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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 12, 2025
Statutory Employee Entitled Workers’ Compensation Benefits

DEFINITION OF “CONTRACTOR” CONTROLLED CONTRACT INTERPRETATION
Post 4993

Read the full article at https://lnkd.in/ga26KM2x, shttps://lnkd.in/ga26KM2x, and https://zalma.com/blog plus more than 4950 posts.

The Eleventh Circuit was asked to resolve who was responsible for a workers’ compensation claim filed by Steven Brock, who was injured while driving a truck for Stafford Transport of Michigan, Inc., while Brock, an authorized driver for Kenneth Carver Trucking Company, LLC, was not covered by workers’ compensation insurance at the time of his accident. However, Stafford had three insurance policies, including a contingent-liability policy issued by Crum.

In Stafford Transport Of Michigan, Inc., d.b.a CEI, d.b.a. Custom Ecology, Great American Alliance Insurance Company v. Crum & Forster Specialty Insurance Company, No. 24-12058, United States Court of Appeals, Eleventh Circuit (February 4, 2025) the Eleventh Circuit was asked to provide coverage for Mr. Brock who had become a paraplegic as a result of the accident.

The district court ruled in favor of Stafford and Great American, stating that Brock was a covered person under the contingent-liability policy. Crum appealed, arguing that Brock was not a covered person and that exclusions applied.

ANALYSIS

On September 9, 2021, Brock filed a claim against Stafford and Great American before the Georgia State Board of Workers’ Compensation seeking payment of workers’ compensation benefits as Stafford’s statutory employee. Great American demanded that Crum defend Stafford against the claim.

Stafford entered into a consent agreement with Brock stating that he was a statutory employee of Stafford. Crum then confirmed that it would not extend coverage under the contingent-liability policy because Brock was not a covered person under the contract as an “Owner/Operator” or “Contractor” of Stafford and did not have a fully executed contract with Stafford.

A contractor is defined as someone who is a party to a contract or a person or company that agrees to do work or provide goods for another company. And contrary to Crum’s argument, the district court was allowed to look at the contract as a whole to determine the reasonable interpretation of that term.

Brock had a covered contract with Stafford through the Kenneth Carver Trucking agreement. The policy states that owner/operators and contractors must “[h]ave a written covered contract with” Stafford. A “Covered Contract means a fully executed contract between a Covered Person” and Stafford. As the Eleventh Circuit explained, a covered person includes owner/operators and contract drivers. And the use of the plural “Covered Person(s)” that “[h]ave a written covered contract,” in contrast to the other three requirements, which use singular verbs, means members of the owner/operator and contract driver group can collectively have a single contract, while the other conditions must be satisfied by one individual. So, Brock had a written covered contract with Stafford based on the Kenneth Carver Trucking agreement, even without an individual contract.

The Eleventh Circuit concluded that the district court correctly rejected Crum’s argument that the Kenneth Carver Trucking agreement was not fully executed even though Stafford did not sign the agreement. Kenneth Carver Trucking signed the agreement, and Stafford’s acceptance could be inferred.

The summary judgment in favor of Stafford and Great American was affirmed.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:06:28
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September 18, 2026
Expert May Only Testify to What Experience Supports

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...

00:03:10
September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

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 ...

00:05:23
September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

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 ...

00:05:14
7 hours ago
John Madden and The US Patent and Trademark Office

Blockchain Fraud Detection Loses Protection

Posted on October 22, 2026 by Barry Zalma

John Earl Madden (April 10, 1936 – December 28, 2021) was an American Professional Football Coach and Sports Commentator in the National Football League Seeking Patent & Trademark Protection

BLOCKCHAIN FRAUD

Mr. Madden was more than football. He was working to establish a program called “Fraud Protection Systems, Methods, and Computer Programs for Blockchain Financial Transactions.”

In Ex parte John Madden, Appeal 2026-001497, Application 18/495,506, Technology Center 3600, United States Patent and Trademark Office, Patent Trial and Appeal Board (October 14, 2026)

The Examiner rejected claims several numbered claims under 35 U.S.C. § 101 as directed to an abstract idea without significantly more.

THE LAW

Section 101 makes patentable any new and useful process, machine, manufacture, or composition of matter.Laws of nature, natural phenomena, and abstract ideas are implicitly excluded.

THE PATENT TRIAL AND ...

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October 21, 2026
Supervisory Officials are not Individually Liable

Sovereign Immunity Defeats Suit Against Police Officers

Post 4866

Posted on October 21, 2026 by Barry Zalma

In Chad Lightfoot, et al. v. Progressive Direct Insurance Company, et al., Civil Action No. 26-434, United States District Court, E.D. Louisiana (October 9, 2026) Chad Lightfoot was involved in an Orleans Parish automobile accident in 2011 and filed claims with several insurers, including Progressive.

After a related civil dispute, Progressive counsel allegedly submitted a false affidavit stating that Lightfoot had fraudulently received a $50,000 payment. A New Orleans police detective relied on the affidavit to obtain an arrest warrant, and Louisiana State Police Lieutenant Alan Arcana allegedly reported that Lightfoot had received the payment. Lightfoot was arrested in 2015 and charged with theft, insurance fraud, and perjury.

Plaintiffs alleged that no record of the payment existed and that the criminal charges were dismissed on October 15, 2024.

Lightfoot and Geralyn Hawkins filed suit in October 2025 and ...

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October 20, 2026
Suit Must be Ripe When Filed

A Suit Filed Before the Claim Exists is Fatal

Post 4870

Posted on October 20, 2026 by Barry Zalma

In Louis Briggs v. Shaun Wimberly; Somerset Services, Inc.; And Wimberly & Associates, PLLC, and Louis Briggs v. Shaun Wimberly And Wimberly & Associates, PLLC Nos. 2024-CA-1471-MR, 2025-CA-1366-MR, Court of Appeals of Kentucky (October 9, 2026) Louis Briggs was arrested in 2014 after an incident with police and charged with several offenses, including third-degree assault.

Probable cause was found and an indictment was returned, but the charges were eventually dismissed. His attorney, Shaun Wimberly, then filed a federal civil rights suit for Briggs in a United States district court, which also asserted state-law claims. The district court dismissed most of the claims and declined to exercise jurisdiction over the remaining state-law claims. Briggs blamed Wimberly for the result, fired him, and appealed to the Sixth Circuit.

While the federal appeal was pending, Briggs filed a legal malpractice action against Wimberly in the Jefferson Circuit Court. The Sixth ...

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