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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 14, 2025
Appraisal Award Sets Amount of Loss

Award Signed by Two of Three Appraisers Binding on Insured and Insurer

Post 5168

See the full video at https://rumble.com/v6xj16m-appraisal-award-sets-amount-of-loss.html and at https://youtu.be/XBy4m31c0AM, and at https://zalma.com/blog plus more than 5150 posts.Dispute Over Extent of Damages is not Bad Faith

Kelly Mallady filed a lawsuit against Homeowners of America Insurance Company due to damages sustained from a nearby explosion in January 2020 that the insurer rejected in part.

In Kelly Mallady v. Homeowners Of America Insurance Company, No. 14-24-00147-CV, Court of Appeals of Texas, Fourteenth District (August 7, 2025) resolution was obtained of the disputes.

CASE BACKGROUND:

1 Mallady’s homeowners insurance policy was effective from September 15, 2019, to September 15, 2020 .
2 The initial claim was acknowledged, and an independent adjuster estimated the property damage to be $13,014.79, covering only the dwelling and fence.
3 Mallady invoked appraisal, demanding $247,860.40 for property and contents damages, plus $10,000 in attorney’s fees .

APPRAISAL AWARDS:

1 The first appraisal award (April award) set the loss for the dwelling at $24,000 replacement cost value and $21,900 actual cash value .
2 The April award did not address contents damages and was later voided.
3 A subsequent appraisal award (June award) assessed damages at $215,616.65 and $145,778.70 actual cash value, covering the dwelling, fence, and contents .

LEGAL PROCEEDINGS:

1 Homeowners of America filed a motion to set aside the June award and confirm the April award, arguing the April award was binding once signed by two parties .
2 The trial court set aside the June award and confirmed the April award .
3 Mallady filed suit alleging breach of contract, bad faith, deceptive trade practices, and other claims .
4 The trial court granted summary judgment in favor of Homeowners of America, which Mallady appealed .

COURT’S DECISION:

1 The appellate court affirmed in part and reversed and remanded in part.
2 The court concluded that the trial court erred in granting summary judgment on Mallady’s breach of contract claim.
3 The court sustained several of Mallady’s issues challenging the trial court’s grant of summary judgment.

ANALYSIS

Breach of Contract Claim:

The court concluded that the trial court erred in granting summary judgment on Mallady’s breach of contract claim. The April award did not set the amount of loss for contents, and the evidence showed that content damages were to be addressed in a separate award after inspection of the property. Therefore, the trial court’s decision to grant summary judgment was incorrect as there was a genuine issue of material fact regarding the contents damages.

Appraisal Awards:

The award, which assessed damages only for the dwelling, was signed by two of the three parties, making it binding. However, the June award, which included damages for the dwelling, fence, and contents, was issued later and signed by McLeod and Choate. The trial court set aside the June award and confirmed the April award, but the appellate court found that the trial court erred in this decision.

Appraisal clauses estop a party from contesting the issue of damages in a lawsuit based on an insurance contract. If a party seeks to avoid an appraisal award, the burden of proof is theirs to raise an issue of material fact as to why the resolution they contractually agreed to should be set aside. If the appraisal award is not set aside, this contractual process settles the issue of damages, and settlement of the full amount owed estops the insured from bringing a breach of contract claim against the insurer.

Examination Under Oath:

The trial court’s order requiring Choate to submit to an examination under oath was vacated. The court concluded that the policy did not require Choate to submit to an examination under oath as he was not considered Mallady’s representative. However, since Choate as a independent appraiser is not a representative of the insured he may not be compelled to testify at EUO.

Independent Injury Rule:

Mallady’s claims for mental anguish and attorney’s fees were not considered independent injuries that could support her extra-contractual claims. The court found that the mental anguish damages stemmed from the denial of policy benefits and were not truly independent injuries.

ZALMA OPINION

Once an appraisal award becomes final – signed by two of the three appraisers – the amount of loss is established. When there is a second appraisal making findings of loss and damage more than $200,000 greater than the first, and final award, the original award must be honored. However, since the first award failed to consider contents damages, it was incomplete and another appraisal of contents was required. The breach of contract can be tried but the bad faith claim was eliminated.

You can find a permanent public version of the document here: https://public.fastcase.com/jaEE2PXzRXmZ99jOLMt1IuUELJK35ulC0JH4o2YTkiYe9ytM%2bHEzVcf4Tgc1Kro9RcFaidgUpgfDK0dIpLN22Q%3d%3d

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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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
October 26, 2026
Expert Report Must Be Admissible or it Will be Excluded

No Breach of Contract no Bad Faith

Post 4568
Posted on October 23, 2026 by Barry Zalma

A Party Cannot Designate One Witness While Submitting An Undifferentiated Product Of That Witness And An Undesignated Collaborator.

Post 4568

In Dustin Cain; Amanda Cain v. State Farm Fire and Casualty Company, No. 25-60442, United States Court of Appeals, Fifth Circuit (October 16, 2026) Dustin and Amanda Cain sought homeowners’ insurance benefits after a tree fell on their Mississippi home on August 27, 2022. State Farm concluded that the tree caused only a roof puncture and that other damage resulted from excluded long-term conditions. It paid $10,042.90 and later an additional $3,130.08.

The Cains relied on an engineering report and contractor estimate asserting substantially greater damage, sued for breach of contract and related relief, and designated Sean Fee as their sole expert. Fee’s report and a later repair estimate were jointly authored with Jim Irmiter, but neither document identified which opinions, work, or ...

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October 22, 2026
John Madden and The US Patent and Trademark Office

Blockchain Fraud Detection Loses Protection

Posted on October 22, 2026 by Barry Zalma

John Earl Madden (April 10, 1936 – December 28, 2021) was an American Professional Football Coach and Sports Commentator in the National Football League Seeking Patent & Trademark Protection

BLOCKCHAIN FRAUD

Mr. Madden was more than football. He was working to establish a program called “Fraud Protection Systems, Methods, and Computer Programs for Blockchain Financial Transactions.”

In Ex parte John Madden, Appeal 2026-001497, Application 18/495,506, Technology Center 3600, United States Patent and Trademark Office, Patent Trial and Appeal Board (October 14, 2026)

The Examiner rejected claims several numbered claims under 35 U.S.C. § 101 as directed to an abstract idea without significantly more.

THE LAW

Section 101 makes patentable any new and useful process, machine, manufacture, or composition of matter.Laws of nature, natural phenomena, and abstract ideas are implicitly excluded.

THE PATENT TRIAL AND ...

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October 21, 2026
Supervisory Officials are not Individually Liable

Sovereign Immunity Defeats Suit Against Police Officers

Post 4866

Posted on October 21, 2026 by Barry Zalma

In Chad Lightfoot, et al. v. Progressive Direct Insurance Company, et al., Civil Action No. 26-434, United States District Court, E.D. Louisiana (October 9, 2026) Chad Lightfoot was involved in an Orleans Parish automobile accident in 2011 and filed claims with several insurers, including Progressive.

After a related civil dispute, Progressive counsel allegedly submitted a false affidavit stating that Lightfoot had fraudulently received a $50,000 payment. A New Orleans police detective relied on the affidavit to obtain an arrest warrant, and Louisiana State Police Lieutenant Alan Arcana allegedly reported that Lightfoot had received the payment. Lightfoot was arrested in 2015 and charged with theft, insurance fraud, and perjury.

Plaintiffs alleged that no record of the payment existed and that the criminal charges were dismissed on October 15, 2024.

Lightfoot and Geralyn Hawkins filed suit in October 2025 and ...

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