ZIFL Volume 29, Issue 7
The Source for the Insurance Fraud Professional
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April 1, 2025
Post 5035
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 April 1, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf.
This issue contains the following articles about insurance fraud:
Lawyers Sanctioned for Tricking a Witness With a False Document
The United States District Court Eastern District Of Texas Marshall Division, Civil Action No. 2:23-CV-00160-JRG in a case entitled Cognipower, LLC v. Samsung Electronics Co., Ltd et al, a report was filed by David Folsom, Special Master a motion for sanctions filed by Samsung.
One of the bases of the decision reached by the Mr. Folsom was the requirement that lawyers are required to deal fairly and in good faith with their adversaries and act honorably in all their actions.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
Guilty of Forgery Affirmed
8 Years in Prison for Forgery to Establish Non-Existent Counseling
Jail House Lawyer Fails
In The People Of The State Of Illinois v. Robert A. Moylan, 2025 IL App (3d) 230248-U, No. 3-23-0248, Court of Appeals of Illinois (March 11, 2025) Robert A. Moylan was found guilty of seven counts of forgery for signing and delivering false documents stating that his clients had successfully completed court-ordered counseling services.
Moylan was sentenced to an aggregate term of eight years’ imprisonment. He appealed, claiming several errors by the court, including the denial of his motions to suppress eavesdrop recordings and evidence seized from his offices, and the denial of his request for a public defender at sentencing.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
Staged Accident is One Where Claimed Collision Was Intentional
Evidence Needed to Use Staged Accident Claim as Defense
In State Farm Fire And Casualty Company v. Felix A. Quinones, et al, INDEX No. 152505/2021, 2025 NY Slip Op 30754(U), MOTION SEQ. No. 002, Supreme Court, New York County (March 7, 2025) State Farm, sought to disclaim coverage for medical treatment provided to the defendants, who were involved in an automobile collision on February 26, 2020.
The court granted the plaintiff’s motion for summary judgment in part, declaring that State Farm has no obligation to pay claims submitted by Grand Medical Supply Corp. due to Quinones’s failure to appear for examinations under oath (EUOs). However, the court denied the plaintiff’s motion for summary judgment on the basis that the collision was staged, citing insufficient evidence.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
Heath Insurance Fraud Convictions
$5 Million False Claims Act Settlement With Providers Of Programs For Adults With Developmental Disabilities
Community Options, Inc. and New York Affiliate admit Billing Medicaid for Services Without Accurate and Adequate Supporting Documentation and Failing to Report and Return Overpayments to Medicaid.
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
MORE MCCLENNY MOSELEY & ASSOCIATES ISSUES
This is ZIFL’s forty-fourth 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.
The proposed settlement agreement in the MMA bankruptcy raises several red flags of which all legal professionals should take serious notice.
March 19, 2025
Disproportionate Fee Allocation to EAJF
Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
CONVICTIONS OF OTHER THAN HEALTH INSURANCE FRAUD
Miami Insurance Broker Sentenced to 3.5 Years in Condo Premium Finance Scheme
Heleonel Gonzalez, known as Leo, a Miami insurance broker was sentenced to 41 months in prison by a federal judge and more than $5 million in restitution for defrauding a Georgia credit union by obtaining loans for condominium associations’ premium financing, then using the loans for personal gain.
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 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
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Read the full article and the full 20 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-04-01-2025.pdf
Post Conviction Review Results in Affirmation of Sentence
Post 5036
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Lewis R. Brown, appealed from the December 20, 2023 order entered in the Delaware County, Pennsylvania Court of Common Pleas denying his petition filed pursuant to the Post Conviction Relief Act (“PCRA”), 42 Pa.C.S. §§ 9541-46, as meritless.
In Commonwealth Of Pennsylvania v. Lewis R. Brown, No. 197 EDA 2024, No. J-S02022-25, Superior Court of Pennsylvania (March 24, 2025) reviewed his appeal after his request for post sentence motion to reconsider his sentence was denied.
FACTS
On June 21, 2022, Appellant entered an open guilty plea to Insurance Fraud, Theft by Deception, Criminal Use of a Communication Facility, and Conspiracy to Commit Insurance Fraud. In pleading guilty, Appellant admitted that he called his insurance company regarding a fraudulent claim from Delaware County ...
An Important Alternative Dispute Resolution Procedure
Post 5034
Sanctions & The Appraisal Process
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Appraisal is a form of alternative dispute resolution that sets a disputed loss amount. When an insurance policy has an appraisal provision, the right to appraisal is not permissive but is instead mandatory, so once a demand for appraisal is made, neither party has the right to deny that demand. [McGowan v. First Acceptance Ins. Co., Inc., 411 F.Supp.3d 1293, 1296 (M.D. Fla. 2019).]
Sometimes the appraisal process is abused by people attempting to abuse an insurer and bring about a future bad faith suit rather than resolve the claim. In an example of such abuse attorney Eric Dick demanded appraisal on behalf of his client only to do everything necessary to make it impossible to reach a fair award.
The Court made the following findings in ...
If Pleadings and Policy Wording Established Claim Was Excluded is Sufficient to Reject Claim in Texas
Post 5032
Title Defects Assumed by the Insured Excluded
Read the full article at https://www.linkedin.com/pulse/title-insurer-properly-denied-claim-barry-zalma-esq-cfe-m4uxc, see the full video at and at and at https://zalma.com/blog plus more than 5000 posts.
In 2017 Yale Street Development LLC v. First National Title Insurance Company, No. 14-23-00688-CV, Court of Appeals of Texas, Fourteenth District (March 13, 2025) the court was faced with a denied title insurance claim related to a failed construction development project in Houston.
BACKGROUND:
In 2015, Terry Fisher created 829 Yale St. LLC to construct a mid-rise condominium development at 829 Yale Street in Houston. Fisher obtained loans from Steadfast Funding and D&A Alvarez Group to complete the project. 829 Yale conveyed its title to Jetall Companies, Inc. to...
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Duties and Liabilities of Insurance Brokers
Posted on March 12, 2025 by Barry Zalma
Excellence in Claims Handling
This blog post is just a taste of the full article that is only available to subscribers to Excellence in Claims Handling. Anyone can subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.
Cases in which insurance brokers’ liability is in question depend in part on whether brokers are seen to be serving a fiduciary role or simply acting as a conduit between the insured and the insurer.
A person or an entity is a fiduciary with respect to a plan to the extent:
he exercises any discretionary authority or discretionary control respecting management of such plan ...
Read the full article at https://www.linkedin.com/pulse/duties-liabilities-insurance-brokers-barry-zalma-esq-cfe-mmpbc, if you Subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.
Duties and Liabilities of Insurance Brokers
Posted on March 12, 2025 by Barry Zalma
Excellence in Claims Handling
This blog post is just a taste of the full article that is only available to subscribers to Excellence in Claims Handling. Anyone can subscribe to “Excellence in Claims Handling” at https://barryzalma.substack.com/subscribe for only $5 a month or $50 a year.
Cases in which insurance brokers’ liability is in question depend in part on whether brokers are seen to be serving a fiduciary role or simply acting as a conduit between the insured and the insurer.
A person or an entity is a fiduciary with respect to a plan to the extent:
he exercises any discretionary authority or discretionary control respecting management of such plan ...
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 ...
