Zalma’s Insurance Fraud Letter Volume 29, Issue 5
The Source for the Insurance Fraud Professional
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Read the full issue of Zalma's Insurance Fraud Letter for March 1, 2025 at https://lnkd.in/g9h3xuGn and https://lnkd.in/gGyuDaze, see the full video at https://lnkd.in/g6dJW9G5 and at https://lnkd.in/gtbchYPG, and at https://zalma.com/blog plus more than 5000 posts.
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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 March 1, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
This issue contains the following articles about insurance fraud:
Auto Fraud Schemes
The Swoop and Squat
The swoop and squat auto insurance fraud is a deliberate attempt by a driver to claim auto insurance payouts by setting up an accident on the roads. These accidents usually involve an unsuspecting victim rear-ending the criminal, with at least an accomplice helping him.
In a swoop and squat auto insurance fraud, at least two people are involved. These two conspirators will scout the streets with their vehicles for their preferred target. Usually, a high value auto or a commercial vehicle will, more likely than not, be insured.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
California Department of Insurance Issues Warning About Tow Truck Scams
The California Department of Insurance issued a PSA with a warning for California drivers about an increase in scams involving tow truck companies targeting car accident victims where vehicles are being held hostage for cash. The scam has become prevalent in SoCal. See the video at https://x.com/i/status/1892004401218245112
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
Heath Insurance Fraud Convictions
Man Convicted, Sentenced After Trial For Submitting False MassHealth Claims For Autism Behavioral Health Treatment
After Five-Day Trial, Defendant Found Guilty of Stealing More Than $33,000 in MassHealth Funds
Donald Martel, age 69, of Georgetown, was convicted after a five-day trial for fraudulently billing MassHealth, the state’s Medicaid program, for applied behavioral analysis (ABA) services that were never provided. Martel was sentenced to three years’ probation and ordered to pay full restitution, stay away from and have no contact with witnesses, and refrain from all work, billing, and responsibilities with MassHealth members.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
MORE MCCLENNY MOSELEY & ASSOCIATES ISSUES
This is ZIFL’s forty-second installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
In MMA Law Firm, PLLC, formerly known as McClenny, Moseley & Associates, PLLC v. PCG Claims, LLC d/b/a PCG Consulting, LLC, No. 01-24-00217-CV, Court of Appeals of Texas, First District, Houston (December 31, 2024), A Law Firm filed a Suggestion of Bankruptcy informing this Court that appellant filed a petition for Chapter 11 bankruptcy in Case Number 24-31596 in the United States Bankruptcy Court for the Southern District of Texas.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
COMPACT BOOK OF ADJUSTING PROPERTY CLAIMS FOURTH EDITION
In Kindle, paperback and hardback formats, The Compact Book of Adjusting Property Claims, Fourth Edition is now available for purchase here and here. The Fourth Edition contains updates and clarifications from the first three editions plus additional material for the working adjuster and the insurance coverage lawyer.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
CONVICTIONS OF OTHER THAN HEALTH INSURANCE FRAUD
Two Washington State Residents Guilty of Insurance Fraud
Jason Weisfeld of Federal Way, Washington, and Fedaa Shakir, pleaded guilty to submitting false insurance claims. A carpet-cleaning claim and a fake theft of a Hyundai has led to guilty pleas for the two people for insurance fraud in Washington.
Weisfeld filed a false insurance claim relating to a carpet cleaning incident that resulted in an investigation by the Washington State Insurance Commissioners’ Investigations Unit.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
Deterring Insurance Fraud
A New Book on Insurance Fraud and How the DOJ Deters and Defeats Insurance Fraud.
INSURANCE FRAUD IS EPIDEMIC
Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. No one knows the amount that is taken by insurance fraud because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $308 billion to more than $500 billion every year. The only certainty is that it is a serious crime that bleeds the insurance industry sufficiently to have states compel insurers to create special investigative units (SIU’s) to investigate, deter and defeat insurance fraud to assist the state in its efforts to prosecute the crime.
The book is now available as a Kindle book, a paperback and hardcover at amazon.com
RED FLAGS OF FRAUD
Suspicious claims have common attributes. Insurers and their anti-fraud organizations have collated the common attributes into lists of indicators or red flags of fraud. The lists were created as training aids and to be used to determine whether further investigation is required to determine if a claim is legitimate or false and fraudulent.
Continually growing, these lists are known as the “red flags” or “indicators” of fraud lists. There are many different categories, ranging from those associated with the claim itself or with insureds to indicators of specific types of fraud, such as bodily injury fraud or arson for profit.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
BARRY ZALMA
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Write to Mr. Zalma at [email protected]; https://www.zalma.com; https://zalma.com/blog.
He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.
Read the full article and the full 18 page ZIFL at https://zalma.com/blog/wp-content/uploads/2025/02/ZIFL-02-15-2025.pdf
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Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
Jury’s Findings Interpreting Insurance Contract Affirmed
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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 ....
Failure to Name a Party as an Additional Insured Defeats Claim
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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. ...
Exclusion Establishes that There is No Duty to Defend Off Site Injuries
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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 ...
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 ...
Professional Health Care Services Exclusion Effective
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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 ...
A Heads I Win, Tails You Lose Story
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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...
