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May 15, 2025
CGL Is Not a Medical Malpractice Policy

Professional Health Care Services Exclusion Effective

Post 5073

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This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.

In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:

Insurance Coverage Dispute:

Travelers issued a Commercial General Liability (CGL) Policy to NMBJI, which includes a Professional Health Care Services exclusion that limits coverage for claims related to medical treatment.

Allegations Against NMBJI:

Dorsey alleges he suffered injuries due to medical negligence by NMBJI providers, leading to a lawsuit that includes multiple claims such as medical negligence and intentional infliction of emotional distress.
Exclusionary Clauses:

Travelers argues that the claims made by Dorsey fall under exclusions in the CGL Policy, thus asserting there is no duty to defend NMBJI.

Court’s Legal Standard:

New Mexico law states that an insurer must defend its insured if the allegations in the complaint could potentially be covered by the policy.

Ruling on Claims:

The court found that the claims related to medical negligence and other allegations arise from professional health care services, which are excluded from coverage under the policy.

No Duty to Indemnify:

Since Travelers had no duty to defend the claims, it also had no obligation to indemnify NMBJI for any potential damages arising from the state lawsuit.

LEGAL STANDARD

New Mexico substantive law governs the issue of whether Travelers has a duty to defend the CGL Policy insureds. To determine whether an insurance company must defend an insured client against a lawsuit, courts compare the factual allegations in the complaint with the insurance policy.

If the claimant’s complaint alleges facts potentially within the coverage of the policy, then the insurer has an obligation to defend its insured. This is true even though the complaint fails to state facts with sufficient clarity so that it may be determined from its face whether or not the action is within the coverage of the policy, provided the alleged facts tend to show an occurrence within the coverage.

Exclusionary clauses in insurance contracts must be narrowly construed.

Travelers Has No Duty To Indemnify.

If the allegations of the complaint clearly fall outside the provisions of the policy, neither defense nor indemnity is required. Because the Magistrate recommend finding that Travelers does not owe “the broader duty to defend in the underlying” state lawsuit, he further recommended finding that Travelers had no duty to indemnify the CGL Policy Insureds for the state claims either.

ZALMA OPINION

I am often confused by people and their lawyers try to turn an exclusion into an insuring agreement. Their arguments are creative and often brilliant, as were the arguments in this case. However, the Magistrate Judge simply read the clear and unambiguous exclusion and applied it to the facts and found that the CGL simply provided no coverage for defense or indemnity to the podiatrists for their medical malpractice and the bodily injuries caused to the plaintiffs because of the Professional Health Care Services exclusion in the Travelers policy.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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August 28, 2025
The Dick Law Firm and its Client Sanctioned

Summary Judgment Against Plaintiff’s Bad Faith Case and Insurer Granted Attorneys Fees
Post 5177

Posted on August 28, 2025 by Barry Zalma

See the full video at   and at

Contumacious Conduct to Texas Court Causes Insured Plaintiff and her Lawyer to Have a Judgment in Favor of the Insurer and Both Charged to Pay More Than $137,000

In Carmen Aleman, Eric B. Dick, And The Dick Law Firm, PLLC v. Standard Casualty Company, No. 01-23-00572-CV, Court of Appeals of Texas, First District (August 26, 2025)

Background

Carmen Aleman, along with Eric B. Dick and the Dick Law Firm, PLLC, filed a lawsuit against Standard Casualty Company for breach of contract, breach of the duty of good faith and fair dealing, fraud, and violations of the Texas Deceptive Trade Practices Act (DPTA) and the Texas Insurance Code.

According to Aleman, at some point, “someone . . . stop[ped] by to look at [the property] and there was some damage,” ...

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August 29, 2025
Convicted of Arson Murder Must Stay in Jail

Killer Abuses Court System With Multiple Attempts to Get Out of Prison
Post 5178

Posted on August 29, 2025 by Barry Zalma

See the full video at https://rumble.com/v6y6ule-convicted-of-arson-murder-must-stay-in-jail.html and at https://youtu.be/nnUpStLmDoM

Attempted Arson for Profit that Resulted in Death Requires Life in Prison

In Suresh Kumar v. United States, No. 1:22-cv-4874 (MKV), United States District Court, S.D. New York (August 26, 2025) Kumar, convicted of arson for profit where four people died sought to be let out of jail by filing a Habeas Corpus motion.

BACKGROUND

Suresh Kumar was convicted by a jury of multiple felonies for his role in burning down a hotel he owned for insurance money. Four people died, and fifteen others were injured. Kumar was only sentenced to life in prison.

Kumar pursued multiple previous challenges to his conviction and sentence, which have withstood both direct appeal and collateral attacks. Kumar now petitions for a writ of habeas corpus arguing actual innocence and citing Supreme ...

00:08:18
August 27, 2025
Continuous Exposure to Breach of Contract Terms is an Occurrence

“Accident” Includes Continuous or Repeated Exposure to Conditions
Post 5176

“Occurrence” is an Accident & Includes Repeated Damage

See the full video at https://lnkd.in/gkvBuWGK and at https://lnkd.in/g9zsY8hi and at https://zalma.com/blog plus more than 5150 posts.

In The Cobblestone Lofts Condominium v. Great American Insurance Company, Admiral Indemnity Company et al., Appeal No. 4265, 2025 NY Slip Op 04749, Index No. 653189/21, Case No. 2024-01860, Supreme Court of New York, First Department (August 21, 2025) the court resolved the issues.

FACTS

The Supreme Court of New York, First Department (trial court) dealt with a declaratory judgment action concerning an insurance coverage dispute. The plaintiff, a condominium association, was being sued for property damage and bodily injury caused by unintended water and moisture infiltration, resulting in toxic contamination of a condominium unit. The infiltration was allegedly caused by the plaintiff’s breaches of its contractual obligations under its bylaws...

00:08:02
August 19, 2025
Shooting Someone to Death is not an Accident

Is Injury in the Course of Self-Defense an Occurrence?
Post 5171

Read the full article at https://lnkd.in/gAJnVny9, see the full video at https://lnkd.in/gUTs-w6E and at https://lnkd.in/gQPspzmB, and at https://zalma.com/blog plus more than 5150 posts.

When There is no Accident the Intentional Acts Exclusion is Irrelevant

The case involves a tragic incident where Kimberly Mollicone was killed during a gunfight between her husband, Matthew Mollicone, and Daniele Giannone. The central issue is whether Giannone’s actions, taken in self-defense, are covered under his State Farm homeowner’s insurance policy.

In State Farm Fire And Casualty Company v. Daniele Giuseppe Giannone; Heidi C. Aull, personal representative for the estate of Kimberly Ann Mollicone, Nos. 24-1264, 24-1265, United States Court of Appeals, Sixth Circuit (August 5, 2025) resolved the dispute.

THE INSURANCE COVERAGE

Although rare in insurance contracts the policy in question provides coverage for the insured’s liability to third parties who are injured ...

July 16, 2025
There is no Tort of Negligent Claims handling in Alaska

Rulings on Motions Reduced the Issues to be Presented at Trial

Read the full article at https://lnkd.in/gwJKZnCP and at https://zalma/blog plus more than 5100 posts.

CASE OVERVIEW

In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.

FACTS

Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.

Prior to trial Bernier had three remaining claims against State Farm:

1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.

Both Bernier and State Farm dispositive motions before ...

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May 15, 2025
Zalma's Insurance Fraud Letter - May 15, 2025

ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional

See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.

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 May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:

Health Care Fraud Trial Results in Murder for Hire of Witness

To Avoid Conviction for Insurance Fraud Defendants Murder Witness

In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...

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