Insurance Agent Has No Obligation to Investigate an Insured’s Coverage Needs
Post 4987
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Plaintiff Liza Sims’ mother owned a house in Magalia, California, that was insured under a policy issued to her by Farmers Insurance. Before the Camp Fire, Sims lived alone in her mother’s house and operated a cosmetic tattoo business there. After the house was destroyed by a wildfire called the Camp Fire in 2018. The insurance company paid Sims’ mother the limits available under her policy but denied Sims’ claim for the loss of her personal and business property. Sims sued Farmers Group, Inc. (Farmers) and insurance agent Dawn Foster (Foster or agent) (collectively, defendants) for negligent misrepresentation and professional negligence.
In Liza Sims v. Farmers Group, Inc., et al., C097755, California Court of Appeals (January 24, 2025) Plaintiff attempted to get coverage for the destruction of business property from a homeowners policy the excluded such coverage.
Trial Court Ruling
The trial court ruled in favor of the defendants, stating that Sims’ claims were legally insufficient because she could not show harm from the agent’s alleged misrepresentations and could not prove the defendants owed or breached any duty of care.
Appeal
Sims appealed, arguing that the court erred. The appellate court affirmed the trial court’s decision.
Issues & Conclusions
Sims’ claims were based on alleged representations by Foster about the insurance coverage on the property.
The trial court concluded that Sims could not establish causation because Foster’s alleged misrepresentations pertained to a different insurance policy that was no longer in effect at the time of the Camp Fire.
Sims’ evidence was insufficient to create a triable issue of material fact.
The trial court also ruled that Sims could not establish Foster owed or breached a duty of care to Sims because the duties of an insurance agent run only to the client, and Sims was not Foster’s client.
The appellate court agreed with the trial court’s findings and affirmed the judgment.
Analysis
Negligent misrepresentation is a species of the tort of deceit. To prove negligent misrepresentation, a plaintiff must show (1) a misrepresentation of a past or existing material fact, (2) made without reasonable ground for believing it to be true, (3) with intent to induce another’s reliance on the fact misrepresented, (4) justifiable reliance on the misrepresentation by the party to whom it was directed, and (5) resulting damage.
Sims alleged that she had two in-person conversations with Foster, the agent, in 2013 and 2014 where she was led to believe her business property was covered. The trial court concluded that Sims could not establish the elements of causation (justifiable reliance and resulting damage) because Foster’s alleged misrepresentations pertain to coverage under an earlier homeowners’ insurance policy, which was replaced by the landlord policy in effect at the time of the fire, more than a year before the Camp Fire that damaged the house.
Disposition:
The judgment was affirmed, and the defendants were awarded their costs on appeal.
The trial court ruled in favor of the defendants because Sims’ claims were legally insufficient because Sims could not show harm from the agent’s alleged misrepresentations and could not prove the defendants owed or breached any duty of care.
In her deposition testimony and discovery responses, Sims admitted facts that directly contradicted the statements in her declaration in opposition to the motion for summary judgment.
Ordinarily, an insurance agent assumes only those duties normally found in any agency relationship. This includes the obligation to use reasonable care, diligence, and judgment in procuring the insurance requested by an insured. However, an insurance agent generally does not have a duty to investigate a customer’s coverage needs, to procure coverage to meet those needs, or to point out the advantages of additional or different insurance coverage.
The trial court properly ruled that because the underlying claims against Foster failed as a matter of law there could be no case against Farmers.
The judgment was affirmed and the defendants were allowed to recover their costs on appeal.
ZALMA OPINION
Insurance agents who do not take on the position of a fiduciary are basically order takers and are only obligated to obtain the insurance ordered. The fact that the agent may have told the plaintiff that her business property was covered by one policy – whether true or not – was not a misrepresentation about a subsequent policy totally different from the one in effect at the time of the fire. People really must read the policy before buying it and before making a claim or filing suit. The court did and the Plaintiff lost.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.
Posted on September 18, 2026 by Barry Zalma
See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html
In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.
The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.
Law
The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...
150 Months in Prison for Tax Fraud
Post 4846
Posted on September 17, 2026 by Barry Zalma
See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.
The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...
Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution
Post 5489
Posted on September 14, 2026 by Barry Zalma
Fraudster Refuses to Answer Questions About His Alleged Fraud
See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr
In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.
Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.
After Great American ...
Inadequately Briefed Issues Defeats Appeal
Post 4852
Issues on Appeal Must be Adequately Briefed
Posted on September 25, 2026 by Barry Zalma
In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.
According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair. The defendant denied negligence and alleged comparative negligence. After a two-day jury trial in November 2023, the jury returned a defense verdict.
The trial court denied Ojekwe’s motion to set aside the verdict and for a new trial, and he appealed.
LAW
A trial court’s refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of ...
Inadequately Briefed Issues Defeats Appeal
Post 4852
Issues on Appeal Must be Adequately Briefed
Posted on September 25, 2026 by Barry Zalma
In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.
According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair.
LAW
Refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of discretion.
Appellate claims receiving only cursory treatment, without record citations, supporting authority, or legal analysis, are inadequately briefed.
DISCUSSION
Improper opening remarks.
Defense counsel referred to Ojekwe’s national origin,...
Psychiatrist Who Was Convicted of Fraud Asked the First Circuit to Reduce his Punishment
Post 4851
Posted on September 24, 2026 by Barry Zalma
Fraud to Private and Public Health Insurers Doesn’t Pay
In United States v. Gustavo Kinrys, Nos. 24-1592, 24-1716, United States Court of Appeals, First Circuit (September 21, 2026) Gustavo Kinrys, a Massachusetts psychiatrist, submitted fraudulent claims to private and public health insurers from 2015 through 2018, including bills for more than 1,000 sessions when he or the purported patient was outside the country. When insurers requested supporting records, he delayed through a fictitious office manager and created false documentation.
A jury convicted Kinrys on fourteen counts. The district court imposed a 99-month sentence, calculated intended loss at slightly more than $19 million based on billed amounts, ordered $6,537,309.59 in restitution, and ordered $6,527,391.19 in forfeiture.
At sentencing, the district court calculated Kinrys’s base offense level to be ...
