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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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March 07, 2025
Fraud is Epidemic

Guilty Verdict of Mortgage Fraud Scheme Stands

Post 5010

Read the full article at https://www.linkedin.com/pulse/fraud-epidemic-barry-zalma-esq-cfe-6kldc, see the full video at https://rumble.com/v6q873m-fraud-is-epidemic.html and at https://youtu.be/8EOUxLFggc0, and at https://zalma.com/blog plus more than 5000 posts.

People Who Commit Fraud Have no Respect and Compelled the Trial Court to Deal With Dozens of Ineffective Motions

People Who Commit Fraud Have no Respect and Compelled the Trial Court to Deal With Dozens of Ineffective Motions

A jury convicted Defendant Jeffrey Young-Bey on twelve counts related to a mortgage-fraud scheme he perpetrated in the District of Columbia. Young-Bey moved for a judgment of acquittal and for a new trial. The USDC, in United States Of America v. Jeffrey M. Young-Bey, Criminal Action No. 21-661 (CKK), United States District Court, District of Columbia (February 28, 2025) found the verdict was based on convincing evidence and denied his motion.

FACTS

A mortgage-fraud scheme in the District of Columbia resulted in the conviction of Jeffrey Young-Bey on twelve counts related to the scheme, including Conspiracy to Commit Mail Fraud and Bank Fraud, Mail Fraud, Bank Fraud, Conspiracy to Launder Monetary Instruments, Expenditure Money Laundering, and Aggravated Identity Theft.

Young-Bey orchestrated a scheme to steal the title to two properties in Washington, D.C. and convinced a bank to loan money against those properties. He created fake deeds, forged signatures, and tricked the D.C. Recorder of Deeds into memorializing the fraudulent ownership. Using these fraudulent deeds, Young-Bey and his co-defendant, Martina Jones, secured loans from Hard Money Bankers.

At trial, the Government proved that Young-Bey orchestrated a scheme to steal the title to two properties in Washington, D.C. and convince a bank to loan money against those properties.

Using the fraudulent deed, Young-Bey and Jones worked together to strike a deal with Hard Money Bankers (“Hard Money”), a real-estate financier. Young-Bey and Jones lied to Hard Money, telling them that Jones had inherited the Bryant Street property and that Jones was renting it to a non-existent tenant. With the fake deed and a fake lease in hand, Young-Bey and Jones convinced Hard Money to lend Jones $350,000 against the Bryant Street Property. When Jones received the money, she wired half of it to Young-Bey at his direction. And Young-Bey used these proceeds to buy a BMW with a cashier’s check.

The jury found him guilty of conspiring to commit, and committing, frauds and confidence schemes. The entire purpose of the conspiracy and the frauds was to make forged documents and lies appear as legitimate as possible.

LEGAL STANDARD

Federal Rule of Criminal Procedure 29 permits a defendant to move for a post-verdict judgment of acquittal if the evidence presented at trial cannot sustain a conviction. The Court must presume, when considering such a motion, that the jury has properly carried out its functions of evaluating the credibility of witnesses, finding the facts, and drawing justifiable inferences.

MOTION FOR ACQUITTAL

A rational jury could have concluded that, with fraudulent documents in hand, Young-Bey felt no need to lie or obscure his identity. Viewing the evidence in the light most favorable to the Government, a rational jury could have concluded that Young-Bey acted knowingly and with the intent to defraud.

Viewing the evidence in the light most favorable to the Government, and for all the reasons stated, the Court denied Young-Bey’s Motion for Acquittal.

MOTIONS DENIED

In sum, Young-Bey is not entitled to a new trial because has not shown any error that was substantial and not harmless that affected his substantial rights.

The court’s decision was based on the sufficiency of the evidence presented at trial, which showed that Young-Bey knowingly participated in the fraudulent scheme with the intent to defraud. The court also addressed various legal standards and arguments presented by Young-Bey, ultimately finding no basis for acquittal or a new trial.

Accordingly, the Court denied Young-Bey’s Motion for a New Trial and Motion for Judgement of Acquittal.

ZALMA OPINION

I’m tired of reading cases taking up the time of courts across the USA to try, convict, argue, appeal and just annoy the legal process. Mr. Young-Bey was convicted in a fair trial before a jury of his peers of crimes relating to fraudulent actions damaging lenders to live well, profit and purchase expensive automobiles. His conviction, as described in a multi-page opinion of the USDC was founded in convincing evidence that a rational jury could only find him, as it did, guilty. May he enjoy his time in prison.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:30
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March 06, 2025
Denial of Claim Alone is Not Evidence of Bad Faith

Reliance on Expert Opinion Avoids Claim of Bad Faith

Post 5009

Read the full article at https://lnkd.in/gXxK7AQx, see the full video at https://lnkd.in/gaH7yAJM and at https://lnkd.in/g_3Ss3wn, and at https://zalma.com/blog plus more than 5000 posts.

