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 21, 2025
False Documentation to Obtain a Loan is a Crime

Arrest for False Impersonation Protected Property Owners from Losing Insurance

See the full video at https://lnkd.in/gYYWmkbQ and at https://lnkd.in/gEe2Wc86. and at https://zalma.com/blog plus more than 5100 posts.

In United States Of America v. Christopher J. Gallo and Mehmet Ali Elmas, No. 2:24-cr-00712 (BRM), USDC, D. New Jersey (July 16, 2025) Gallo and Elmas each filed Motions to Dismiss Count Eighteen which charges the CoDefendants with Aggravated Identity Theft.

BACKGROUND

Co-Defendants were charged in a criminal complaint (the “Complaint”) with conspiracy to commit bank fraud. Gallo, as a senior loan officer originated more than $1.4 billion in loans for the Financial Institution.

A grand jury returned an eighteen-count indictment charging Co-Defendants with Conspiracy to Commit Bank Fraud, False Statement to a Financial Institution and Aggravated Identity Theft.

LEGAL PROCEEDINGS

Motions to Dismiss

The court found that the identity theft was central to the fraudulent scheme, as the defendants relied on the property manager’s identity to secure the mortgage.

CONCLUSION

The court denied the defendants’ motions to dismiss and the case continues with the charges of conspiracy to commit bank fraud, bank fraud, false statements to a financial institution, and aggravated identity theft.

The “Crux” of the Alleged Fraud

The Court found the allegations in this matter go to the "who" element that is central to the aggravated identity theft charge.

Rather, Co-Defendants forged this safety attestation from the Property Manager because the Property Manager had the authority to confirm or deny the safety of the balconies. Accordingly, the Court concluded the Co-Defendants’ alleged conduct fits within the statutory definition of aggravated identity theft and constitutes the “crux” of the offense.

Consequently, Co-Defendants’ Motions to Dismiss Count Eighteen of the Indictment (Aggravated Identity Theft was DENIED.

ZALMA OPINION

Although I often think about insurance fraud this crime – before a false insurance claims was made – would have created a major insurance fraud if any of the facilities incurred a loss. If the false safety statement was presented to an insurer for the property the policy would be never be issued or would be void from inception. When loans are obtained based upon a false safety attestation and the insurer learned that the loans were obtained by a fraudulent safety attestation, the insurer, like the bank, was, deceived when it agreed to insure the property under false pretenses and the contracts are void.

(c) 2025 Barry Zalma & ClaimSchool, Inc.
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00:08:14
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21 minutes ago
Party Seeking Discovery is Entitled to “Anything Relevant to Party’s Claim or Defense

Discovery Attempt by Alleged Fraudulent Health Care Provider Fails

Post 5232

Read the full article at https://www.linkedin.com/pulse/party-seeking-discovery-entitled-anything-relevant-zalma-esq-cfe-ce7kc, see the video at https://rumble.com/v7204g8-discovery-is-entitled-to-anything-relevant-to-partys-claim-or-defense.html and at https://youtu.be/Nuet_er3qXU, and https://zalma.com/blog plus more than 5200 posts.

Upcoding and Health Care Fraud

In UnitedHealthcare Services, Inc., et al. v. Team Health Holdings, Inc., et al., No. 3:21-cv-00364-DCLC-DCP, United States District Court for the Eastern District of Tennessee, District Judge Clifton L. Corker (November 18, 2025) This is a discovery ruling, not a final merits decision.

The Disputes

This is a fraud/RICO lawsuit brought by UnitedHealthcare (and affiliates, collectively “United”) aganst TeamHealth (a large physician staffing company focused on emergency medicine). The companies have a history of mutual litigation over billing practices, including prior suits where TeamHealth accused ...

00:09:59
38 minutes ago
Party Seeking Discovery is Entitled to “Anything Relevant to Party’s Claim or Defense

Discovery Attempt by Alleged Fraudulent Health Care Provider Fails

Post 5232

Read the full article at https://www.linkedin.com/pulse/party-seeking-discovery-entitled-anything-relevant-zalma-esq-cfe-ce7kc, see the video at https://rumble.com/v7204g8-discovery-is-entitled-to-anything-relevant-to-partys-claim-or-defense.html and at https://youtu.be/Nuet_er3qXU, and https://zalma.com/blog plus more than 5200 posts.

Upcoding and Health Care Fraud

In UnitedHealthcare Services, Inc., et al. v. Team Health Holdings, Inc., et al., No. 3:21-cv-00364-DCLC-DCP, United States District Court for the Eastern District of Tennessee, District Judge Clifton L. Corker (November 18, 2025) This is a discovery ruling, not a final merits decision.

The Disputes

This is a fraud/RICO lawsuit brought by UnitedHealthcare (and affiliates, collectively “United”) aganst TeamHealth (a large physician staffing company focused on emergency medicine). The companies have a history of mutual litigation over billing practices, including prior suits where TeamHealth accused ...

00:09:59
22 hours ago
Not Fair to Require Tenant to Pay for Damage Insured by Landlord

No Right to Subrogation Against Tenant
Post 5231

Not Fair to Require Tenant to Pay for Damage Insured by LandlordSee the video at https://lnkd.in/gFkrp_6M and at https://lnkd.in/gQdFQBWj and at https://zalma.com/blog plus more than 5200 posts.

See the video at and at

For Insurer to Subrogate Lease Must Require Tenant to Obtain Insurance for the Benefit of the Landlord

In AmGUARD Insurance Co. v. Tyrone Ellis and Shakyra Ellis, U.S. District Court, District of Connecticut Civil No. 3:25-cv-946 (JCH) (November 19, 2025), Judge, Janet C. Hall the defendant’s Motion to Dismiss the Amended Complaint on the basis of Connecticut’s anti-subrogation doctrine required dismissal.

KEY FACTS

Landlord Michael Caldwell, a Connecticut citizen, owned a multi-family building in Windsor, Connecticut. Defendants Tyrone and Shakyra Ellis were residential tenants in the building. On or about March 1, 2025, a fire ...

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October 31, 2025
The Zalma Philosophy of Claims Handling – Part 9

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 ...

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October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

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 ...

post photo preview
October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

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 ...

post photo preview
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