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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One Year Private Limitation of Action Provision Enforceable
Post 5233
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Barn Roof Collapse Suit Attempts to Avoid Federal Court Fails Because of Fraudulent Joinder
In Funaro v. State Farm Fire & Casualty Co., United States District Court for the Western District of Pennsylvania, Civil Action No. 25-04, Judge: W. Scott Hardy (W.D. Pa. Nov. 19, 2025) the District Court was faced with motions by Plaintiff Funaro including the following:
1 Motion to Remand.
2 State Farm’s Partial Motion to Dismiss.
3 Statutory bad faith (42 Pa. C.S. § 8371) against State Farm alone
KEY FACTS
On January 10, 2021 a large barn roof in Honesdale, PA collapsed under weight of snow. The barn incurred structural damage, contents damage (including $90,000 to 100,000 in a custom French stove).
Plaintiffs were insured under a State Farm policy (using a standard ...
Discovery Attempt by Alleged Fraudulent Health Care Provider Fails
Post 5232
Read the full article at https://www.linkedin.com/pulse/party-seeking-discovery-entitled-anything-relevant-zalma-esq-cfe-ce7kc, see the video at https://rumble.com/v7204g8-discovery-is-entitled-to-anything-relevant-to-partys-claim-or-defense.html and at https://youtu.be/Nuet_er3qXU, and https://zalma.com/blog plus more than 5200 posts.
Upcoding and Health Care Fraud
In UnitedHealthcare Services, Inc., et al. v. Team Health Holdings, Inc., et al., No. 3:21-cv-00364-DCLC-DCP, United States District Court for the Eastern District of Tennessee, District Judge Clifton L. Corker (November 18, 2025) This is a discovery ruling, not a final merits decision.
The Disputes
This is a fraud/RICO lawsuit brought by UnitedHealthcare (and affiliates, collectively “United”) aganst TeamHealth (a large physician staffing company focused on emergency medicine). The companies have a history of mutual litigation over billing practices, including prior suits where TeamHealth accused ...
Discovery Attempt by Alleged Fraudulent Health Care Provider Fails
Post 5232
Read the full article at https://www.linkedin.com/pulse/party-seeking-discovery-entitled-anything-relevant-zalma-esq-cfe-ce7kc, see the video at https://rumble.com/v7204g8-discovery-is-entitled-to-anything-relevant-to-partys-claim-or-defense.html and at https://youtu.be/Nuet_er3qXU, and https://zalma.com/blog plus more than 5200 posts.
Upcoding and Health Care Fraud
In UnitedHealthcare Services, Inc., et al. v. Team Health Holdings, Inc., et al., No. 3:21-cv-00364-DCLC-DCP, United States District Court for the Eastern District of Tennessee, District Judge Clifton L. Corker (November 18, 2025) This is a discovery ruling, not a final merits decision.
The Disputes
This is a fraud/RICO lawsuit brought by UnitedHealthcare (and affiliates, collectively “United”) aganst TeamHealth (a large physician staffing company focused on emergency medicine). The companies have a history of mutual litigation over billing practices, including prior suits where TeamHealth accused ...
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 ...
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 ...
