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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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February 10, 2025
Insurance Fraudsters are Annoying

Parole Violation Puts Convicted Insurance Fraudster Back in Jail
Post 4991

Read the full article at https://lnkd.in/gjj4ppSa, see the full video at https://lnkd.in/g_ubV4Cr and at https://lnkd.in/geyVYPNu, and https://zalma.com/blog plus more than 4950 posts.

Facts

In Commonwealth Of Pennsylvania v. Kalani Watts, Nos. 2399 EDA 2023, 895 EDA 2024, No. J-S37026-24, Superior Court of Pennsylvania (January 27, 2025) Watts entered a negotiated guilty plea to one count each of obtaining possession of a controlled substance by misrepresentation, fraud, forgery or subterfuge, and insurance fraud. On July 21, 2014, in accordance with the plea agreement, the trial court imposed an aggregate sentence of 6 to 12 years in prison.

Watts also pled guilty to one count of receiving stolen property. On September 3, 2014, the trial court sentenced Appellant to 16 to 36 months in prison, to run concurrently with Appellant’s sentence in the drug and insurance fraud case.

Watts alleged he was paroled on 6-20-19, and moved thereafter to the State of Georgia. Three years later, Watts was arrested on misdemeanors and returned back to Pennsylvania on a parole violation. Upon being seen by the Pennsylvania Board of Probation and Parole (Parole Board), Watts was informed that his maximum sentence was moved from 7-12-2026 to 4-29-29.

The Appeal

In this consolidated appeal, Kalani Watts (Appellant) appeals, pro se, from the orders dismissing as untimely his first petitions filed under the Post Conviction Relief Act (PCRA), 42 Pa.C.S.A. §§ 9541-9546.

Post Conviction Relief

Appellant filed identical, pro se PCRA petitions at two dockets. Appellant filled out portions of a pre-printed PCRA petition form and also incorporated an attached “Petition for Enforcement of Negotiated Plea Agreement” (Attachment).

The PCRA court further observed that Appellant’s petitions appeared to challenge the Parole Board’s decision to revoke his parole and pull his street time. In the alternative, the PCRA court determined that the Parole Board’s decision did not constitute a violation of Appellant’s plea agreement.

Analysis

Pro se litigants must comply with the procedural rules set forth in the Pennsylvania Rules of Court.

Preliminarily, although the Court was willing to construe liberally materials filed by a pro se litigant, a pro se appellant enjoys no special benefit. To the contrary, any person choosing to represent himself in a legal proceeding must, to a reasonable extent, assume that his lack of expertise and legal training will be his undoing.

Here, though Appellant cites various provisions of the federal and state constitutions, he fails to identify any decision of the United States Supreme Court or Pennsylvania Supreme Court recognizing a new constitutional right.

As Appellant has waived each of his issues raised on appeal, the Court of Appeals affirmed the PCRA court’s orders dismissing his petitions.

ZALMA OPINION

People who engage in criminal conduct, especially when that conduct is insurance fraud, are not members of MENSA. Mr. Watts was a regular, albeit inept, criminal. He was lucky enough to be paroled only to be put back in jail for breaching the conditions of his parole by committing some misdemeanors. He then tried to change his sentence by applying as his own attorney for post conviction relief. That also failed because the bases he claimed were not established.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:23
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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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12 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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12 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 ...

post photo preview
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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