ZIFL Volume 29, Issue 6
The Source for the Insurance Fraud Professional
Post 5019
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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 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
Convicted Criminal Seeks to Compel Receiver to Protect his Assets
Post number 5291
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The Work of a Court Appointed Receiver is Constitutionally Protected
In Simon Semaan et al. v. Robert P. Mosier et al., G064385, California Court of Appeals, Fourth District, Third Division (February 6, 2026) the Court of Appeals applied the California anti-SLAPP statute which protects defendants from meritless lawsuits arising from constitutionally protected activities, including those performed in official capacities. The court also considered the doctrine of quasi-judicial immunity, which shields court-appointed receivers from liability for discretionary acts performed within their official duties.
Facts
In September 2021, the State of California filed felony charges against Simon Semaan, alleging violations of Insurance Code section 11760(a) for making...
When There are Two Different Other Insurance Clauses They Eliminate Each Other and Both Insurers Owe Indemnity Equally
Post number 5289
In Great West Casualty Co. v. Nationwide Agribusiness Insurance Co., and Conserv FS, Inc., and Timothy A. Brennan, as Administrator of the Estate of Pat- rick J. Brennan, deceased, Nos. 24-1258, 24-1259, United States Court of Appeals, Seventh Circuit (February 11, 2026) the USCA was required to resolve a dispute that arose when a tractor-trailer operated by Robert D. Fisher (agent of Deerpass Farms Trucking, LLC-II) was involved in a side-impact collision with an SUV driven by Patrick J. Brennan, resulting in Brennan’s death.
Facts
Deerpass Trucking, an interstate motor carrier, leased the tractor from Deerpass Farms Services, LLC, and hauled cargo for Conserv FS, Inc. under a trailer interchange agreement. The tractor was insured by Great West Casualty Company with a $1 million policy limit, while the trailer was insured by Nationwide Agribusiness Insurance Company with a $2 million ...
Opiod Producer Seeks Indemnity from CGL Insurers
Post number 5288
Read the full article at https://lnkd.in/guNhStN2, see the full video at https://lnkd.in/gYqkk-n3 and at https://lnkd.in/g8U3ehuc, and at https://zalma.com/blog plus more than 5250 posts.
Insurers Exclude Damages Due to Insured’s Products
In Matthew Dundon, As The Trustee Of The Endo General Unsecured Creditors’ Trust v. ACE Property And Casualty Insurance Company, et al., Civil Action No. 24-4221, United States District Court, E.D. Pennsylvania (February 10, 2026) Matthew Dundon, trustee of the Endo General Unsecured Creditors’ Trust, sued multiple commercial general liability (CGL) insurers for coverage of opioid-related litigation involving Endo International PLC a pharmaceutical manufacturer.
KEY FACTS
Beginning as early as 2014, thousands of opioid suits were filed by governments, third parties, and individuals alleging harms tied to opioid manufacturing and marketing.
Bankruptcy & Settlements
Endo filed Chapter 11 in August 2022; before bankruptcy it ...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lost the ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah. Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and wonder how did all these wonderful things come into being. Jews believe the force we call G_d created the entire universe and everything in it. Jews feel G_d is all seeing and knowing and although we can’t see Him, He is everywhere and in everyone.We understand...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
Read the full article at https://www.linkedin.com/pulse/passover-americans-barry-zalma-esq-cfe-5vgkc.
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lostthe ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah.
Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and ...
You Get What You Pay For – Less Coverage Means Lower Premium
Post number 5275
Posted on January 30, 2026 by Barry Zalma
See the video at and at
When Experts for Both Sides Agree That Two Causes Concur to Cause a Wall to Collapse Exclusion Applies
In Lido Hospitality, Inc. v. AIX Specialty Insurance Company, No. 1-24-1465, 2026 IL App (1st) 241465-U, Court of Appeals of Illinois (January 27, 2026) resolved the effect of an anti-concurrent cause exclusion to a loss with more than one cause.
Facts and Background
Lido Hospitality, Inc. operates the Lido Motel in Franklin Park, Illinois. In November 2020, a windstorm caused one of the motel’s brick veneer walls to collapse. At the time, Lido was insured under a policy issued by AIX Specialty Insurance Company which provided coverage for windstorm damage. However, the policy contained an exclusion for any loss or damage directly or indirectly resulting from ...
