Creative Litigation Fails Because Crime Does not Pay
Post 5109
See the full video at https://lnkd.in/gWgSsVgE and at https://lnkd.in/g9ng3A3M, and at https://zalma.com/blog plus more than 5100 posts.
Prisoner Acting as His Own Lawyer Misses Prerequisite to His Suit
In this pro se prisoner case brought under 42 U.S.C. § 1983, United States Magistrate Judge Bradley W. Rath’s Report and Recommendation recommends that Defendants Sheriff John Ledbetter, Geneva Drummond, and VitalCore’s Motions for Summary Judgment be granted, that Plaintiff Monnie Villarreal’s Motion to Amend be denied as moot, and that the Court dismiss this case without prejudice for failure to exhaust administrative remedies.
In Monnie Villarreal v. Vitalcore, et al. No. 1:24-cv-99-HSO-BWR, United States District Court, S.D. Mississippi, (June 18, 2025) the District Judge adopted Magistrate Judge’s Report and Recommendation as the opinion of the Court.
BACKGROUND
Plaintiff Monnie Villarreal (“Plaintiff”) pled guilty to conspiracy to commit insurance fraud in the Circuit Court of Jackson County, Mississippi, and was sentenced to serve five years in the custody of the Mississippi Department of Corrections (“MDOC”). In 2024 Plaintiff violated the terms of his post-release supervision, and was ordered to serve the remainder of his sentence in MDOC custody, where he remained until his release in December 2024.
Plaintiff’s allegations stem from two incidents, an alleged denial of medical care and a purported failure to protect Plaintiff from violence at the hands of another inmate.
Plaintiff asserted that Defendants VitalCore and Nancy Unknown committed “attempted murder” by depriving him “of [a] proper dosage of insulin[,]” by not allowing him “to see a license[d] doctor[,]” and by forcing him to “live with high blood sugar.”
Plaintiff accused Sheriff Ledbetter and Drummond of “negligence and cruel punishment.” He asserts that he was assaulted by another inmate with a “broken wooden mop handle” on April 21, 2024, and that Drummond refused to answer his calls for help. Plaintiff filed three grievances during his incarceration at JCADC, all of which were submitted through the normal JCADC grievance system.
The Magistrate Judge recommended that Plaintiff’s claims be dismissed without prejudice for failure to exhaust administrative remedies under the Prison Litigation Reform Act. The Report and Recommendation highlighted that under the PLRA, “[e]xhaustion of administrative remedies through the prison grievance system is a prerequisite for lawsuits filed under § 1983.” Because Plaintiff had not filed any grievances related to the alleged incidents through the ARP, the Magistrate Judge found that Plaintiff had not exhausted his administrative remedies as to either of his claims.
DISCUSSION
Since exhaustion is a threshold issue that courts must address to determine whether litigation is being conducted in the right forum at the right time, judges may resolve factual disputes concerning exhaustion without the participation of a jury.
Plaintiff was not a pretrial detainee facing a new conviction but was instead a post-conviction inmate serving out the remainder of his sentence.
The JCADC Inmate Handbook required Plaintiff to use the JCADC grievance system and then the ARP grievance system before filing a lawsuit. The ARP was available to Plaintiff, and he has never maintained or argued that he used it to report the complained-of incidents.
CONCLUSION
It was ordered and adjudged that Defendants Sheriff John Ledbetter, Geneva Drummond, and VitalCore’s Motions for Summary Judgment were granted, and Plaintiff Monnie Villareal’s claims were dismissed without prejudice as to all Defendants for failure to exhaust administrative remedies.
ZALMA OPINION
Insurance fraud perpetrators are well known for their “Chutzpah” (Yiddish for unmitigated gall) and even when convicted and allowed to run free he violated the terms of his release and was incarcerated to serve the remainder of his sentence. He sued, in pro se, the Sheriff who ran the jail and others claiming many vicious actions against his person and health only to find he had failed to use the administrative remedies available to him so his suit was dismissed proving that no matter how creative his pleading crime does not pay.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Detail Charging Defendant for Fraud is Sufficient
Post 5242
Read the full article at https://lnkd.in/g_HVw36q, see the video at https://lnkd.in/gpBd-XTg and at https://lnkd.in/gzCnBjgQ and at https://zalma.com/blog plus more than 5200 posts.
Charges that Advises the Defendant of the Crime Cannot be Set Aside
In United States Of America v. Lourdes Navarro, AKA Lulu, No. 25-661, United States Court of Appeals, Ninth Circuit (December 4, 2025) Lourdes Navarro appealed the district court’s denial of her motion to dismiss the indictment and enter final judgment was in error.
FACTUAL BACKGROUND
The indictment alleged that insurers reimburse only for medically necessary services. Navarro performed unnecessary respiratory pathogen panel (RPP) tests on nasal swabs collected from asymptomatic individuals for COVID-19 screening.
Navarro billed over $455 million to insurers for those additional RPP tests that she knew to be medically unnecessary. These allegations constituted a plain, concise, and definite written ...
Louisiana Statute Prevents Enforcement of Contract Term Requiring Arbitration of Disputes
Post 5241
Read the full article at https://www.linkedin.com/pulse/international-convention-requiring-enforcement-award-barry-sttdc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
In Town of Vinton v. Indian Harbor Insurance Company, Nos. 24-30035, 24-30748, 24-30749, 24-30750, 24-30751, 24-30756, 24-30757, United States Court of Appeals, Fifth Circuit (December 8, 2025) municipal entities including the Town of Vinton, et al sued domestic insurers after dismissing foreign insurers with prejudice. The insurers sought arbitration under the Convention on the Recognition and Enforcement of Foreign Arbitral Awards (the “Convention”) but the court held Louisiana law — prohibiting arbitration clauses in such policies—controls, as the Convention does not apply absent foreign parties who ...
Refusal to Provide Workers’ Compensation is Expensive
Post 5240
Read the full article at https://lnkd.in/guC9dnqA, see the video at https://lnkd.in/gVxz-qmk and at https://lnkd.in/gUTAnCZw, and at https://zalma.com/blog plus more than 5200 posts.
In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.
Company Overview:
USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...
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 ...
