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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 20, 2025
Four Corners of Suit Allows Refusal to Defend

Exclusion Establishes that There is No Duty to Defend Off Site Injuries

Post 5103

Read the full article at https://lnkd.in/geje73Gh, see the full video at https://lnkd.in/gnQp4X-f and at https://lnkd.in/gPPrB47p, and at https://zalma.com/blog plus more than 5100 posts.

Attack by Vicious Dog Excluded

In Foremost Insurance Company, Grand Rapids, Michigan v. Michael B. Steele and Sarah Brown and Kevin Lee Price, Civil Action No. 3:24-CV-00684, United States District Court, M.D. Pennsylvania (June 16, 2025)

Foremost Insurance Company (“Foremost”) sued Michael B. Steele (“Steele”), Sarah Brown (“Brown”), and Kevin Lee Price (“Price”) (collectively, “Defendants”). Foremost sought declaratory relief in the form of a declaration that

1. it owes no insurance coverage to Steele and has no duty to defend or indemnify Steele in an underlying tort action and
2. defense counsel that Foremost has assigned to Steele in the underlying action may withdraw his appearance.

Presently before the Court are two motions for entry of a default judgment filed by Foremost against Price and Steele respectively.

BACKGROUND

On October 5, 2023, Brown sued Price and Steele asserting claims of negligence and negligence per se. Brown alleged that she was outside of her residence and at the same time, Price was outside of the property he rents from Steele with his dog Miami. Without provocation, Miami suddenly got loose and attacked Brown, causing her injuries.

Miami had a bad history by previously getting loose and attacking humans without provocation. Brown contended that Steele knew that Miami was dangerous because when Steele collects rent from Price, he does not enter the residence due to the danger of Miami’s presence.

After the incident, the Larksville police cited Price for violations of the Pennsylvania Dog Law and Larksville Borough Ordinances.

THE INSURANCE

Foremost insured Steele under the Dwelling Fire One Policy Vacant or Unoccupied, policy number 381-0091679411-07. Under the Foremost policy, Foremost is required to insure Steele for accidents, including bodily injuries to other persons and medical costs related thereto as well as property damage, at covered premises. One such covered premise is the property that Defendant Price rented from Defendant Steele when the incident leading to the Brown Litigation occurred.

The Foremost policy includes certain exclusions including one that explicitly excludes coverage for bodily injury or property damage that results from the actions that occur on insured premises of (1) any animal which the insured (or the insured’s family member or employee) is aware has a prior history of biting or attacking humans or other animals or (2) any dog that is deemed dangerous as defined by Pennsylvania Public Law 784, as amended.

DISCUSSION

Foremost asserted that there was no coverage available to Steele because the exclusions related to dangerous animals apply because Steele was aware of Miami’s history of attacking and biting people. Consequently, Foremost alleged that Steele is not entitled to coverage related to the Brown Litigation and the counsel it has thus far provided to Steele should be permitted to withdraw.

Foremost requests a declaratory judgment that it has no duty to defend or indemnify Steele or Price as a result of pending state court litigation. According to Pennsylvania law, an insurer’s duty to defend or indemnify an insured in litigation is triggered by the language and factual allegations in the underlying complaint.

It should be, and was, obvious that when the clear and unambiguous terms of the policy do not provide for off-site injuries and when the injuries which occurred in this case occurred off-site, an insurer owes no duty to defend or indemnify the insured.

The Brown Complaint filed against Steele and Price in state court alleges Brown was outside of her residence when Price was outside of the property he rents from Steele with Miami. On the face of the complaint, the injuries took place at a place which is not an insured premise, as defined by the Foremost policy.

Therefore, Steele and Price are not entitled to defense or indemnification by Foremost. Given Steele and Price’s repeated failures to answer, respond or defend this case, the Court granted Foremost’s motions and entered declaratory judgments in favor of Foremost against Steele and Price, providing that Foremost has no duty or obligation to defend or indemnify Steele or Price.

ZALMA OPINION

When the insured took his vicious dog off his premises and it viciously attacked a woman causing serious injuries she sued the insured. Foremost, the dog owner’s insurer obtained an order that it need not defend or indemnify the insured because a clear and unambiguous exclusion excluded coverage for dog bites off premises. Insurance companies that write clear and unambiguous policies are entitled to seek court orders to enforce the language of their policy.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:08:29
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June 19, 2025
Sloth and Failure to Follow Court Orders Requires Dismissa

Failure to Prosecute Suit Required Dismissal
Post 5102

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

When Litigant Ignores Court Orders its Suit Must Be Dismissed

In Kmart Corporation v. AIG Assurance Company et al, No. EDCV 15-1520-KK-DTBx, United States District Court, C.D. California (June 16, 2025) Kmart sued its insurers for breach of contract and failure to indemnify in a separate lawsuit.

The proceedings encountered multiple delays due to Kmart’s bankruptcy, resulting in a court-ordered stay.

Court’s Stay on Proceedings: On October 25, 2018, the court issued a stay on the case pending the resolution of Kmart’s bankruptcy, with instructions for counsel to provide updates to the court.

Lack of Communication: Kmart did not file timely status reports with the last communication dated December 14, 2022. Consequently, the court issued orders for updates in May and June 2025.

Factors for Dismissal: The court evaluated five ...

00:08:25
June 18, 2025
Malicious Prosecution Requires Successful Termination

Malicious Prosecution Tort Supported by Fabricated Evidence

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

Sarah Steinmetz filed a five-count complaint against Lindsey Pickholtz and Steven Gordon, alleging malicious prosecution, abuse of process, intentional infliction of emotional distress, and conspiracy to commit malicious prosecution because the defendants reported her to the Division of Insurance with making false statements and being arrested by the State in connection with those charges. The complaint detailed events spanning two-and-a-half years, beginning with the sale of Steinmetz’s condominium to Pickholtz and Gordon. The relationship between the parties deteriorated after a prank call incident, leading to fabricated evidence and legal actions against Steinmetz.

In Sarah Steinmetz v. Lindsey Pickholtz, et al., No. 3D24-0417, Florida Court of Appeals, Third District (June 11, 2025) most of the issues raised on appeal were ...

00:09:11
June 18, 2025
Malicious Prosecution Requires Successful Termination

Malicious Prosecution Tort Supported by Fabricated Evidence

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

Sarah Steinmetz filed a five-count complaint against Lindsey Pickholtz and Steven Gordon, alleging malicious prosecution, abuse of process, intentional infliction of emotional distress, and conspiracy to commit malicious prosecution because the defendants reported her to the Division of Insurance with making false statements and being arrested by the State in connection with those charges. The complaint detailed events spanning two-and-a-half years, beginning with the sale of Steinmetz’s condominium to Pickholtz and Gordon. The relationship between the parties deteriorated after a prank call incident, leading to fabricated evidence and legal actions against Steinmetz.

In Sarah Steinmetz v. Lindsey Pickholtz, et al., No. 3D24-0417, Florida Court of Appeals, Third District (June 11, 2025) most of the issues raised on appeal were ...

00:09:11
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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