ZIFL Volume 29, Issue 6
The Source for the Insurance Fraud Professional
Post 5019
Read the full article at https://zalma.com/blog plus more than 5000 posts.
Subscribe to the e-mail Version of ZIFL, it’s Free! https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D
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 15, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.pdf
This issue contains the following articles about insurance fraud:
Mold Fraud Case Defeated
I received the following in an email from Jennifer Herrick who used my Mold Books to help defeat what they believed were fraudulent mold claims. I felt it worth while to pass it on. I simply copied her e-mail.
Read the full article and the full 22 pages of the issue ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.pdf
American Insurers Need to Adopt and Implement Excellence in Claims Handling
Attempts to Obtain a Quarterly Profit Insurers Lose Multi-Year Profits
Insurers have, over the last three decades, decimated their professional claims staffs. Experienced claims adjusters were fired and replaced with young, untrained, unprepared people. A virtual clerk replaced the old professional claims handler. Software programs took over from the seasoned interviewer to analyze the right to claims proceeds. Hands-on human skill, empathy and judgment were removed from insurers contact with those to whom they promised to provide indemnity fairly, promptly and in good faith. Money was saved from the insurer’s expense column by paying lower salaries. Within three months of firing the experienced claims people gross profit increased for a quarter of a year or two quarters.
Read the full article and the full 22 pages of the issue ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.pdf
Heath Insurance Fraud Convictions
Arkansas Reports 6 Medicaid Fraud Convictions and 1 Civil Settlement
On March 11, 2025, Trey Franks, 28, of Jacksonville pleaded guilty to Abuse of an Endangered or Impaired Person (Exploitation), a Class ‘C’ Felony, and was sentenced to a five-year term of probation, and ordered to pay a $250 fine, court costs, and restitution in the amount of $867.89. Franks used an impaired person’s debit card to pay his credit card bills.
Read the full article, reports of dozens of convictions, and the full 22 pages of the issue ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.pdf
MORE MCCLENNY MOSELEY & ASSOCIATES ISSUES
This is ZIFL’s forty-third 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.
March 25, 2025 – $3 Million MMA Investor Sued with Allegations of Fraudulent Estimates
Read the full article and the full 22 pages of the issue ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.pdf
The Compact Book of Adjusting Liability Claims Fourth Edition
A Handbook for the Liability Claims Adjuster
The insurance adjuster is seldom, if ever, mentioned in an insurance policy. The strict wording of third party liability policies set the obligation to prove a claim that entitles the insured to defense or indemnity of a claim against the insured by an injured third party.
Read the full article and the full 22 pages of the issue ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.pdf
CONVICTIONS OF OTHER THAN HEALTH INSURANCE FRAUD
40 Fraudulent Insurance Policies Worth $20 Million
Maureen Wilson, of Owings Mills, Maryland was convicted by a federal jury for conspiracy to commit insurance fraud, and related charges for wire fraud, money laundering and filing false tax returns.
According to court documents, Wilson conspired with her husband James Wilson to defraud insurance companies by obtaining over 40 life insurance policies for applicants by misrepresenting their health, wealth and existing life insurance coverage. The total death benefits from these policies exceeded $20 million.
Read the full article and the full 22 pages of the issue ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.pdf
Deterring Insurance Fraud
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.
A New Book on Insurance Fraud and How the DOJ Deters and Defeats Insurance Fraud.
The book is now available as a Kindle book, a paperback and hardcover
Read the full article and the full 22 pages of the issue ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.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 22 pages of the issue ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-15-2025.pdf
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 ...
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 ...
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...
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 ...
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 ...
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 ...
