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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March 11, 2026
Public Adjusters Attempt to Represent an Insured Subject to APA Clause

Anti-Public Adjuster Clause Is Effective in New York

Post number 5301

Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.

Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster

In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.

FACTS

NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...

00:08:05
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March 11, 2026
Public Adjusters Attempt to Represent an Insured Subject to APA Clause

Anti-Public Adjuster Clause Is Effective in New York

Post number 5301

Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.

Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster

In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.

FACTS

NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...

00:08:05
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March 10, 2026
Acting as Your Own Lawyer is Foolish

Proof of Highly Contaminated Water is Required for Extra Payments

Post number 5300

Read the full article at https://www.linkedin.com/pulse/acting-your-own-lawyer-foolish-barry-zalma-esq-cfe-mbg0c, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.

Acting as Your Own Lawyer is Foolish

Evidence of Breach of Contract Survives Dismissal of All Other Charges

In Lee Lifeng Hsu and Jane Yuchen Hsu v. State Farm Fire And Casualty Company, C. A. No. N24C-09-020 CLS, Superior Court of Delaware (February 27, 2026) a claim to State Farm who paid approximately $61,000 after assessments but denied coverage for additional items including ceramic tiles, the kitchen floor ceiling, underlayment plywood, and numerous personal property items resulted in suit by the Hsu’s acting in pro per.
Facts

Lee Lifeng Hsu and Jane Yuchen Hsu (“Plaintiffs”) purchased a homeowners’ insurance policy from State Farm Fire...

00:07:28
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13 hours ago
Portable Storage Containers are not Buildings

Insurance Condition Requires Following the Intent of the Parties

Post number 5307

Principles of Contract Interpretation Compels Reading Contract as Written

Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.

In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)

In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...

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13 hours ago
Failure to Provide Well-Pled Facts Defeats Most of Action

ERISA Saves Fraudulent Claims Suit

Post number 5306

Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.

Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity

In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.

FACTUAL BACKGROUND

United and Oxford, who administer both ERISA and ...

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March 19, 2026
Failure to Provide Well-Pled Facts Defeats Most of Action

ERISA Saves Fraudulent Claims Suit

Post number 5306

Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.

Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity

In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.

FACTUAL BACKGROUND

United and Oxford, who administer both ERISA and ...

post photo preview
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