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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 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

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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 court granted Orengo’s motion to dismiss in part and denied it in part, while Hanover’s motion to dismiss has been granted in full.

Factual Background

The incident occurred on the evening of July 22, 2023, when Plaintiff’s vehicle was “T-boned” by Orengo’s vehicle at a highway onramp. Plaintiff alleges that Orengo was found to be at fault by the State Police Officer and issued a written warning for failure to maintain proper lane. Following the accident, Plaintiff experienced significant physical pain and suffering, which he attributed to the collision.

The court’s ruling addresses several legal claims:

Negligence:

The court dismisses the negligence claims against Hanover but finds that Plaintiff has stated claims for negligence and negligence per se against Orengo.

Intentional Infliction of Emotional Distress (IIED):

The court dismissed the IIED claims against both Defendants, finding that the conduct alleged does not rise to the level of extreme and outrageous required to sustain an IIED claim.

Negligent Infliction of Emotional Distress (NIED):

The court dismissed the NIED claims against both Defendants, noting that the claims are duplicative of the negligence claims and failed to state a claim.

Insurance Fraud:

The court dismisses the insurance fraud claims against both Defendants, finding that Plaintiff failed to meet the heightened pleading requirements for actions alleging fraud.

Assumption of Duty:

The court dismissed the assumption of duty claims without leave to replead, as the issue of assumption of duty is usually part of analyzing whether a duty exists to support a breach of contract or tort claim .

Breach of the Implied Covenant of Good Faith and Fair Dealing:

The court dismisses these claims, noting that Plaintiff does not allege that a contract existed between him and Hanover or Orengo.

Malice:

The court dismisses the malice claims, finding that malice is not a legally cognizable tort claim.

Violation of CUTPA:

The court dismissed the CUTPA claims against Hanover, noting that Plaintiff has neither alleged more than one act of insurance misconduct nor asserted a breach of contract claim.

CONCLUSION

The court granted Hanover’s motion to dismiss in full, and granted in part and denies in part Orengo’s motion to dismiss. Plaintiff may file a Second Amended Complaint by August 21, 2025, consistent with the court’s ruling.

DISCUSSION

Beginning with Hanover, Plaintiff does not articulate how Hanover in any way caused the alleged injuries. Plaintiff’s arguments as to negligence focus solely on the collision between Orengo and Plaintiff. Hanover was not a party to the car accident and the amended complaint does not allege that Hanover acted negligently in any manner to cause the collision to occur.

Even if the negligence cause of action against Hanover were based on its alleged denial of liability coverage for the accident, it must still fail. Absent a direct contractual relationship between the injured party bringing the action and the insurance company of the alleged tortfeasor, or a third-party beneficiary relationship, an injured party is precluded from bringing a direct action for negligence against the insurer until judgment is obtained against the tortfeasor. It was undisputed that Plaintiff has no direct contractual relationship with Hanover.

As to Orengo, however, the Court held that Plaintiff has plausibly stated a negligence claim.

Negligence Per Se

Negligence per se effectively engrafts a particular statutory standard onto the standard of care imposed by the duty element of a negligence cause of action. To establish negligence per se, a plaintiff need not prove that the defendant failed to act as an ordinarily prudent person would have acted under the circumstances.

Plaintiff has alleged sufficient facts to support a negligence per se claim.

ZALMA OPINION

Automobile Liability Insurance is a contract that promises to defend and, if necessary, indemnify its insured. When there is no evidence that the insurer was involved in causing the accident there can be no case against the insurer. Pro Se plaintiffs cause this kind of problem for courts by charging torts that don’t exist and suing parties that had no involvement. Giving the Pro Se plaintiff the benefit of the doubt the court allowed an amended complaint so that more judicial time can be taken to deal with incompetent lawyering by a non lawyer.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:09:16
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March 11, 2026
Public Adjusters Attempt to Represent an Insured Subject to APA Clause

Anti-Public Adjuster Clause Is Effective in New York

Post number 5301

Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.

Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster

In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.

FACTS

NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...

00:08:05
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March 11, 2026
Public Adjusters Attempt to Represent an Insured Subject to APA Clause

Anti-Public Adjuster Clause Is Effective in New York

Post number 5301

Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.

Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster

In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.

FACTS

NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...

00:08:05
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March 10, 2026
Acting as Your Own Lawyer is Foolish

Proof of Highly Contaminated Water is Required for Extra Payments

Post number 5300

Read the full article at https://www.linkedin.com/pulse/acting-your-own-lawyer-foolish-barry-zalma-esq-cfe-mbg0c, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.

Acting as Your Own Lawyer is Foolish

Evidence of Breach of Contract Survives Dismissal of All Other Charges

In Lee Lifeng Hsu and Jane Yuchen Hsu v. State Farm Fire And Casualty Company, C. A. No. N24C-09-020 CLS, Superior Court of Delaware (February 27, 2026) a claim to State Farm who paid approximately $61,000 after assessments but denied coverage for additional items including ceramic tiles, the kitchen floor ceiling, underlayment plywood, and numerous personal property items resulted in suit by the Hsu’s acting in pro per.
Facts

Lee Lifeng Hsu and Jane Yuchen Hsu (“Plaintiffs”) purchased a homeowners’ insurance policy from State Farm Fire...

00:07:28
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10 hours ago
Portable Storage Containers are not Buildings

Insurance Condition Requires Following the Intent of the Parties

Post number 5307

Principles of Contract Interpretation Compels Reading Contract as Written

Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.

In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)

In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...

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10 hours ago
Failure to Provide Well-Pled Facts Defeats Most of Action

ERISA Saves Fraudulent Claims Suit

Post number 5306

Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.

Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity

In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.

FACTUAL BACKGROUND

United and Oxford, who administer both ERISA and ...

post photo preview
March 19, 2026
Failure to Provide Well-Pled Facts Defeats Most of Action

ERISA Saves Fraudulent Claims Suit

Post number 5306

Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.

Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity

In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.

FACTUAL BACKGROUND

United and Oxford, who administer both ERISA and ...

post photo preview
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