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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August 06, 2025
Incompetent Fraudster Guilty

The Quality of Insurance Fraud Perpetrators is Declining
Post 5162

Read the full article at https://lnkd.in/gu5JuZCD, see the full video at https://lnkd.in/ghayiupt and at https://lnkd.in/gAxTeR8w, and at https://zalma.com/blog plus more than 5150 posts.

Insured Admits Fake Theft and Shows Allegedly Stolen Item to Insurance Investigator

Christie Paolino an investigator for Westfield Insurance Company testified that appellant Matthew McGrath reported the theft of his vehicle and equipment to Westfield, including the VIN for the GMC truck. Paolino met with McGrath at his residence in Cleveland. She asked if they could move to a quieter spot such as the backyard. As they walked up the driveway towards the backyard, Paolino noticed “two snowplows sitting in the driveway” and recognized one as the snowplow “that he had reported stolen.” She asked appellant “if that was, in fact, the snowplow,” and he admitting to the falsity of his claim he responded that it was.

In STATE OF OHIO v. MATTHEW MCGRATH, 2025-Ohio-2600, No. 114758, Court of Appeals of Ohio, Eighth District, Cuyahoga (July 24, 2025) affirmed the trial court verdict finding him guilty at trial.

THE TRIAL

McGrath waived his right to a jury trial, opting instead for a bench trial held on August 26 and 27, 2024. The state presented five witnesses. The evidence showed that on June 21, 2023, McGrath reported his truck, plow, salt spreader, and crack filler stolen to the University Heights Police, an interaction documented on body camera. McGrath was found guilty at trial of falsification, attempted grand theft, and insurance fraud. On January 13, 2025, he was sentenced to the minimal one year of community-control sanctions.

The appellate court found no merit to his appeal and affirmed the trial court’s decision.

ANALYSIS

An appellate court views the evidence in a light most favorable to the prosecution to determine whether any rational trier of fact could have found the essential elements of the crime proven beyond a reasonable doubt. Appellate courts are not to assess whether the State’s evidence is to be believed, but whether, if believed, was the evidence against a defendant sufficient to support a conviction. In essence, sufficiency is a test of adequacy. Whether the evidence is legally sufficient to sustain a verdict is a question of law.

The Court of Appeals concluded that the state’s evidence was sufficient to support the trial court’s verdicts because the evidence was sufficient to prove that McGrath knowingly made false statements and that his purpose was to commit or facilitate a theft offense, and that he was thereby attempting, by deception, to knowingly deprive his insurer of a sum exceeding $7,500.

The evidence was sufficient to establish that appellant’s statements reporting the theft of his vehicle were false and that appellant knew it.

To warrant reversal from a bench trial under a manifest weight of the evidence claim, the Court of Appeals must review the entire record, weigh the evidence and all reasonable inferences, consider the credibility of witnesses and determine whether in resolving conflicts in evidence, the trial court clearly lost its way and created such a manifest miscarriage of justice that the judgment must be reversed, and a new trial ordered.

Here, the State introduced substantial evidence to establish, beyond a reasonable doubt, that appellant committed the offenses of falsification and attempted grand theft. He initiated a claim with Westfield Insurance for the lost property. The testimony and the State’s exhibits established that appellant’s report was false and that he made the deceptive report in a thwarted effort to collect insurance proceeds from Westfield. The judgment was affirmed.

ZALMA OPINION

It seems people believe that insurance fraud is so easy that anyone can do it and profit from the fraud with ease. Mr. McGrath was a believer but was so stupid as to invite an investigator from his insurance company into his back yard where the allegedly stolen property was parked and admitted it was the same item that was the subject of his claim, admitting to the fraud. With such damning evidence McGrath, who received a light sentence and no jail time, had the unmitigated gall to appeal the verdict and waste the time of the Court of Appeals affirming the trial court’s verdict.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:42
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September 18, 2026
Expert May Only Testify to What Experience Supports

Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.

Posted on September 18, 2026 by Barry Zalma

See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html

In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.

The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.

Law

The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...

00:03:10
September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

150 Months in Prison for Tax Fraud
Post 4846

Posted on September 17, 2026 by Barry Zalma

See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.

FACTS

In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS

Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.

The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...

00:05:23
September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution

Post 5489

Posted on September 14, 2026 by Barry Zalma

Fraudster Refuses to Answer Questions About His Alleged Fraud

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

In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.

Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.

After Great American ...

00:05:14
November 05, 2026
Convicted of Felony Fraud You Lose the Right to Vote

Payment of Fines & Completion of Probation Reinstates Right to Vote

Post 4576

Posted on November 5, 2026 by Barry Zalma

To Restore Voting Rights The Felon Must Pay Fines of $546.00

In Florida Supreme Court Mediator Ethics Advisory Committee, ETH F-26-377, No. F-26-377 (October 29, 2026) citizen unnamed and to Ron Desantis Governor, Cord Byrd the Secretary of State Florida Division of Elections provided an advisory opinion to a convicted felon about his right to vote:

To: [redacted] We received your request for an advisory opinion. You indicate that you have one or more felony convictions and request whether you are eligible to vote, including whether you have any outstanding legal financial obligations under section 98.0751, Florida Statutes, and, if so, a statement of the amount that must be paid to make you eligible to vote, and an explanation of how the amount was calculated.

The Division hereby responds to your request pursuant to its legal authority under section 106.23(2), Florida Statutes, and Florida ...

November 04, 2026
Castro Valdez Had an Available Administrative Appeal and Failed to Establish a Ground for Excusing

Administrative Review Permits the Agency to Apply its Expertise

Post 4574

In Erwin Jordan Castro Valdez v. Warden, Otay Mesa Detention Center, No. 26-cv-06147-BAS-JLB, United States District Court, S.D. California (October 30, 2026) Castro Valdez, a Cuban national paroled into the United States, was arrested on June 23, 2026, for alleged insurance fraud, grand theft, and making a false report to law enforcement. In his first habeas action, the district court ordered a bond hearing within fourteen days to determine whether the changed circumstances justified revoking his parole.

An Immigration Judge subsequently denied bond because of his pending state criminal case. Castro Valdez filed a second petition under 28 U.S.C. § 2241, challenging that determination and requesting immediate release without first appealing to the Board of Immigration Appeals (BIA).

LAW

According to the supplied text, § 2241 does not expressly require administrative exhaustion, but courts impose exhaustion as a prudential requirement. ...

November 03, 2026
Jury Found Prudential to be the Victim of Fraud

Insured’s Ordered to Pay Insurer for Fraud by the Insureds

Post 4573

Posted on November 3, 2026 by Barry Zalma

In The Prudential Insurance Company Of America v. Carol Gardina and George Gardina, No. 6:23-cv-1125-JSS-DCI, United States District Court, M.D. Florida, Orlando Division (October 22, 2026).

THE JURY TRIAL AND VERDICT

Plaintiff sued Defendants for numerous causes of action stemming from its allegations that Defendants fraudulently collected benefits under their long-term care insurance policies. Plaintiff's case proceeded to a nine-day jury trial, after which the jury found Defendants liable for fraudulent misrepresentation, fraudulent concealment, and civil conspiracy.

The jury also found Defendant Carol Gardina liable to Plaintiff for $1,930,129 in compensatory damages and Defendant George Gardina liable to Plaintiff for $12,496 in compensatory damages and $20 in punitive damages. Thereafter, the court entered judgment in Plaintiff's favor and awarded Plaintiff $1,930,129 in compensatory damages from...

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