Zalma’s Insurance Fraud Letter Volume 29, Issue 5
The Source for the Insurance Fraud Professional
Post 5008
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
Happy Law Day
ZIFL – Volume 30, Issue 9 – May 1, 2026
Read the full article at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-may-1-2026-barry-zalma-esq-cfe-2tywc, see the video at at and at https://zalma.com/blog plus more than 5300 posts.
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
ZIFL – Volume 30, Issue 9 – May 1, 2026
Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year and is written by Barry Zalma.
DOJ Creates National Fraud Enforcement Division
Will the Feds Take on Insurance Fraud? Possibly as Part of a National Anti-Fraud Effort
On April 7, 2026, the Acting Attorney General, Todd Blanche, issued a memorandum establishing the Department of Justice National Fraud Enforcement Division (NFED). The memo describes an ambitious, but perhaps redundant, vision for this ...
When Abalone Died As a Result of Multiple Causes The Efficient Proximate Cause Requires Payment
Post number 5345
Read the full article at https://www.linkedin.com/pulse/efficient-proximate-cause-doctrine-saves-claim-barry-zalma-esq-cfe-yndlc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
In American Abalone Farms, LLC v. Star Insurance Company et al., H052643, California Court of Appeals, Sixth District (April 27, 2026) the Court of Appeals dealt with an insurance coverage issue that required application of the efficient proximate cause doctrine.
FACTS
American Abalone Farms, LLC ("American Abalone" ) operates an aquaculture farm in Santa Cruz County, California, raising abalone in tanks. In August 2020, the CZU Lightning Complex Fires led to a prolonged power outage and road closures near the farm. As a result, the farm’s water pumps failed, causing the death of most of the ...
Breach of a Specific Condition Precedent Is a Complete Defense
See the video at and at and at https://zalma.com/blog plus more than 5300 posts.
In United Services Automobile Association and State Farm Mutual Automobile Insurance Company v. Anthony Wenzell, 2026 CO 25 (Colo. Apr. 27, 2026) Anthony Wenzell was rear-ended in a car accident. He had a significant prior 2014 accident that required back surgery.
Wenzell claimed underinsured-motorist (UIM) benefits under three policies: (1) the tortfeasor’s liability policy, (2) his own primary UIM policy with State Farm, and (3) an excess UIM policy issued by USAA (under his brother’s policy, which contained an “other insurance” clause making USAA’s coverage excess over any collectible insurance).
After receiving the claims, both USAA and State Farm repeatedly requested that Wenzell execute comprehensive medical-release authorizations so they could obtain his full medical records and ...
It is Fraud to Make the Same Claim Twice
Read the full article at https://www.linkedin.com/pulse/fraud-make-same-claim-twice-barry-zalma-esq-cfe-c4g8c and at https://zalma.com/blog.
Chutzpah: After Being Paid for a New Roof Insured Makes Second Claim For Same Damages
Post number 5347
No One is Entitled to be Paid for the Same Loss Twice
In Mohammed Ali Khalili v. State Farm Lloyds, No. 14-25-00611-CV, Court of Appeals of Texas (April 30, 2026) Khalili maintained a State Farm Lloyds homeowners insurance policy for decades. In 2008 he filed a roof-damage claim; State Farm paid him to replace the entire roof (shingles and gutters). Khalili never replaced the roof and repeated his claim.
BACKGROUND
In 2021 he filed a second roof claim. State Farm’s inspectors found the roof “very old” with extensive non-storm-related damage. The claim was denied because (1) the damage did not exceed the deductible and (2) State Farm had already paid for a full roof replacement.
PROCEDURAL HISTORY
State Farm filed motion for summary...
It is Fraud to Make the Same Claim Twice
Read the full article at https://www.linkedin.com/pulse/fraud-make-same-claim-twice-barry-zalma-esq-cfe-c4g8c and at https://zalma.com/blog.
Chutzpah: After Being Paid for a New Roof Insured Makes Second Claim For Same Damages
Post number 5347
No One is Entitled to be Paid for the Same Loss Twice
In Mohammed Ali Khalili v. State Farm Lloyds, No. 14-25-00611-CV, Court of Appeals of Texas (April 30, 2026) Khalili maintained a State Farm Lloyds homeowners insurance policy for decades. In 2008 he filed a roof-damage claim; State Farm paid him to replace the entire roof (shingles and gutters). Khalili never replaced the roof and repeated his claim.
BACKGROUND
In 2021 he filed a second roof claim. State Farm’s inspectors found the roof “very old” with extensive non-storm-related damage. The claim was denied because (1) the damage did not exceed the deductible and (2) State Farm had already paid for a full roof replacement.
PROCEDURAL HISTORY
State Farm filed motion for summary...
What Must be Done after Notice of a Claim is Received by the Insurer
Read the full article at https://lnkd.in/gzvvdkMZ and at https://zalma.com/blog.
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A first party property policy does not insure property: it insures a person, partnership, corporation or other entity against the risk of loss of the property. Before an insured can make a claim for indemnity under a policy of first party property insurance the insured must prove that there was damage to property the risk of loss of which was insured by the policy. The obligation imposed on the insured ...
