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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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Zalma’s Insurance Fraud Letter – January 15, 2026

ZIFL Volume 30, Number 2

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL

Post number 5260

Read the full article at https://lnkd.in/gzCr4jkF, see the video at https://lnkd.in/g432fs3q and at https://lnkd.in/gcNuT84h, https://zalma.com/blog, and at https://lnkd.in/gKVa6r9B.

Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th 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/ This issue contains the following articles about insurance fraud:

Read the full 19 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/01/ZIFL-01-15-2026.pdf.

The Contents of the January 15, 2026 Issue of ZIFL Includes:

Use of the Examination Under Oath to Defeat Fraud

The insurance Examination Under Oath (“EUO”) is a condition precedent to indemnity under a first party property insurance policy that allows an insurer ...

00:09:20
January 14, 2026
USDC Must Follow the Finding of the Administrator of the ERISA Plan

ERISA Life Policy Requires Active Employment to Order Increase in Benefits

Post 5259

Read the full article at https://lnkd.in/gXJqus8t, see the full video at https://lnkd.in/g7qT3y_y and at https://lnkd.in/gUduPkn4, and at https://zalma.com/blog plus more than 5250 posts.

In Katherine Crow Albert Guidry, Individually And On Behalf Of The Estate Of Jason Paul Guidry v. Metropolitan Life Insurance Company, et al, Civil Action No. 25-18-SDD-RLB, United States District Court, M.D. Louisiana (January 7, 2026) Guidry brought suit to recover life insurance proceeds she alleges were wrongfully withheld following her husband’s death on January 9, 2024.

FACTUAL BACKGROUND

Jason Guidry was employed by Waste Management, which provided life insurance coverage through Metropolitan Life Insurance Company (“MetLife”). Plaintiff contends that after Jason’s death, the defendants (MetLife, Waste Management, and Life Insurance Company of North America (“LINA”)) engaged in conduct intended to confuse and ultimately deny her entitlement to...

00:07:30
January 13, 2026
Mediation in State Court Resolves Action in USDC

Failure to Respond to Motion to Dismiss is Agreement to the Motion
Post 5259

Read the full article at https://lnkd.in/gP52fU5s, see the video at https://lnkd.in/gR8HMUpp and at https://lnkd.in/gh7dNA99, and at https://zalma.com/blog plus more than 5250 posts.

In Mercury Casualty Company v. Haiyan Xu, et al., No. 2:23-CV-2082 JCM (EJY), United States District Court, D. Nevada (January 6, 2026) Plaintiff Mercury Casualty Company (“plaintiff”) moved to dismiss. Defendant Haiyan Xu and Victoria Harbor Investments, LLC (collectively, “defendants”) did not respond.

This case revolves around an insurance coverage dispute when the parties could not be privately resolved, litigation was initiated in the Eighth Judicial District Court of Nevada. Plaintiff subsequently filed for a declaratory judgment in this court.

On or about April 15, 2025, the state court action was dismissed with prejudice pursuant to a stipulation following mediation. Plaintiff states that the state court dismissal renders its ...

00:04:26
December 31, 2025
“Sudden” is the Opposite of “Gradual”

Court Must Follow Judicial Precedent
Post 5252

Read the full article at https://www.linkedin.com/pulse/sudden-opposite-gradual-barry-zalma-esq-cfe-h7qmc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.

Insurance Policy Interpretation Requires Application of the Judicial Construction Doctrine

In Montrose Chemical Corporation Of California v. The Superior Court Of Los Angeles County, Canadian Universal Insurance Company, Inc., et al., B335073, Court of Appeal, 337 Cal.Rptr.3d 222 (9/30/2025) the Court of Appeal refused to allow extrinsic evidence to interpret the word “sudden” in qualified pollution exclusions (QPEs) as including gradual but unexpected pollution. The court held that, under controlling California appellate precedent, the term “sudden” in these standard-form exclusions unambiguously includes a temporal element (abruptness) and cannot reasonably be construed to mean ...

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December 29, 2025
Doctor Accused of Insurance Fraud Sues Insurer Who Accused Him

Lack of Jurisdiction Defeats Suit for Defamation

Post 5250

Posted on December 29, 2025 by Barry Zalma

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He Who Represents Himself in a Lawsuit has a Fool for a Client

In Pankaj Merchia v. United Healthcare Services, Inc., Civil Action No. 24-2700 (RC), United States District Court, District of Columbia (December 22, 2025)

FACTUAL BACKGROUND
Parties & Claims:

The plaintiff, Pankaj Merchia, is a physician, scientist, engineer, and entrepreneur, proceeding pro se. Merchia sued United Healthcare Services, Inc., a Minnesota-based medical insurance company, for defamation and related claims. The core allegation is that United Healthcare falsely accused Merchia of healthcare fraud, which led to his indictment and arrest in Massachusetts, causing reputational and business harm in the District of Columbia and nationwide.

Underlying Events:

The alleged defamation occurred when United ...

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December 15, 2025
Zalma’s Insurance Fraud Letter – December 15, 2025

Zalma’s Insurance Fraud Letter

Read the full article at https://lnkd.in/dG829BF6; see the video at https://lnkd.in/dyCggZMZ and at https://lnkd.in/d6a9QdDd.

ZIFL Volume 29, Issue 24

Subscribe to the e-mail Version of ZIFL, it’s Free! https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D

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/

Zalma’s Insurance Fraud Letter

Merry Christmas & Happy Hannukah

Read the following Articles from the December 15, 2025 issue:

Read the full 19 page issue of ZIFL at ...

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