Zalma on Insurance
Education • Business
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.
Interested? Want to learn more about the community?
May 07, 2025
There is no Free Lunch

Insured May Limit the Extent of UM Coverage Acquired

You Only Get What You Pay For

Post 5068

See the full video at https://lnkd.in/gqivVZD2 and at https://lnkd.in/gybKeWtf, or at https://zalma.com/blog plus more than 5050 posts.

Sonya Harness was employed as a home health nurse with Volunteer Staffing, Inc. On July 10, 2021, Ms. Harness was injured in a two-car collision while driving her vehicle in connection with her employment. She later sought uninsured motorist benefits under a business automobile liability policy issued to her employer.

In Sonya Harness v. John Mansfield et al., No. E2023-00726-COA-R3-CV, the Court of Appeals of Tennessee, Knoxville (April 30, 2025) resolved the dispute.

FACTS

Arguing that the uninsured motorist coverage in the business policy did not apply to the Ms. Harness’ accident, the insurer successfully moved for summary judgment.

At the time of the accident, she was driving her own vehicle, a Chevrolet Trax, within the course and scope of her employment. Ms. Harness had insurance coverage for her vehicle under a personal automobile liability insurance policy issued by Tennessee Farmer’s Mutual Insurance Company. Her policy included uninsured motorist coverage. Volunteer Staffing maintained a business automobile liability policy issued by The Cincinnati Insurance Company that also provided liability coverage for Ms. Harness under these circumstances.

The Commercial Policy

By its plain terms, the policy limited uninsured motorist coverage to injuries that occurred while the insured was occupying an automobile specifically listed in the declarations. Because Ms. Harness’s Chevrolet Trax was not listed, the insurer argued that the uninsured motorist coverage in the Cincinnati policy did not apply.

ANALYSIS

By statute, every general automobile liability policy issued or renewed in Tennessee must include uninsured motorist coverage. The named insured may reject coverage completely or select lower limits not less than the minimum coverage limits in [he Financial Responsibility Law in a signed writing.

It is undisputed that Ms. Harness was an additional “insured” under the liability provisions of the Cincinnati policy. As required by the statute, the Cincinnati policy includes uninsured motorist coverage with limits equal to the liability limits for bodily injury.

The Coverage Form specifies that each type of coverage in the policy only applies to the automobiles shown as covered. By its plain terms, the policy expressly limits uninsured motorist coverage to injuries that occur while occupying the one described vehicle and Ms. Harness suffered her injuries while driving her vehicle, the Chevrolet Trax not the described vehicle.

The statute mandates the coverage amount. Otherwise, the statute does not explicitly address the scope of the required coverage or dictate the form of coverage. Ms. Harness contended that the statutory requirement is “for the protection of persons insured under the policy” who are injured by an uninsured motorist. And she is an “insured” under the liability provisions of the Cincinnati policy.

The Court of Appeals noted that the statutory language does not guarantee uninsured motorist coverage for Ms. Harness in this instance. Ms. Harness’ rights under the policy necessarily depend on the choices and selections of coverage made by the named insured Volunteer Staffing that chose to include the mandated amount of uninsured motorist coverage in the Cincinnati policy. Volunteer Staffing decided to limit that coverage to specifically listed vehicles and its choices did not contravene the plain language of the uninsured motorist statute.

Because the Cincinnati policy unambiguously limits uninsured motorist coverage to injuries that occur while the insured is occupying a specifically listed vehicle and because Ms. Harness was not in that automobile the statute allowed Cincinnati to exclude from UM coverage. The limitation in the Cincinnati policy appears to be designed to avoid duplicate coverage. As such, it is a permissible limitation under the statute. The Cincinnati policy does not provide uninsured motorist coverage for Ms. Harness’s injuries.

ZALMA OPINION

Statutory interpretation by an appellate court must be reasonable and directed to fulfill the intention of the Legislature. Finding that it was appropriate to allow an insured and its insurer to limit its uninsured motorist coverage to named vehicles and limit Ms. Harness’ coverage to that she purchased for her own vehicle and not allow her to double the available coverage by recovering from her employer’s insurance which the insured refused to purchase. Reasonable interpretation made it appropriate to affirm the trial court.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.

Subscribe to my substack at https://barryzalma.substack.com/subscribe

Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://lnkd.in/gwEYk

00:07:59
Interested? Want to learn more about the community?
What else you may like…
Videos
Posts
September 18, 2026
Expert May Only Testify to What Experience Supports

Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.

Posted on September 18, 2026 by Barry Zalma

See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html

In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.

The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.

Law

The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...

00:03:10
September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

150 Months in Prison for Tax Fraud
Post 4846

Posted on September 17, 2026 by Barry Zalma

See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.

FACTS

In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS

Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.

The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...

00:05:23
September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution

Post 5489

Posted on September 14, 2026 by Barry Zalma

Fraudster Refuses to Answer Questions About His Alleged Fraud

See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr

In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.

Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.

After Great American ...

00:05:14
September 25, 2026
Unwise for a Appellant to Represent Himself.

Inadequately Briefed Issues Defeats Appeal

Post 4852

Issues on Appeal Must be Adequately Briefed

Posted on September 25, 2026 by Barry Zalma

In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.

According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair. The defendant denied negligence and alleged comparative negligence. After a two-day jury trial in November 2023, the jury returned a defense verdict.

The trial court denied Ojekwe’s motion to set aside the verdict and for a new trial, and he appealed.

LAW

A trial court’s refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of ...

post photo preview
September 25, 2026
Unwise for a Appellant to Represent Himself.

Inadequately Briefed Issues Defeats Appeal

Post 4852

Issues on Appeal Must be Adequately Briefed

Posted on September 25, 2026 by Barry Zalma

In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.

According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair.

LAW

Refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of discretion.

Appellate claims receiving only cursory treatment, without record citations, supporting authority, or legal analysis, are inadequately briefed.

DISCUSSION

Improper opening remarks.

Defense counsel referred to Ojekwe’s national origin,...

September 24, 2026
Restitution Sentence Affirmed

Psychiatrist Who Was Convicted of Fraud Asked the First Circuit to Reduce his Punishment
Post 4851

Posted on September 24, 2026 by Barry Zalma

Fraud to Private and Public Health Insurers Doesn’t Pay

In United States v. Gustavo Kinrys, Nos. 24-1592, 24-1716, United States Court of Appeals, First Circuit (September 21, 2026) Gustavo Kinrys, a Massachusetts psychiatrist, submitted fraudulent claims to private and public health insurers from 2015 through 2018, including bills for more than 1,000 sessions when he or the purported patient was outside the country. When insurers requested supporting records, he delayed through a fictitious office manager and created false documentation.

A jury convicted Kinrys on fourteen counts. The district court imposed a 99-month sentence, calculated intended loss at slightly more than $19 million based on billed amounts, ordered $6,537,309.59 in restitution, and ordered $6,527,391.19 in forfeiture.

At sentencing, the district court calculated Kinrys’s base offense level to be ...

post photo preview
See More
Available on mobile and TV devices
google store google store app store app store
google store google store app tv store app tv store amazon store amazon store roku store roku store
Powered by Locals