USDC Dismisses Multiple Counts Against Insurer
Post 5038
See the full video at https://rumble.com/v6rjvsl-gap-in-coverage-not-bad-faith.html and at https://youtu.be/P9hzlsS8O4g, and at https://zalma.com/blog plus more than 5000 posts.
Vincent Cusumano and Vincent Cusumano Architect P.C. (VCA), alleged that the defendants, Berkshire Hathaway issued a professional liability policy with a three-month gap in coverage, which precluded coverage for claims arising from prior work. The plaintiffs asserted thirteen causes of action, including breach of contract, promissory estoppel, and common law fraud.
In Vincent Cusumano Architect P.C. and Vincent Cusumano v. Berkshire Hathaway Direct Insurance Company d/b/a Three By Berkshire Hathaway, Todd Sharpee, John Does 1-10 names being fictitious and unknown, and ABC Corps. 1-10 names being fictitious and unknown, Civil Action No. 23-cv-22970 (JXN)(JSA), United States District Court, D. New Jersey (March 29, 2025) dismissed multiple causes of action.
COUNTS DISMISSED
The court dismissed several counts in the case for the following reasons:
1. Declaratory Judgment (Count 1):
The court found that the declaratory judgment claim was duplicative of the breach of contract claim. Since the breach of contract claim would resolve the same issue, the declaratory judgment was deemed unnecessary.
2. Specific Performance (Count 2):
The court dismissed this claim because specific performance is an equitable remedy, not an independent cause of action. Plaintiffs cannot amend their complaint through opposition briefs.
3. Breach of Contract (Count 3):
The court dismissed this claim because the plaintiffs failed to identify a provision within the insurance contract that the defendants breached. The policy’s terms were clear and did not cover the underlying claim.
4. Quantum Meruit/Unjust Enrichment (Count 5):
The court dismissed this claim because the existence of an express and enforceable contract (the Berkshire Policy) precludes a claim for unjust enrichment.
5. Breach of Covenant of Good Faith and Fair Dealing (Count 6):
The court dismissed this claim as it was duplicative of the breach of contract claim and failed to establish bad faith under New Jersey law.
Common Law Fraud (Count 7):
6. The court dismissed this claim because the plaintiffs could not establish reasonable reliance in the face of clear contradictory language in the insurance policy.
7. Breach of Fiduciary Duty (Count 12):
The court dismissed this claim because the insurance agent owed a fiduciary duty to the insurance company, not to the insured.
The USDC determined that the suit can proceed on the remaining counts but concluded that the 7 counts dismissed were not viable.
ZALMA OPINION
When a person or entity sues an insurance company they often throw in the kitchen sink of causes of action. The architect did just that and found that seven of at least 13 causes of action were not viable and the remaining counts will face either an additional motion for summary judgment or at trial.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Post Conviction Review Results in Affirmation of Sentence
Post 5036
See the full video at https://rumble.com/v6rjqp3-challenge-to-guilty-plea-fails.html and at https://youtu.be/1atskrw8-og and at https://zalma.com/blog plus more than 5000 posts.
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 ...
ZIFL Volume 29, Issue 7
The Source for the Insurance Fraud Professional
See the full video at https://lnkd.in/gQM9yR3n and at https://lnkd.in/gZDkH7RU, and at https://zalma.com/blog plus more than 5000 posts.
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 ...
An Important Alternative Dispute Resolution Procedure
Post 5034
Sanctions & The Appraisal Process
Read the full article at https://lnkd.in/gTDubMra, see the full video at https://lnkd.in/gRG_iPVc and at https://lnkd.in/gJ2D7w_2 and at https://zalma.com/blog plus more than 5000 posts.
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 ...
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 ...
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 ...
