It is the Obligation of an Insured to Prove his Claim
Post 5084
See the full video at https://lnkd.in/gA_JbKCA and at https://lnkd.in/gdCQcUYJ and at https://zalma.com/blog plus more than 5050 posts.
Theft Claim Insufficient to Allow Total Gutting of Structure
Posted on May 28, 2025 by Barry Zalma
In Seviiri Bunjo v. State Farm Fire And Casualty Company, No. 1-24-1010, 2025 IL App (1st) 241010-U, Court of Appeals of Illinois, First District, First Division (May 19, 2025), an attempt to gain payment to remodel building failed when the insurer refused to pay for non-covered claims.
Seviiri Bunjo sued for declaratory judgment against State Farm Fire and Casualty Company (State Farm) after a break-in at his property in Chicago on May 31, 2019. Bunjo sought additional insurance proceeds for incident-related losses and lost rental income. The circuit court granted summary judgment in favor of State Farm, finding that Bunjo failed to show the damages estimate was inaccurate or that State Farm violated the terms of the insurance policy.
FACTUAL BACKGROUND
The court found that Bunjo’s contractor, Sean Rogers, provided an estimate for a full gut rehab of the property rather than just for damages from the break-in. Additionally, Bunjo’s public adjuster, Vito Misceo, admitted that he could not accurately assess the damages because the property had already been gutted.
Regarding lost rental income, the court noted that Bunjo was under a court order prohibiting him from renting, using, leasing, or occupying the property at the time of the break-in. Therefore, State Farm was not obligated to pay for lost rents or additional living expenses.
In summary, the appellate court affirmed the circuit court’s decision to grant summary judgment in favor of State Farm, finding no merit in Bunjo’s arguments. The circuit court properly entered summary judgment in favor of the insurer where the insured failed to show the damages estimate was inaccurate or that the insurer violated the terms of the insurance policy.
State Farm met its initial burden of production by establishing that plaintiff lacks sufficient evidence to prove his claim. This shifted the burden of proof to plaintiff and the court found that “plaintiff *** failed to bring forward any additional evidence regarding the extent of the initial Incident-related losses,” and therefore, “there is no genuine issue of material fact on the extent of initial losses.”
ANALYSIS
Summary judgment should be granted when, as here, the pleadings, admissions on file, depositions and any affidavits, construed strictly against the moving party, reveal no genuine issue of material fact so that the movant is entitled to judgment as a matter of law.
Because an insurance policy is a contract, the court applies general rules of contract interpretation to the policy. If the words employed in the contract are clear and unambiguous, as is the case here, they must be given their plain, ordinary and popular meaning
Plaintiff was planning to do a full gut rehab of the Property before the break-in occurred. What’s more, plaintiff failed to include appropriate citations to his arguments on these issues on appeal. As a result, the appellate court affirmed the circuit court’s judgment, concluding that Bunjo did not present sufficient evidence to prove his claim.
ZALMA OPINION
Insurance is a contract that is designed to indemnify an insured for losses due to an insured against anYfortuitous event. In this case a burglary did some damage to the structure but did not destroy the structure or make it impossible to repair. Rather than seek repair only of the damage caused by the thieves Bunjo sought to have State Farm pay for what he planned before the loss, a full gutting of the property and reconstruction. The court felt it sufficient to dismiss the suit but, in my opinion, the trial court or the appellate court should have reported Bunjo to the Department of Justice for attempted insurance fraud.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Motion for Summary Judgment Requires Evidence Establishing Defenses
Post 5223
Read the full article at https://www.linkedin.com/pulse/motion-summary-judgment-fail-because-insurer-failed-zalma-esq-cfe-jhfsc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
In Michael Tillema, Kim Til- Lema v. Meridian Security Insurance Company, No. SA-24-CV-00661-JKP, United States District Court, W.D. Texas, San Antonio Division (October 7, 2025) Plaintiffs Michael Tillema and Kim Til-Lema claimed coverage from Meridian Security Insurance Company for benefits for alleged wind and hail damage from a storm on April 26, 2022.
Meridian Security Insurance Company denied the claim, citing inspection reports and weather data indicating no hail event occurred on the alleged date. Plaintiffs hired an independent contractor, who also found no hail within one mile of the property on the ...
Hertz Succesfully Refuses to Pay Alleged Fraudulent Health Care Providers
Post 5222
Read the full article at https://www.linkedin.com/pulse/man-bites-dog-story-hertz-sues-alleged-fraudsters-zalma-esq-cfe-efbgc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
Proactive Victim of Fraud Defeats Health Care Providers
In Hertz Vehicles, LLC v. Alignment Chiropractic, P.C., et al, Index No. 157368/2024, 2025 NY Slip Op 33627(U), Motion Seq. No. 001, NYSCEF Doc. No. 46, Supreme Court, New York County (September 30, 2025) Plaintiff alleged it is not obligated to pay no-fault benefits for the medical treatment of defendants for injuries while occupants of a 2023 Hyundai, owned and self-insured by Hertz.
FACTUAL BACKGROUND
Plaintiff moved for a default judgment against defendants Alignment Chiropractic, P.C., and many other alleged health care providers.
Plaintiff also ...
Hertz Succesfully Refuses to Pay Alleged Fraudulent Health Care Providers
Post 5222
Read the full article at https://www.linkedin.com/pulse/man-bites-dog-story-hertz-sues-alleged-fraudsters-zalma-esq-cfe-efbgc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
Proactive Victim of Fraud Defeats Health Care Providers
In Hertz Vehicles, LLC v. Alignment Chiropractic, P.C., et al, Index No. 157368/2024, 2025 NY Slip Op 33627(U), Motion Seq. No. 001, NYSCEF Doc. No. 46, Supreme Court, New York County (September 30, 2025) Plaintiff alleged it is not obligated to pay no-fault benefits for the medical treatment of defendants for injuries while occupants of a 2023 Hyundai, owned and self-insured by Hertz.
FACTUAL BACKGROUND
Plaintiff moved for a default judgment against defendants Alignment Chiropractic, P.C., and many other alleged health care providers.
Plaintiff also moved...
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 ...
