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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June 04, 2025
Police Properly Charged Fraud Perpetrator

False Report of Theft of Vehicle Established
Post 5090

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Creating a Fake Theft of Vehicle and Insurance Claim is a Crime

Shonda Brown faced multiple charges, including felonies related to false reporting and insurance fraud changed to class A misdemeanors such as tampering with public records and making false statements.

The case arose from allegations that Brown paid an informant to move her inoperable vehicle and then reported it stolen to the NYPD, despite evidence suggesting the vehicle had been tampered with and was found in a damaged state.

In The People of the State of New York v. Shonda Brown, Index No. CR-024423-24KN, 2025 NY Slip Op 25122, Criminal Court of the City of New York, Kings County (May 23, 2025) the Criminal Court concluded that the charges were appropriately filed and rejected Brown’s motion to dismiss.

Sufficiency of the Accusatory Instrument

The court assessed whether the accusatory instrument met the legal standards for facial sufficiency. The court concluded that the instrument adequately designated the offenses and provided reasonable cause to believe that Brown committed the alleged crimes. The court noted that the statement of Fire Marshal Joseph Hayes (“FM Hayes”) of the New York City Fire Department (“FDNY”) and the supporting deposition from the informant, Mohammed, provided sufficient factual basis to support the charges. Furthermore, FM Hayes’ averment that he “observed All-State Insurance records to show defendant filed an insurance claim for said vehicle,” taken together with his averment that he was informed that defendant paid Mohammed to move defendant’s vehicle, satisfied the reasonable cause standard to the extent that defendant was informed of the accusations, i.e., making sworn false statements in violation of PL § § 210.35, 210.45, and provided her with enough information as to the defenses available.

The court highlighted that non-hearsay allegations were present in the instrument, which included the details of the vehicle’s condition and the actions taken by Brown and although some statements were deemed hearsay, they were remedied by the supporting deposition that confirmed their truthfulness.

Validity of the People’s Certificate of Compliance

The court found that the prosecution exercised due diligence in disclosing discoverable materials. The absence of certain items, such as recordings or police reports, did not invalidate the certificate as the prosecution demonstrated that these items did not exist.

Discovery Obligations

The prosecution was required to disclose all relevant materials, including those that could potentially exculpate Brown.

Speedy Trial Considerations

The court analyzed the timelines related to the speedy trial rights of the defendant. The original felony complaint was filed on June 13, 2024, and the charges were reduced on October 23, 2024. The court calculated the elapsed time and determined that the prosecution had complied with the speedy trial requirements, as they acted within the six-month period mandated by law.

Therefore, the court denied the defendant’s motion to dismiss the charges, affirming that the legal proceedings adhered to the necessary protocols and standards and defendant’s motion to dismiss was denied.

ZALMA OPINION

People who commit insurance fraud, like Ms. Brown, refuse to accept the fact that they were caught and charged with crimes relating to their attempt at fraud. Ms. Brown attempted to avoid the charges by a motion to dismiss with charges of wrongdoing by the police and the prosecution without a factual basis. She will go to trial on the charges and there is a good chance she will be convicted or plead guilty before trial.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:06:48
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11 hours ago
Health Insurance Benefit Not Available Forever

Medicare Supplement Plan Properly Discontinued by City

Post 5108

Read the full article at https://lnkd.in/gfHSn7nx, see the full video at https://lnkd.in/g-hkvd3h and at https://lnkd.in/gcN7BP5u, and at https://zalma.com/blog plus more than 5100 posts.

New York’s Highest Court Approves Change in Medicare Plan

The City of New York decided to discontinue its Medicare supplemental plan, Senior Care, and enroll all retirees in a custom-designed Medicare Advantage Plan (MAP) managed by Aetna Life Insurance Company. Petitioners, consisting of nine retirees and one organization, initiated legal proceedings to prevent the City from eliminating their existing health insurance plans. They argued that the City had repeatedly promised to provide and pay for a Medicare supplemental plan upon retirement, and that they relied on these promises when making financial, employment, and retirement decisions.

In the Matter of Robert Bentkowski, et al. v. City of New York, et al., 2025 NY Slip Op 03690, No. 57, New York Court of Appeals ...

00:07:17
June 25, 2025
Failure to Read Policy Fatal to Claim

Ignorance of UM Coverage for Pedestrian Hit by Car is Inexcusable
Post 5107

Read the full article at https://lnkd.in/gyX8BgrF, see the full video at https://lnkd.in/gPejDHQV and at https://lnkd.in/gkPqNw4Y and at https://zalma.com/blog plus more than 5100 posts.

Dennis Malcolm Patterson was struck by an automobile while crossing the street, he sued the driver who hit him and sought uninsured/underinsured motorist coverage from his own insurer, United Services Automobile Association (“USAA”). USAA filed a motion to dismiss, arguing that Patterson failed to comply with the policy provision requiring prompt notification. Following a hearing, the trial court granted the motion and Patterson appealed.

In Patterson v. United Services Automobile Association, No. A25A0259, Court of Appeals of Georgia, Fifth Division (June 20, 2025) the trial court’s judgment was affirmed.

Key Points:

Trial Court’s Decision:

It treated the court’s order as a denial of summary judgment

Incident Details:

Patterson was injured on May ...

00:07:54
June 24, 2025
Ambiguity in Insurance Contract Resolved by Jury

Jury’s Findings Interpreting Insurance Contract Affirmed
Post 5105

See the full video at https://lnkd.in/gPa6Vpg8 and at https://lnkd.in/ghgiZNBN, and at https://zalma.com/blog plus more than 5100 posts.

Madelaine Chocolate Novelties, Inc. (“Madelaine Chocolate”) appealed the district court’s judgment following a jury verdict in favor of Great Northern Insurance Company (“Great Northern”) concerning storm-surge damage caused by “Superstorm Sandy” to Madelaine Chocolate’s production facilities.

In Madelaine Chocolate Novelties, Inc., d.b.a. The Madelaine Chocolate Company v. Great Northern Insurance Company, No. 23-212, United States Court of Appeals, Second Circuit (June 20, 2025) affirmed the trial court ruling in favor of the insurer.

BACKGROUND

Great Northern refused to pay the full claim amount and paid Madelaine Chocolate only about $4 million. In disclaiming coverage, Great Northern invoked the Policy’s flood-exclusion provision, which excludes, in relevant part, “loss or damage caused by ....

00:07:02
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 ...

May 15, 2025
CGL Is Not a Medical Malpractice Policy

Professional Health Care Services Exclusion Effective

Post 5073

See the full video at https://lnkd.in/g-f6Tjm5 and at https://lnkd.in/gx3agRzi, and at https://zalma.com/blog plus more than 5050 posts.

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 ...

April 30, 2025
The Devil’s in The Details

A Heads I Win, Tails You Lose Story
Post 5062

Posted on April 30, 2025 by Barry Zalma

"This is a Fictionalized True Crime Story of Insurance Fraud that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help everyone 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."

Immigrant Criminals Attempt to Profit From Insurance Fraud

People who commit insurance fraud as a profession do so because it is easy. It requires no capital investment. The risk is low and the profits are high. The ease with which large amounts of money can be made from insurance fraud removes whatever moral hesitation might stop the perpetrator from committing the crime.

The temptation to do everything outside the law was the downfall of the brothers Karamazov. The brothers had escaped prison in the old Soviet Union by immigrating to the United...

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