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
Detail Charging Defendant for Fraud is Sufficient
Post 5242
Read the full article at https://lnkd.in/g_HVw36q, see the video at https://lnkd.in/gpBd-XTg and at https://lnkd.in/gzCnBjgQ and at https://zalma.com/blog plus more than 5200 posts.
Charges that Advises the Defendant of the Crime Cannot be Set Aside
In United States Of America v. Lourdes Navarro, AKA Lulu, No. 25-661, United States Court of Appeals, Ninth Circuit (December 4, 2025) Lourdes Navarro appealed the district court’s denial of her motion to dismiss the indictment and enter final judgment was in error.
FACTUAL BACKGROUND
The indictment alleged that insurers reimburse only for medically necessary services. Navarro performed unnecessary respiratory pathogen panel (RPP) tests on nasal swabs collected from asymptomatic individuals for COVID-19 screening.
Navarro billed over $455 million to insurers for those additional RPP tests that she knew to be medically unnecessary. These allegations constituted a plain, concise, and definite written ...
Louisiana Statute Prevents Enforcement of Contract Term Requiring Arbitration of Disputes
Post 5241
Read the full article at https://www.linkedin.com/pulse/international-convention-requiring-enforcement-award-barry-sttdc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
In Town of Vinton v. Indian Harbor Insurance Company, Nos. 24-30035, 24-30748, 24-30749, 24-30750, 24-30751, 24-30756, 24-30757, United States Court of Appeals, Fifth Circuit (December 8, 2025) municipal entities including the Town of Vinton, et al sued domestic insurers after dismissing foreign insurers with prejudice. The insurers sought arbitration under the Convention on the Recognition and Enforcement of Foreign Arbitral Awards (the “Convention”) but the court held Louisiana law — prohibiting arbitration clauses in such policies—controls, as the Convention does not apply absent foreign parties who ...
Refusal to Provide Workers’ Compensation is Expensive
Post 5240
Read the full article at https://lnkd.in/guC9dnqA, see the video at https://lnkd.in/gVxz-qmk and at https://lnkd.in/gUTAnCZw, and at https://zalma.com/blog plus more than 5200 posts.
In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.
Company Overview:
USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...
Zalma’s Insurance Fraud Letter
Read the full article at https://lnkd.in/dG829BF6; see the video at https://lnkd.in/dyCggZMZ and at https://lnkd.in/d6a9QdDd.
ZIFL Volume 29, Issue 24
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/
Zalma’s Insurance Fraud Letter
Merry Christmas & Happy Hannukah
Read the following Articles from the December 15, 2025 issue:
Read the full 19 page issue of ZIFL at ...
The Professional Claims Handler
Post 5219
Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
