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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January 30, 2025
Failure to Profit From the Crime of Insurance Fraud Does not Excuse the Crime

CONVICTION FOR INSURANCE FRAUD AFFIRMED

Post 4984

UNSUCCESSFUL FAKE ACCIDENT STILL GOES TO JAIL

Read the full article at https://lnkd.in/gBvuyK3F, see the full video at https://lnkd.in/gWJAwz_h and at https://lnkd.in/gf9_pqzn and at https://zalma.com/blog plus more than 4950 posts.

THE PEOPLE v. STEPHEN R. JACKSON, H052419, California Court of Appeals, Sixth District (January 23, 2025) Jackson tried to have his felony conviction reduced to a misdemeanor because of Proposition 47.

FACTUAL BACKGROUND

In 1992, Jackson was charged by information with conspiracy to commit insurance fraud, causing or participating in a vehicular collision or any other vehicular accident for the purpose of presenting a false or fraudulent claim; presenting or causing to be presented a false or fraudulent insurance claim; presenting a false or fraudulent claim for loss or theft, destruction, damage, or conversion of the contents of a motor vehicle; and, preparing a false police report and authorization of medical records/employment records with intent to present it in support of a false or fraudulent claim. Jackson was convicted by plea of count 2, violation of Insurance Code section 1871.1, subdivision (a)(3), a felony, and placed on felony probation.

In 2024, Jackson filed an application to have his felony conviction designated as a misdemeanor

Proposition 47, approved in November 2014, makes certain drug-and theft-related offenses misdemeanors. Nothing in the relevant statute bases the punishment for the crime of participating in a vehicular collision for the purpose of presenting a false claim on the value of the property or claim at issue.

In addition to alleging that the value of the claim at issue in his conviction should make him eligible for relief under section 1170.18, subdivision (f), Jackson argued that he “was never given a check,” “never saw the check”, and that he “didn’t destroy any property or damage any property.”

ANALYSIS

Stephen R. Jackson’s appeal was based on his conviction for causing or participating in a vehicular collision to present a false or fraudulent claim. He argued that under Proposition 47, which reduces certain property theft crimes to misdemeanors when the value is $950 or less, his offense should also be reclassified since the value of the checks was under $950.

Key Points

1. Both before and after Proposition 47, Jackson’s offense was classified as a felony under Insurance Code section 1871.1 and current Penal Code section 550.
2. The legislature intended to treat causing or participating in a vehicular collision for the purpose of presenting a false claim as a felony, regardless of the value of the claim.
3. The punishment for Jackson’s crime does not depend on the claim’s value, unlike other offenses under Insurance Code section 1871.1 and section 550, which are misdemeanors if the claim is below certain amounts.

Conclusion

The trial court properly denied Jackson’s section 1170.18, subdivision (f) petition to redesignate his felony conviction for causing or participating in a vehicular collision or any other vehicular accident for the purpose of presenting a false or fraudulent claim as a misdemeanor.

ZALMA OPINION

The people of California did away with most of Proposition 47 but it was in effect when Jackson was convicted. However, since his crime, auto insurance fraud, is always a felony even if he was so incompetent he made nothing from his crime, he was properly convicted and the court refused to change his felony to a misdemeanor. There is no excuse for committing insurance fraud and even if the fraud failed to make any money for Jackson he committed the crime. Jackson was probably caught, tried and convicted because he was an incompetent criminal and must now continue to live with the shame of a felony conviction.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:21
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15 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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