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 18, 2025
If Policy is Rescinded Neither Named nor Additional Insureds Recover

Additional Insureds Can Intervene to Try to Defeat Suit to Rescind Policy

Post 5170

See the full video at https://lnkd.in/gYfHuADV and at https://lnkd.in/gnw6FFdX, and at https://zalma.com/blog plus more than 5150 posts.

Posted on August 18, 2025 by Barry Zalma

The case involves Accelerant Specialty Insurance Company (“Accelerant”) seeking a declaratory judgment against Big Apple Designers, Inc. (“Big Apple”), declaring that the insurance policies issued by Accelerant to Big Apple are invalid and do not create a duty to defend or indemnify Big Apple in several personal injury actions currently pending in New York State Supreme Court. M&R Construction Group, Inc. (“M&R”) and Continental Indemnity Company (“Continental”) filed a motion to intervene, asserting that M&R is entitled to coverage from Accelerant as an additional insured.

In Accelerant Specialty Insurance Company v. Big Apple Designers, Inc., No. 24-CV-7793 (ARR) (RML), United States District Court, E.D. New York (August 6, 2025) the USDC ruled to allow intervention to dispute the claim of rescission.

BACKGROUND

Indemnification and Duty to Defend:

The court discussed the distinction between an insurer’s duty to defend and its duty to indemnify. The duty to defend is triggered by the initiation of a claim under which the insured may eventually be found liable, while the duty to indemnify is contingent upon a liability finding.
INTERVENTION:

The court granted the motion to intervene by M&R and Continental, allowing them to assert counterclaims against Accelerant. The court found that intervention will promote efficiency and prevent inconsistent judgments to allow proper defense of Accelerant’s claim of rescission.

DECLARATORY JUDGMENT AND RESCISSION:

Accelerant sought a declaratory judgment that the insurance policies were void due to Big Apple’s material misrepresentations in its insurance application. The court discussed the principles of rescission and the impact of misrepresentations on the validity of insurance policies but did not rule on the issue.

COURT’S DECISION:

The court granted the motion to intervene by M&R and Continental, allowing them to assert their proposed counterclaims against Accelerant, with the exception of any claims seeking indemnification. The court declined to exercise jurisdiction over M&R’s claim for indemnification under the Declaratory Judgment Act, as liability has not yet been determined in the underlying Yunga Action.

ANALYSIS

Accelerant’s first and second claims both sougt declaratory judgments that disclaim Big Apple’s entitlement to coverage under the Accelerant Policies. The first claim asserts a breach of contract-that Big Apple’s misrepresentations in its insurance application breached the Accelerant Policies’ contractual warranties.

Intervention as a Matter of Right

To establish intervention as of right pursuant to Rule 24(a)(2), an intervenor must show that (1) the motion is timely; (2) the applicant asserts an interest relating to the property or transaction that is the subject of the action; (3) the applicant is so situated that without intervention, disposition of the action may, as a practical matter, impair or impede the applicant’s ability to protect its interest; and (4) the applicant’s interest is not adequately represented by the other parties.

The decision to permit intervention is not unlimited, however. Intervenors seek a declaration that Accelerant owes a duty to defend and indemnify M&R in the Yunga Action. As the Second Circuit has explained, even in circumstances when a declaratory judgment would serve a useful purpose in clarifying and settling the legal relations in issue, district courts retain broad discretion to decline jurisdiction under the DJA.

An insurer’s duty to defend an additional insured is triggered by the initiation of a claim under which its insured may eventually be found liable. It is not contingent upon a liability finding.

DECLARATORY JUDGMENT AND RESCISSION:

The court concluded that the named insured did not represent the interests of the additional insured in disputing the rescission and so granted leave to intervene.

ZALMA OPINION

Rescission, if granted, puts the parties back to the place where they were before the inception of the policy. The court noted that the named insured was not interested, nor were they trying to defeat the rescission, but that the additional insured who intervened would put in the effort so the court granted intervention and left the issue of rescission for a more detailed consideration. If Accelerant can prove the policy was obtained by fraud or material misrepresentation the policy will be void from its inception and neither the named nor the additional insureds will be allowed defense or indemnification.

You can find a permanent public version of the document here: https://public.fastcase.com/jaEE2PXzRXmZ99jOLMt1Il4uCbo8ZFJ5okOMj4HOg56hikcK0S3TPNmeOPNAlT7%2fWbJynHYMpBbNuraQPgltZA%3d%3d

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:08:06
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December 12, 2025
$455 Million for Unnecessary Covid Tests is a Crime

Detail Charging Defendant for Fraud is Sufficient
Post 5242

Read the full article at https://lnkd.in/g_HVw36q, see the video at https://lnkd.in/gpBd-XTg and at https://lnkd.in/gzCnBjgQ and at https://zalma.com/blog plus more than 5200 posts.

Charges that Advises the Defendant of the Crime Cannot be Set Aside

In United States Of America v. Lourdes Navarro, AKA Lulu, No. 25-661, United States Court of Appeals, Ninth Circuit (December 4, 2025) Lourdes Navarro appealed the district court’s denial of her motion to dismiss the indictment and enter final judgment was in error.

FACTUAL BACKGROUND

The indictment alleged that insurers reimburse only for medically necessary services. Navarro performed unnecessary respiratory pathogen panel (RPP) tests on nasal swabs collected from asymptomatic individuals for COVID-19 screening.

Navarro billed over $455 million to insurers for those additional RPP tests that she knew to be medically unnecessary. These allegations constituted a plain, concise, and definite written ...

00:07:41
December 11, 2025
An International Convention Requiring Enforcement of Foreign Arbitration Award Doesn’t Apply

Louisiana Statute Prevents Enforcement of Contract Term Requiring Arbitration of Disputes

Post 5241

Read the full article at https://www.linkedin.com/pulse/international-convention-requiring-enforcement-award-barry-sttdc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.

In Town of Vinton v. Indian Harbor Insurance Company, Nos. 24-30035, 24-30748, 24-30749, 24-30750, 24-30751, 24-30756, 24-30757, United States Court of Appeals, Fifth Circuit (December 8, 2025) municipal entities including the Town of Vinton, et al sued domestic insurers after dismissing foreign insurers with prejudice. The insurers sought arbitration under the Convention on the Recognition and Enforcement of Foreign Arbitral Awards (the “Convention”) but the court held Louisiana law — prohibiting arbitration clauses in such policies—controls, as the Convention does not apply absent foreign parties who ...

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December 10, 2025
$500 a Day Penalty if no Workers’ Compensation Insurance

Refusal to Provide Workers’ Compensation is Expensive
Post 5240

Read the full article at https://lnkd.in/guC9dnqA, see the video at https://lnkd.in/gVxz-qmk and at https://lnkd.in/gUTAnCZw, and at https://zalma.com/blog plus more than 5200 posts.

In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.

Company Overview:

USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...

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9 hours ago
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 ...

October 31, 2025
The Zalma Philosophy of Claims Handling – Part 9

The Professional Claims Handler
Post 5219

Posted on October 31, 2025 by Barry Zalma

An Insurance claims professionals should be a person who:

Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.

How to Create Claims Professionals

To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...

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October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

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