Denying a Church’s Claim Based on an Expert’s Report is not Evidence of Bad Faith

Lakeside Evangelical Congregational Church sued Church Mutual Insurance Company (CMIC), for Breach of Contract and for Bad Faith stemming from CMIC’s alleged failure to provide insurance payments for roof damage caused by hail. CMIC moved to dismiss Count II (the Bad Faith count of its suit).

In Lakeside Evangelical Congregational Church v. Church Mutual Insurance Company, No. 2:24-CV-00859-MJH, United States District Court, W.D. Pennsylvania, Pittsburgh (March 3, 2025) the District Court applied the rule that an insurer relying on an expert report is not acting in bad faith when it denies a claim.

BACKGROUND

Lakeside alleged that the roof of its church sustained wind and hail ...

00:08:19
March 05, 2025
Chiropractor Sues to Get Share of Fraudulent Bills

Lack of Standing Requires Dismissal
Post 5008

Read the full article at https://lnkd.in/gvSemwVK, See the full video at https://lnkd.in/gcH7RrhH and at https://lnkd.in/gqmF2Jqi, and at https://zalma.com/blog plus more than 5000 posts.

Chutzpah: Attempt to Use Federal Court to Obtain a Share of the Proceeds of an Insurance Fraud

Tyanna Dodson is a chiropractor who sought compensation from ExamWorks, L.L.C.'s ("ExamWorks" ), a medical billing and scheduling provider. Dodson alleged that ExamWorks over-billed her patients' insurers for her services to insurers for independent medical exams (IME) she conducted.

In Tyanna Dodson, Doctor of Chiropractic v. ExamWorks, L.L.C., No. 24-50248, the United States Court of Appeals, Fifth Circuit (on February 28, 2025) Dodson contended that the IME's she conducted to help insurers defeat attempted insurance fraud were billed by ExamWorks fraudulently overcharging he insurer clients. She sued EamWorks for half of the excessive billing and damages because she faced discipline and charges of ...

00:09:30
March 04, 2025
No Coverage for Known False Statements

Exclusion of Defamatory Or Disparaging Statements Made With Knowledge Of Their Falsity Effective

Post 5007

Liability Insurance is Limited to Unintentional Conduct

Read the full article at https://lnkd.in/gJ2XXKB3, see the full video at https://lnkd.in/g5HA2uAA and at https://lnkd.in/gDd9PE6C, and at https://zalma.com/blog plus more than 5000 posts.

The main issue presented to the Tenth Circuit Court of Appeals was whether the insurance policies’ exclusions, which deny coverage for defamatory or disparaging statements made with knowledge of their falsity, apply. The District Court held that the exclusions do apply, as the underlying complaint alleged that the insureds knowingly published false statements.

In New Hampshire Insurance Company; National Union Fire Insurance Company Of Pittsburgh v. TSG Ski & Golf, LLC; The Peaks Owners Association, Inc.; Peak Hotel, LLC; H. Curtis Brunjes, No. 23-1248, United States Court of Appeals, Tenth Circuit (February 24, 2025) the Tenth Circuit affirmed.

BACKGROUND

TSG Ski & Golf,...

00:10:16
February 25, 2025
Adjusting Liability Claims

The Basics Needed by a Liability Adjuster

Post 5003
Posted on February 25, 2025 by Barry Zalma

See the full video at and at

Adjusting liability insurance claims requires skill, patience, knowledge of insurance, basic knowledge of tort and contract law, and knowledge and experience as an investigator. The liability claims adjuster is faced with the following basic obligations:

  • To understand the law of torts as applied in the state where the adjuster works.
  • To understand the law of contracts as applied in the state where the adjuster works.
  • To understand sufficient medical terminology to be able to evaluate claims of injury.
  • To understand the costs to repair or replace damaged real or personal property.
  • To understand how to read and apply the terms and conditions of a liability insurance policy.
  • To understand how to thoroughly investigate all claims assigned.
  • To conduct an investigation of every claim ...
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February 25, 2025
“Deterring Insurance Fraud” A New Book by Barry Zalma

Posted on February 24, 2025 by Barry Zalma

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 $87 billion to more than $300 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.

Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance ...

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February 24, 2025
“Deterring Insurance Fraud” A New Book by Barry Zalma

Posted on February 24, 2025 by Barry Zalma

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 $87 billion to more than $300 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.

Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance ...

post photo preview
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