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 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 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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July 22, 2026
The Real Cost of Fraud

The Largest Residential Burglary of All Time
Post 5407

Fraud & the Fear of Bad Faith Suits
Posted on July 22, 2026 by Barry Zalma

See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.

After ...

00:12:33
July 20, 2026
Search Warrant Produces Evidence of Insurance Fraud

Chutzpah is not Enough
Post 5397

Posted on July 20, 2026 by Barry Zalma

See the video and at https://lnkd.in/gNUs2XzT and at https://lnkd.in/g2MawyzX

Magistrate Issues a Search Warrant if there is a Fair Probability that Contraband or Evidence of a Crime will be Found in a Particular Place.

In United States Of America v. Frank Suess, et al., CRIMINAL No. 3:24-308, United States District Court, M.D. Pennsylvania (July 16, 2026) a federal grand jury indicted Frank Suess, Melissa Driscoll, and others in a 55-count health care fraud and anti-kickback prosecution arising from an alleged scheme involving medically unnecessary prescription “foot baths.”

As part of the investigation, the FBI obtained an August 19, 2022 warrant to search Driscoll’s Sterling Pharmacy Yahoo email account for emails from January 1, 2018 through December 31, 2020. Driscoll moved to suppress the resulting evidence, arguing that the warrant lacked probable cause, was overbroad, and rested on material misstatements and omissions.

LAW:

The ...

00:08:22
July 17, 2026
The Great Jewel Theft

Fraud Shouldn’t Pay

Post 5396

See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.

The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.

One month after the policy was ...

00:09:42
9 hours ago
Plaintiff Sues Because State Employees Stigmatized Her

Day Care Owner Loses Subsidies Because She Criticized State

Post 5421

Posted on August 11, 2026 by Barry Zalma

First Amendment Right Will be Allowed to Go to Trial

In Betsey J. Grant v. Maine State Department Of Heath And Human Services, No. 1:25-cv-00490-JAW, United States District Court, D. Maine (August 6, 2026), Betsey J. Grant, a licensed childcare provider and operator of Tiny Tikes Daycare in Trenton, Maine, sued Maine DHHS and several employees after she publicly criticized DHHS before Maine’s Government Oversight Committee and alleged that officials retaliated against her.

She claimed DHHS imposed and extended a conditional license, published stigmatizing information, interfered with subsidies and program funding, removed her from a food program, rescinded an expansion grant, and used biased or falsified evidence in licensing proceedings. Following the March 10, 2023, GOC testimony, Ms. Grant alleges that foster children's subsidies (approximately $30,000) were withheld; she was removed from the ...

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August 05, 2026
It Doesn’t Pay to Lie in an Application for Insurance

Rescission for Material Misrepresentation
Post 5418

Posted on August 5, 2026 by Barry Zalma

An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.

In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units. After an underlying personal injury action was filed, Union Mutual determined that the property actually contained three apartment units and rescinded the policies on the ground that the defendants had made a material misrepresentation in the applications.
LAW:

A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true ...

post photo preview
August 05, 2026
It Doesn’t Pay to Lie in an Application for Insurance

Rescission for Material Misrepresentation
Post 5418

Posted on August 5, 2026 by Barry Zalma

An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.

In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units.

LAW:

A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true facts been disclosed. To establish materiality as a matter of law, the insurer must submit documentation of its underwriting practices, such as manuals, guidelines, bulletins, or rules addressing similar risks.

DISCUSSION/ANALYSIS:

As a result, the...

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