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 24, 2025
Conviction of Health Insurance Fraud Sustained

Double Jeopardy Claims Fails Because There was no Second Prosecution for the Same Offense

Post 5057

See the full video at https://lnkd.in/dHta_-yp and at https://lnkd.in/ddck47wm and at https://zalma.com/blog plus more than 5050 posts.

Posted on April 24, 2025 by Barry Zalma

Tariq M. Abdulaziz was charged with larceny in the first degree by defrauding a public community, health insurance fraud, and failure to appear. The charges of larceny and health insurance fraud were tried to the court, and Abdulaziz was found guilty of health insurance fraud.

In State Of Connecticut v. Tariq M. Abdulaziz, No. AC 45916, Court of Appeals of Connecticut (April 8, 2025) the Court of Appeals found that Abdulaziz had submitted false claims for face-to-face services to the Department of Social Services’ Medicaid program while he was in Texas.

The trial court acquitted him of larceny in the first degree due to the state’s failure to prove the value of the wrongfully obtained property exceeded $2000 and the court found him guilty of health insurance fraud, as he had presented false statements to the insurer with the intent to defraud.

The court sentenced Abdulaziz to three months of incarceration, execution suspended, and eighteen months of probation. The state filed a motion to correct an illegal sentence, arguing that the court should apply the sentencing provisions for larceny in the second degree. The court partially granted the motion and resentenced Abdulaziz to three months of incarceration, execution suspended, and one year of probation.

The defendant claimed that the trial court violated the double jeopardy clause and his constitutional right to due process. The court rejected these claims and affirmed the conviction of health insurance fraud.

ANALYSIS

The United States Supreme Court has explained that the fifth amendment guarantee against double jeopardy gives rise to three separate constitutional protections.

It protects against:

1. a second prosecution for the same offense after acquittal.
2. a second prosecution for the same offense after conviction.
3. multiple punishments for the same offense.

The defendant’s present claim invokes the first of these protections under the collateral estoppel branch of double jeopardy jurisprudence.

The defendant contends that the court’s findings on the ”intent to defraud or deceive” and the ”material[ity]” elements of health insurance fraud cannot be reconciled with his acquittal on the larceny charge because these elements both require that the ”alleged fraud concern something of value.”

The Court of Appeals concluded that the trial court did not, as the defendant claims, find ”that no value . . . was proven.” In fact, the court expressly found that ”some value [was] proven,” which is precisely what the defendant claims the court was required to do.

The nature of the services the defendant and the recipients’ other providers and supporters were offering were supposed to be home and community based. It simply is not reasonable or logical to conclude that they could, or would, be offering these types of services from Texas, on 114 separate occasions, particularly when in-person, face-to-face meetings without the service recipient present are ”highly unusual.”

Instead, the reasonable and logical view of the evidence presented supports the court’s finding that at least some of the face-to-face services for which payment was sought and obtained were not performed at all, and thus the defendant was properly convicted of health insurance fraud.

The judgment was affirmed.

ZALMA OPINION

It takes a great amount of Chutzpah to claim that a health care provider in Texas did “face to face” treatment with a patient in Connecticut. It is not ”highly unusual” as the defendant claimed, it is impossible. He was convicted of insurance fraud for claiming face to face treatment and had the unmitigated gall to claim he did the impossible and the court was wrong because he was acquitted of a similar, but different crime. The Court of Appeals took dozens of pages to explain why it affirmed the trial court who was kind enough to keep the defendant out of jail. I would hope more insurance fraud perpetrators are sentenced to serve a long time in prison.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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September 26, 2025
No Way Out After Murder Conviction

Intentionally Shooting a Woman With A Rifle is Murder

Post 5196

See the full video at and at and at https://zalma.com/blog and more than 5150 posts.

You Plead Guilty You Must Accept the Sentence

In Commonwealth Of Pennsylvania v. Mark D. Redfield, No. 20 WDA 2025, No. J-S24010-25, Superior Court of Pennsylvania (September 19, 2025) the appellate court reviewed the case of Mark D. Redfield, who pleaded guilty to third-degree murder for killing April Dunkle with malice using a rifle.

Affirmation of Sentence:

The sentencing court’s judgment was affirmed, and jurisdiction was relinquished, concluding no abuse of discretion occurred.

