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 09, 2025
Guilty Pleas of Some Defendants Not Enough for Disclosure

Prosecutors Have the Right to Keep Some Secrets
Post 5093

Application of New York's Freedom of Information Law (FOIL)

See the full video at https://lnkd.in/g5FHC3bf and at https://lnkd.in/gNt6447Q, and at https://zalma.com/blog plus more than 5050 posts.

James M. Haddad sought to compel Alvin L Bragg  (Bragg) to produce certain material seized pursuant to a search warrant executed in connection with a now-completed criminal matter.

In James M. Haddad v.  Alvin L Bragg, in his official capacity as District Attorney of the County of New York, 2025 NY Slip Op 31779(U), Index No. 158493/2023, Supreme Court, New York County (May 15, 2025) the court resolved the dispute.

FACTUAL BACKGROUND

OneTeam Restoration, Inc., its owner and president, Mario Rojas, Jr., and certified public accountant Steven Lyon were charged with three counts of Insurance Fraud in the First Degree and Falsifying Business Records in the First Degree based on allegations that Lyon, Rojas, and OneTeam engaged in a scheme to defraud the New York State Insurance Fund.

On April 26, 2023, petitioner submitted a Freedom of Information Law (FOIL) request to Bragg, the New York County District Attorney's Office. The FOIL sought the original rap sheets, warrants and corporate summons, production log and a thumb drive containing the discovery materials.  The "discovery materials" on the thumb drive were, at least in part, thousands of pages of these defendants' business and financial records seized pursuant to a search warrant.

Bragg's Records Access Officer ("RAO" ) Corey S. Shoock denied petitioner's request on the grounds that disclosure would "interfere with the criminal judicial process, as well as with any further investigation and future judicial proceedings that might be necessary." Petitioner appealed the denial of his FOIL request.

Shortly thereafter, Rojas and OneTeam pled guilty to one count each of First Degree Falsifying Business Records and were sentenced that day.

Because the third defendant, Steven Lyon, remained open the appeal affirmed the RAO's determination and denial on pending judicial proceeding grounds and incorporate by reference his reasoning and cited authority.

In a post-remand decision on June 16, 2023, RAO Shoock wrote: “[P]ursuant to that portion of the AO's decision granting your appeal, you will be provided access to the following thirty-three (33) pages of material ... [but] [i]nsofar as criminal charges remain pending against defendant Steven Lyon, Omnibus Motion papers relating to defendant Lyon, discovery produced in the criminal prosecution against defendant Lyon, together with email correspondence between opposing counsel and with the Court, is exempt from production on the grounds that disclosure of such records would interfere with three pending prosecutions conducted by this Office against this defendant ...” [emphasis added]).

DISCUSSION

FOIL imposes a broad duty on government to make its records available to the public and all government records are thus presumptively open for public inspection and copying unless they fall within an enumerated statutory exemption contained in Public Officers Law § 87(2). The burden rests on the agency to establish that requested material qualifies for any of the exemptions, which must be narrowly construed.

Bragg met the burden by establishing that the requested records fell "squarely" within an exemption to disclosure. The statute exempts from disclosure records or portions thereof that are compiled for law enforcement purposes and which, if disclosed, would interfere with law enforcement investigations or judicial proceedings.

The petition was denied and this special proceeding dismissed.

ZALMA OPINION

FOIL limits the freedom of information available to criminal litigants and the public if it has an effect on the prosecution to disclose that information. Even after some defendants pleaded guilty to insurance fraud, others did not, so the FOIL request stayed refused. Regardless of the need for information to be freely available from prosecutors like Bragg, that freedom is not unlimited and the prosecutor may keep the evidence private for the purposes of trial.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:49
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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
October 05, 2026
Short And Plain Statement Containing Enough Factual Matter To State A Facially Plausible Claim

If Grounds For Dismissal Are Apparent From The Face Of The Complaint, A Court May Also Dismiss The Case on The Court’s Own Motion

Posted on October 5, 2026 by Barry Zalma

Pro Se Plaintiff Failed to Make a Short and Plain Statement

Post 4856

In Tak Lun Ng v. United Financial Casualty Company, No. 26-cv-03136-LJC, United States District Court, N.D. California (September 28, 2026) Tak Lun Ng, proceeding pro se, sued United Financial Casualty Company over a March 2, 2021 automobile accident and the insurer’s March 24, 2021 refusal to pay him.

He appeared to assert breach of contract, fraud, negligence, premises liability, product liability, and related theories. United removed the action from state court and moved to dismiss.

Ng missed that deadline but later filed several documents, including a motion for leave to amend, all of which the court reviewed.

LAW

Under Federal Rules of Civil Procedure, a complaint must provide a short and plain statement containing enough factual matter to state a facially plausible...

post photo preview
October 05, 2026
Short And Plain Statement Containing Enough Factual Matter To State A Facially Plausible Claim

If Grounds For Dismissal Are Apparent From The Face Of The Complaint, A Court May Also Dismiss The Case on The Court’s Own Motion

Posted on October 5, 2026 by Barry Zalma

Pro Se Plaintiff Failed to Make a Short and Plain Statement

Post 4856

In Tak Lun Ng v. United Financial Casualty Company, No. 26-cv-03136-LJC, United States District Court, N.D. California (September 28, 2026) Tak Lun Ng, proceeding pro se, sued United Financial Casualty Company over a March 2, 2021 automobile accident and the insurer’s March 24, 2021 refusal to pay him.

He appeared to assert breach of contract, fraud, negligence, premises liability, product liability, and related theories. United removed the action from state court and moved to dismiss.

Ng missed that deadline but later filed several documents, including a motion for leave to amend, all of which the court reviewed.

LAW

Under Federal Rules of Civil Procedure, a complaint must provide a short and plain statement containing enough factual matter to state a facially plausible...

post photo preview
October 02, 2026
Announcement About False Claims Act Settlement Results in Damages Suit

Employee Report of Fraud Results in Damages Suit After Qui Tam Suit Settled

No Statutory Hearing Right Arose Because No Dental Commission Complaint License Suspension, Revocation, Or Sanction Occurred.

Post 4855

Posted on October 2, 2026 by Barry Zalma

In Abbas Mohammadi et al. v. William M. Tong et al., No. AC 47598, Court of Appeals of Connecticut (September 29, 2026) Abbas Mohammadi owned and operated Columbia Dental, P.C., which provided dental services through multiple Connecticut offices; Columbia Oral Maxillofacial Imaging, LLC served as the billing entity.

From April 2012 to February 27, 2013, Columbia Dental employed Brittany Ames Mahoney as a dental assistant. During her employment, Mahoney claimed to have discovered certain billing irregularities, including, but not limited to, false and fraudulent reimbursement claims submitted to the Department of Social Services for services rendered to Medicaid beneficiaries. Mahoney filed a complaint and an affidavit in the United States District Court for the District of...

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