Policy Limit is the Most an Insured Can Recover for a Loss
Post 5174
Read the full article at https://www.linkedin.com/pulse/insurer-free-liability-claims-consultant-barry-zalma-esq-cfe-dqrbc, see the full video at https://rumble.com/v6y1wvu-insurer-free-of-liability-claims-consultant-not.html and at https://youtu.be/Te7UsKzhGNU, and at https://zalma.com/blog plus more than 5150 posts.
Water Damage Special Limit of Liability Enforced
In Abraham & Co. Inc v. Markel Insurance Company And Hirschfield Risk Services, Inc. D/B/A H&H Claims Consultants, No. 14-24-00242-CV, Court of Appeals of Texas, Fourteenth District (August 19, 2025) dealt with damages caused by Winter Storm Uri in February 2021 when pipes at Abraham's location burst, causing water damage to numerous rugs.
KEY FACTS:
Insurance Policy:
Markel issued an insurance policy to Abraham, effective from November 16, 2020, to November 16, 2021, with a liability limit of $2 million for covered property and a special limit of $750,000 for water damage.
Claim and Dispute:
Abraham filed a claim under the policy and Markel paid only $750,000 based on an endorsement limiting liability for water damage.
Legal Proceedings:
Abraham filed suit against Markel for breach of contract and other claims, and against H&H for negligence and violations of the Texas Insurance Code.
LEGAL CONCLUSIONS:
Coverage Limit:
The trial court concluded that the policy's unambiguous language limited the coverage for Abraham's claim to $750,000.
Negligence Claims:
The Court of Appeals concluded that the trial court did not err in granting summary judgment for H&H on the negligent claims handling but erred in dismissing Abraham's general negligence claim.
Extra-Contractual Claims:
The trial court did not err in granting summary judgment on Abraham's extra-contractual claims against Markel and H&H.
CONCLUSIONS:
It was undisputed that Abraham's claim was based on a loss caused by water damage and that Markel has paid $750,000 on this claim and the trial court did not err in granting summary judgment and dismissing with prejudice Abraham's breach-of-contract claim against Markel.
To the extent the trial court granted summary judgment as to Abraham's claim for negligent claims handling, dismissed the claim, and determined that H&H cannot be liable based on a theory of negligent claims handling, the trial court did not err, and the Court of Appeals affirmed the trial court's judgment.
To the extent the trial court granted summary judgment as to Abraham's General Negligence Claim, dismissed the claim, and determined that H&H cannot be liable on a theory of general negligence, the trial court erred and the Court of Appeals reversed the trial court's judgment and remanded the case for further proceedings.
Did The Trial Court Err In Granting Summary Judgment As To Abraham's Negligence Claims Against H&H?
In part of its first issue and in its second issue Abraham challenges the trial court's granting of summary judgment as to its negligence claims against H&H, the claims consultants.
To the extent the trial court granted summary judgment as to Abraham's claim for negligent claims handling, dismissed the claim, and determined that H&H cannot be liable based on a theory of negligent claims handling, the trial court did not err, and the trial court's judgment was affirmed. To the extent the trial court granted summary judgment as to Abraham's General Negligence Claim, dismissed the claim, and determined that H&H cannot be liable on a theory of general negligence, the trial court erred.
ZALMA OPINION
Many insurance companies do not have a claims staff to deal with all claims and retain the services of independent claims adjusters and consultants like H&H. The Court of Appeals found that everything that the insurer did was appropriate it still allowed the case to go forward against H&H who only can act as an agent of the insurer and, if it acted negligently, it can be liable for any damages resulting from its negligence. How, if the claim was handled appropriately and the insured paid the limit of liability of the policy, the claims handler could be negligent is difficult to prognosticate.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.
Subscribe to my substack at https://barryzalma.substack.com/subscribe
Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://lnkd.in/gwEYk.
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...
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 ...
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 ...
Defendants Successfully Moved for Summary Judgment
Post 4854
Posted on September 30, 2026 by Barry Zalma
In Jeffrey Wayne Phillips v. Creative Website Studios, et al., No. 5:23-CV-568-BO-BM, United States District Court, E.D. North Carolina, Western Division (September 28, 2026) the Court needed to rule on the order and memorandum and recommendation (“M&R”) of the Magistrate.
Jeffrey Wayne Phillips had contracted with Creative Website Studios and SR Telecommunications for website and hosting services. He alleged that defendants repeatedly billed him for hosting periods he had already paid for and later took down his website. Phillips claimed the outage prevented him from bidding on U.S. government security contracts and sought roughly $300 million in consequential damages.
LAW
Under North Carolina law, fraud requires a false material representation or concealment, intent and effect of deception, resulting damage, and reasonable reliance. Obtaining property by false pretenses similarly requires an ...
Accused of 17 Counts Of Fraud Attempts to Keep Out Evidence of Crimes
Post 4853
Posted on September 29, 2026 by Barry Zalma
Court Refuses to Grant Most Motions in Limine
In United States Of America v. Seth Allen Aikens, II, Criminal No. 22-119, United States District Court, W.D. Pennsylvania (September 23, 2026) Defendant Seth Allen Aikens II faces thirty federal counts. The indictment alleges that, from about June 2016 through March 2020, Aikens solicited start-up businesses seeking websites, applications, hosting, payment processing, and related services. The Government estimated aggregate losses of approximately $1.3 million involving about eight charged customers.
The Government also sought to introduce evidence involving three uncharged persons. Robert Polonsky allegedly paid about $10,000 for web development, hosting, and advertising services but did not receive the promised core deliverables. Brandon Canwright allegedly paid approximately $1,877 for a website and related services that were not delivered and received no ...
Accused of 17 Counts Of Fraud Attempts to Keep Out Evidence of Crimes
Post 4853
Posted on September 29, 2026 by Barry Zalma
Court Refuses to Grant Most Motions in Limine
In United States Of America v. Seth Allen Aikens, II, Criminal No. 22-119, United States District Court, W.D. Pennsylvania (September 23, 2026) Defendant Seth Allen Aikens II faces thirty federal counts. The indictment alleges that, from about June 2016 through March 2020, Aikens solicited start-up businesses seeking websites, applications, hosting, payment processing, and related services. The Government estimated aggregate losses of approximately $1.3 million involving about eight charged customers.
The Government also sought to introduce evidence involving three uncharged persons. Robert Polonsky allegedly paid about $10,000 for web development, hosting, and advertising services but did not receive the promised core deliverables. Brandon Canwright allegedly paid approximately $1,877 for a website and related services that were not delivered and received no ...