Reasonable Inference on Trigger Pulling:

The sentencing court reasonably inferred from the guilty plea facts that the appellant pulled the trigger causing the victim’s death, an inference supported by the record and consistent with the plea.

Guilty Plea Facts:

The appellant admitted during the plea hearing...

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September 25, 2025
Prelitigation Communications Privileged

The Judicial Proceedings Privilege
Post 5196

Posted on September 25, 2025 by Barry Zalma

See the full video at and at

Judicial Proceeding Privilege Limits Litigation

In David Camp, and Laura Beth Waller v. Professional Employee Services, d/b/a Insurance Branch, and Brendan Cassity, CIVIL No. 24-3568 (RJL), United States District Court, District of Columbia (September 22, 2025) a defamation lawsuit filed by David Camp and Laura Beth Waller against Insurance Branch and Brendon Cassity alleging libel based on statements made in a letter accusing them of mishandling funds and demanding refunds and investigations.

The court examined whether the judicial proceedings privilege applieD to bar the defamation claims.

Case background:

Plaintiffs Camp and Waller, executives of NOSSCR and its Foundation, sued defendants Insurance Branch and Cassity over a letter alleging financial misconduct and demanding refunds and audits. The letter ...

00:07:56
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September 24, 2025
Untrue Application for Insurance Voids Policy

Misrepresentation or Concealment of a Material Fact Supports Rescission

Post 5195

Don’t Lie to Your Insurance Company

See the full video at and at https://rumble.com/v6zefq8-untrue-application-for-insurance-voids-policy.html and at https://zalma.com/blog plus more than 5150 posts.

In Imani Page v. Progressive Marathon Insurance Company, No. 370765, Court of Appeals of Michigan (September 22, 2025) because defendant successfully established fraud in the procurement, and requested rescission, the Court of Appeals concluded that the Defendant was entitled to rescind the policy and declare it void ab initio.

FACTS

Plaintiff's Application:

Plaintiff applied for an insurance policy with the defendant, indicating that the primary use of her SUV would be for "Pleasure/Personal" purposes.

Misrepresentation:

Plaintiff misrepresented that she would not use the SUV for food delivery, but records show she was compensated for delivering food.

Accident:

Plaintiff's SUV was involved in an accident on August ...

00:07:48
September 09, 2025
The Dishonest Chiropractor/Physician

How a Need for Profit Led Health Care Providers to Crime
Post 5185
Posted on September 8, 2025 by Barry Zalma

See the full video at https://lnkd.in/gePN7rjm and at https://lnkd.in/gzPwr-9q

This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.

The Dishonest Chiropractor/Physician

How a Need for Profit Led Health Care Providers to Crime

See the full video at and at

This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ­­­Perpetrators than any Other Crime.

How Elderly Doctors Fund their ...

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September 08, 2025
The Dishonest Chiropractor/Physician

How a Need for Profit Led Health Care Providers to Crime
Post 5185
Posted on September 8, 2025 by Barry Zalma

See the full video at https://lnkd.in/gePN7rjm and at https://lnkd.in/gzPwr-9q

This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.

The Dishonest Chiropractor/Physician

How a Need for Profit Led Health Care Providers to Crime

See the full video at and at

This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ­­­Perpetrators than any Other Crime.

How Elderly Doctors Fund their ...

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September 03, 2025

Barry Zalma: Insurance Claims Expert Witness
Posted on September 3, 2025 by Barry Zalma
The Need for a Claims Handling Expert to Defend or Prove a Tort of Bad Faith Suit

© 2025 Barry Zalma, Esq., CFE

When I finished my three year enlistment in the US Army as a Special Agent of US Army Intelligence in 1967, I sought employment where I could use the investigative skills I learned in the Army. After some searching I was hired as a claims trainee by the Fireman’s Fund American Insurance Company. For five years, while attending law school at night while working full time as an insurance adjuster I became familiar with every aspect of the commercial insurance industry.

On January 2, 1972 I was admitted to the California Bar. I practiced law, specializing in insurance claims, insurance coverage and defense of claims against people insured and defense of insurance companies sued for breach of contract and breach of the implied covenant of good faith and fair dealing. After 45 years as an active lawyer, I asked that my license to practice law be declared inactive ...

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