fully apprise itself of the actual losses and damages, it has failed to pay the amount due under the policies required by Louisiana law.

Plaintiff sued Foremost in Louisiana state court asserting claims under Louisiana law for breach of contract and bad faith damages. Foremost removed the matter to the USDC on the basis of diversity jurisdiction.

Foremost moved to Dismiss Plaintiff’s claims based upon the improper cumulation of claims and because the suit did not state a claim for which relief can be granted.

LEGAL STANDARD

Joining Claims

Federal Rule of Civil Procedure 18 provides that, “[a] party asserting a claim . . . may join, as independent or alternative claims, as many claims as it has against an opposing party.”

Under Federal Rule of Civil Procedure 12(b)(6), a defendant can seek dismissal of a complaint, or any part of it, for failure to state a claim upon which relief may be granted. To survive a Rule 12(b)(6) motion to dismiss, “a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’”

Dismissal is appropriate when the complaint on its face shows a bar to relief.

ANALYSIS

Regarding the insurance policies attached by Foremost, the Court found that those are referenced in Plaintiff’s state court Petition and are central to Plaintiff’s claims and thus may be rightfully considered by the Court.
Cumulation of Claims

The Court found that Plaintiff properly included its claims concerning each of the three properties in one lawsuit pursuant to Fed.R.Civ.P. 18(a).

Failure to State a Claim

The allegations in the Petition are insufficient to support a breach of contract claim. The Petition contains only vague and conclusory allegations and does not refer to specific actions or omissions by Foremost.

Plaintiff alleged that Hurricane Ida caused substantial amounts of damage to the exterior, interior, roof, and other structures of the Insured Properties, that Plaintiff provided timely notice of the loss event to Defendant. The Court found that Plaintiff’s Petition failed to state a breach of contract claim against Foremost.

The Court reached the same conclusion with respect to Plaintiff’s bad faith claim. The Petition merely sets forth the legal standard applicable to Louisiana bad faith claims, without providing factual support for Plaintiff’s allegations that Foremost acted in bad faith.

Leave to Amend

In its Opposition brief, Plaintiff requested leave to amend its Petition if the Court agrees with Foremost that the Petition is deficient.

While Plaintiff has failed to explain how it would amend its Petition Plaintiff shall have fourteen (14) days to file an amended petition addressing the deficiencies raised as to the sufficiency of its breach of contract and bad faith claims.

The Motion to Dismiss Pursuant to Federal Rule 12 was granted.

Plaintiff was granted fourteen (14) days from the date of this Order to file an amended pleading that addresses the deficiencies raised in the Motion to Dismiss regarding the sufficiency of its breach of contract and bad faith claims. Failure to amend will result in dismissal.

ZALMA OPINION

The USDC requires proper, detailed and effective pleading when suing for breach of contract or the tort of bad faith, not just a parade of horribles alleged against the defendant with the statutory requirements without supportive facts. The USDC spend much of its opinion explaining to the Plaintiff what is required to plead a viable complaint against Foremost if the facts exist.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:08
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20 hours ago
Allegations That Establish Breach of a Condition Defeats Suit

Notice of Claim Later than 60 Days After Expiration is Too Late

Post 5089

Injury at Massage Causes Suit Against Therapist

Read the full article at https://lnkd.in/gziRzFV8, see the full video at https://lnkd.in/gF4aYrQ2 and at https://lnkd.in/gqShuGs9, and at https://zalma.com/blog plus more than 5050 posts.

Hiscox Insurance Company (“Hiscox”) moved the USDC to Dismiss a suit for failure to state a claim because the insured reported its claim more than 60 days after expiration of the policy.

In Mluxe Williamsburg, LLC v. Hiscox Insurance Company, Inc., et al., No. 4:25-cv-00002, United States District Court, E.D. Missouri, Eastern Division (May 22, 2025) the trial court’s judgment was affirmed.

FACTUAL BACKGROUND

Plaintiff, the operator of a massage spa franchise, entered into a commercial insurance agreement with Hiscox that provided liability insurance coverage from July 25, 2019, to July 25, 2020. On or about June 03, 2019, a customer alleged that one of Plaintiff’s employees engaged in tortious ...

00:08:31
June 02, 2025
Zalma’s Insurance Fraud Letter – June 1, 2025

ZIFL – Volume 29, Issue 11
The Source for the Insurance Fraud Professional
Posted on June 2, 2025 by Barry Zalma

Post 5087

See the full video at and at

Read the full article and the full issue of ZIFL June 1, 2025 at https://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-06-01-2025.pdf

Zalma’s Insurance Fraud Letter – June 1, 2025

See the full video at https://lnkd.in/gw-Hgww9 and at https://lnkd.in/gF8QAq4d, and at https://zalma.com/blog plus more than 5050 posts.

ZIFL – Volume 29, Issue 11

The Source for the Insurance Fraud Professional

Read the full article and the full issue of ZIFL June 1, 2025 at https://lnkd.in/gTWZUnnF

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 ...

00:08:42
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May 30, 2025
Plain Language of Policy Enforced

No Coverage if Home Vacant for More Than 60 Days

Failure to Respond To Counterclaim is an Admission of All Allegations

Post 5085

See the full video at https://lnkd.in/gbWPjHub and at https://lnkd.in/gZ9ztA-P, and at https://zalma.com/blog plus more than 5050 posts.

In Nationwide Mutual Insurance Company v. Rebecca Massey, Civil Action No. 2:25-cv-00124, United States District Court, S.D. West Virginia, Charleston Division (May 22, 2025) Defendant Nationwide Mutual Insurance Company's (“Nationwide”) motion for Default Judgment against Plaintiff Rebecca Massey (“Plaintiff”) for failure to respond to a counterclaim and because the claim was excluded by the policy.

BACKGROUND

On February 26, 2022, Plaintiff's home was destroyed by a fire. At the time of this accident, Plaintiff had a home insurance policy with Nationwide. Plaintiff reported the fire loss to Nationwide, which refused to pay for the damages under the policy because the home had been vacant for more than 60 days.

Plaintiff filed suit ...

00:06:50
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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