Zalma on Insurance
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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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April 08, 2025
Policy Must Specifically and Unequivocally Advise the Insured of Limitation

Oregon Concludes Requirement that Insured Occupy Residence Premises Only Applies to Inception of Policy

Read the full article at https://lnkd.in/gmfMRxdE, see the full video at https://lnkd.in/g54q4gwR and at https://lnkd.in/gJYJdHPG, and at https://zalma.com/blog plus more than 50,000 posts.

Post 5040

Ambiguity Makes Condition Unenforceable

In John Durkheimer and Karen Durkheimer v. Safeco Insurance Company Of Illinois, No. 3:24-cv-1333-SB, United States District Court, D. Oregon (April 1, 2025)

John and Karen Durkheimer (“Durkheimers”) sued Safeco Insurance Company of Illinois (“Safeco”), alleging claims for breach of insurance contract, breach of the implied covenant of good faith and fair dealing, and negligence per se. The Durkheimers’ residence in southwest Portland suffered significant water damage due to burst water pipes. The Durkheimers submitted an insurance claim to Safeco, the issuer of their homeowner’s insurance policy (“the Policy”). Although Safeco provided partial payment, the Durkheimers claimed additional outstanding damages. Safeco asserted, as its sixth affirmative defense, that “[t]he Policy limits dwelling coverage to the ‘Residence Premises’ . . . [and t]o the extent that [the Durkheimers] did not reside at the Premises when the Loss occurred, the Policy does not cover damage sustained to the Property.” The Durkheimers moved to strike this affirmative defense on the ground that it is insufficient as a matter of law.

The Court agreed with the Durkheimers. The phrase “owned and occupied” is merely a “description” of the property at the time the policyholder obtained insurance.

The USDC held that the insured’s lease of their residence to a third party did not forfeit coverage under a homeowner’s policy for “residence premises” where the policy defined that term as “where you reside.” The court explained that the phrase “where you reside” “could be grammatically interpreted to modify only ‘part of any other building,’ not ‘family dwelling.’”

When a policy leads to multiple reasonable interpretations, that policy does not “explicitly and unambiguously” terminate a homeowner’s policy. Even if a policy is phrased in a way that covers only family dwellings where a policyholder resides, that residence requirement applies to when the policy was first purchased, and not when a claim was filed.

The Durkheimers’ insurance policy did not specifically and unequivocally put them on notice that their coverage would end if they did not reside in the house in question and granted the Durkheimers’ motion to strike.

The Court concluded that the policy is ambiguous, and that therefore, the Durkheimers’ policy did not explicitly put them on notice that they needed to reside at the property to maintain coverage and the Court granted the Durkheimers’ motion to strike.

ZALMA OPINION

Most states have interpreted the fact that a homeowners policy requires an insured to reside in the dwelling for coverage to apply so, if the insured moves out during the policy term, the coverage is void unless the insured advises the insurer and modifies the policy to tenant occupied and pays any additional premium. The USDC, applying Oregon law found the language to be ambiguous and, therefore, reject the defense that the Durkheimers’ did not reside in the residence premises at the time of the loss but did reside there when the policy was issued. Since the weight of authority across the country is different there is a possibility that an appeal will move forward and a different result will occur.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:06:00
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21 hours ago
FRAUD DOESN’T PAY – IT COSTS

INSURANCE FRAUDSTER MUST PAY INSURER FULL RESTITUTION

Post 5049

See the full video at https://lnkd.in/gmW8qimV and at https://lnkd.in/g_AYN2N7, and https://zalma.com/blog plus more than 5000 posts.

Plaintiff Liberty Insurance Corporation (“Liberty”) issued a homeowners insurance policy to Defendant Jack Strunk that was active when his home was damaged by fire. Strunk made two insurance claims: one for fire damage and another for alleged theft of certain personal property after the fire. Strunk sued Liberty for the payment of the alleged damages. That case was removed to federal court and ultimately settled by Liberty paying $100,000 to Strunk.

In Liberty Insurance Corporation v. Jack A. Strunk, Civil Action No. 5:24-128-DCR, United States District Court, E.D. Kentucky (April 4, 2025) Liberty sued Strunk for return of the amounts paid in settlement after he pleaded guilty to defrauding Liberty.

THE CRIMINAL CONVICTION

Strunk was convicted of felony insurance fraud. This is not contested as Strunk admited to ...

00:06:54
April 16, 2025
Judgment for Insurer Because Suit Filed Late

Private Limitation of Action Provision Defeats Suit Against Insurer
Post 5049

See the full video at https://lnkd.in/gUFvU7-h and at https://lnkd.in/gH4KgkRd and at https://zalma.com/blog plus more than 5000 posts.

This case involves a contractual statute of limitations in an insurance policy. Sidney and Shatika Davis (together, “Davis”) argue the trial court erroneously granted summary judgment in favor of Homeowners of America Insurance Company (“HAIC”).

In Sidney Davis And Shatika Davis v. Homeowners Of America Insurance Company, No. 05-24-00035-CV, Court of Appeals of Texas, Fifth District, Dallas (April 7, 2025) because: (i) the contractual limitations period was valid (ii) the limitations was not tolled, (iii) HAIC did not breach the contract by failing to pay the amounts claimed, and (iv) HAIC addressed the fraud claim in its summary judgment motion.

BACKGROUND

HAIC issued an insurance policy for the Davis property (the “Property”). The Policy includes a contractual limitations period that requires suit to be filed by ...

00:10:32
April 15, 2025
Zalma’s Insurance Fraud Letter – April 15, 2025

Zalma’s Insurance Fraud Letter – April 15, 2025
Posted on April 15, 2025 by Barry Zalma
ZIFL – Volume Number 29 Issue No. 8

Read the full article at https://lnkd.in/gfbHTC6G, See the full issue of ZIFL in Adobe .pdf format at https://lnkd.in/ghr52uM4, see the full video at https://lnkd.in/gnuSwaYN and at https://lnkd.in/gFPWAJEW, and at https://zalma.com/blog plus more than 5000 posts.

See the full video at and at
See the full issue of ZIFL in Adobe .pdf format at https://zalma.com/blog/wp-content/uploads/2025/04/ZIFL-04-15-2025.pdf

The Source for the Insurance Fraud Professional

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 ...

00:11:26
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March 13, 2025

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 ...

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March 12, 2025

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 ...

post photo preview
February 25, 2025
Adjusting Liability Claims

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 ...
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