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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July 09, 2025
No Right to Sue a Person Not a Party for Breach of Contract

A Court Will Never Accept Legal Conclusions in a Suit

Post 5115

A Contract Cannot Legally Bind A Person Or Entity Which Is Not A Party To The Contract.

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The plaintiff, Nataly Gasova, claimed a breach of contract related to an insurance policy which IISS sold to her. IISS moved to dismiss the complaint, arguing inter alia that there was no contract between these parties. Gasova moved to amend her complaint to abandon her breach of contract claim and instead bring claims related to the advertising and sale of the insurance policy.

In Nataly V. Gasova v. Intact Insurance Specialty Solutions, Civ. No. 1:24-CV-2279, United States District Court, M.D. Pennsylvania (June 26, 2025) Intact Insurance Specialty Solutions (“IISS”) moved the court to dismiss the suit.
Background

On November 4, 2023, Gasova was involved in an automobile accident while working as a rideshare driver. Gasova sued IISS, Uber Technologies Inc., and Farmers Insurance Exchange, alleging all three defendants were liable for a failure to make payments due to Gasova under the policy IISS sold to her, as well as alleging fraud. Gasova amended her complaint, dismissed Uber and Farmers, naming IISS as the sole defendant and alleging breach of contract.

On December 4, 2024, the parties entered into a settlement agreement wherein Gasova released all claims against IISS related to the car accident underlying this case. On December 31, 2024, IISS removed the case to federal court, claiming diversity jurisdiction pursuant to 28 U.S.C. § 1332(a). On January 7, 2025, IISS moved to dismiss the complaint for failure to state a claim arguing, inter alia, that the release foreclosed Gasova’s pursuit of her claims in the second amended complaint and that the complaint failed to state a claim as it did not establish there was a breach of contract.

DISCUSSION

Motion to Dismiss – Standard of Review

A court is not required to accept legal conclusions or a formulaic recitation of the elements of a cause of action. Threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice. A complaint has to show an entitlement with its facts. Where the well-pleaded facts do not permit the court to infer more than the mere possibility of misconduct, the complaint has alleged-but it has not shown that the pleader is entitled to relief.

The Motion to Dismiss Will be Granted.

It is axiomatic that a contract cannot legally bind a person or entity which is not a party to the contract. Because Gasova has not alleged facts showing there was a contract between the parties, the USDC concluded she has failed to state a claim.

Gasova’s theory of liability relies primarily on IISS’s inaction, alleging that IISS failed to inform her about certain elements of the policy, which is inadequate to establish a viable cause of action.

The USDC concluded there is no contract between these parties, and that permitting Gasova’s desired amendment would be futile. Therefore, IISS’s motion to dismiss was granted and it denied Gasova’s motion to amend.

ZALMA OPINION

Some people wrongly believe that it is easy to sue an insurance company and become wealthy from the attempt. This case establishes that the belief if unfounded. Insurers fight back and refuse to pay a suit that fails to state a cause of action sufficient to allow the case to go to trial. Gasova should have stopped when she settled.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:06:20
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23 hours ago
Fraud Succeeds When Insurer Chooses to Not Sue for Fraud

Unjust Enrichment is an Non-Contract Remedy
Post 5158

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When an Insurer is Defrauded it Should Sue For Fraud Only

MONY Life Insurance Company v. Bernard R. Perez, No. 23-10770, United States Court of Appeals, Eleventh Circuit (July 23, 2025) resulted in a decision that allows an insured of a Disability Insurance policy to successfully defraud his insurer.

The case involved a dispute between MONY Life Insurance Company and Bernard R. Perez, an ophthalmologist, over a disability insurance contract. Perez was diagnosed with throat cancer in 2011 and began receiving monthly disability benefits from MONY. However, MONY later suspected Perez of dishonesty in his disability claims and discontinued payments in 2018.

FACTS

In 1987, ophthalmologist Bernard R. Perez formed a for-profit medical practice in Tampa, Florida. Soon thereafter, in June 1988, Perez applied for, and, in September 1988, was ...

00:08:33
July 30, 2025
Insurer Not Negligent in Causing Accident Caused by Its Insured

USDC Bends Over Backwards to Give a Pro Se Plaintiff Some Causes of Action
Post 5157

See the full video at https://lnkd.in/g9Q_P2tQ and at https://lnkd.in/g6HPdF9q, and at https://zalma.com/blog plus more than 5150 posts.

When You Represent Yourself in Litigation You Have a Fool for a Lawyer

Plaintiff Gordon Clark, proceeding pro se, sued Defendant Olga L. Orengo and her auto insurance carrier, The Hanover Insurance Group, Inc. (“Hanover”), related to a motor vehicle collision between Plaintiff and Orengo. Plaintiff alleged that Orengo was at fault for the accident, but Hanover has refused to accept liability. In Gordon Clark v. The Hanover Insurance Group, Inc., No. 3:24-cv-348 (SVN), United States District Court, D. Connecticut (July 22, 2025)

Claims and Motions

Plaintiff has brought eight claims against both Defendants and a ninth claim against Hanover for alleged violations of Plaintiff’s rights under federal and state law. Defendants have both moved to dismiss Plaintiff’s amended complaint in full for failure to state a claim. The ...

00:09:16
July 29, 2025
Corporate Owners are not Innocent Co-Insureds

Arson by Insured’s Management Voids Coverage

Post 5156

Read the full article at https://lnkd.in/gwkA76x5, see the full video at https://lnkd.in/gBekGhfK and at https://lnkd.in/gwReRCKz and at https://zalma.com/blog plus more than 5150 posts.

Corporate Owners are not Innocent Co-Insureds

Read the full article at https://lnkd.in/gwkA76x5, see the full video at https://lnkd.in/gBekGhfK and at https://lnkd.in/gwReRCKz and at https://zalma.com/blog plus more than 5150 posts.

Arson by Insured’s Management Voids Coverage

Post 5156

Arson for Profit by Corporate Entity Management Voids Policy

Following a fire that destroyed The Press Bar and Parlor in St. Cloud, Minnesota the insurer denied coverage after its determination that Andrew Welsh – a controlling officer of the insured intentionally set the fire and submitted a false proof of loss.

In Timeless Bar, Inc., doing business as The Press Bar and Parlor; Horseshoe Club, LLC; Jessie Welsh v. Illinois Casualty Company, No. 24-2245, United States Court of Appeals, Eighth ...

00:07:29
July 16, 2025
There is no Tort of Negligent Claims handling in Alaska

Rulings on Motions Reduced the Issues to be Presented at Trial

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CASE OVERVIEW

In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.

FACTS

Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.

Prior to trial Bernier had three remaining claims against State Farm:

1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.

Both Bernier and State Farm dispositive motions before ...

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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 ...

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