A Claim by Any Other Name is not a Claim
Post 5182
It is Imperative that Insured Report Potential Claim to Insurers
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In Jeffrey B. Scott v. Certain Underwriters At Lloyd’s, London, Subscribing To Policy No. B0901li1837279, RLI Insurance Company, Certain Underwriters At Lloyds, London And The Insurance Company, Subscribing To Policy No. B0180fn2102430, No. 24-12441, United States Court of Appeals, Eleventh Circuit (August 25, 2025) the court explained the need for a claim to obtain coverage.
Case Background:
This appeal arises from a coverage dispute under a Directors & Officers (D&O) insurance policy. Jeffrey B. Scott, the plaintiff-appellant, was terminated from his role as CEO, President, and Secretary of Gemini Financial Holdings, LLC in October 2019. Following his termination, Scott threatened legal action against Gemini, and Gemini sent him letters accusing him of misconduct and demanding the return of company property.
Insurance Policy:
The D&O insurance policy issued by Underwriters at Lloyd’s, London, provides coverage for directors, officers, and managers of Gemini. The policy defines a “Claim” as a “written demand for monetary damages, non-monetary, or injunctive relief against any of the Insureds”. It also provides coverage if the Chief Executive Officer, Chief Financial Officer, or Chief Actuary (or equivalent position) of the company gives “notice of circumstances . . . that may reasonably be expected to give rise” to a claim.
Legal Dispute:
Scott submitted a letter to Lloyd’s on November 23, 2019, entitled “Notice of Claim,” enclosing Gemini’s letters. Lloyd’s denied coverage, determining that no “Claim” against Scott had been made under the policy. Scott sued Lloyd’s for insurance coverage, but the district court dismissed the case. Scott’s arguments included that his documents reflected a “claim” or a “notice of circumstances” for a future claim.
Legal Principles:
In diversity cases arising under Florida law, a federal court is bound by the law articulated by the Florida Supreme Court. Unambiguous policy terms are interpreted according to their plain meaning as written.
If the Florida Supreme Court has not spoken on an issue, Florida District Court of Appeals decisions control absent persuasive indication that the Florida Supreme Court would rule otherwise. As a matter of Florida law, unambiguous policy terms are interpreted according to their plain meaning as written.
The letters cited by Scott do not contain a demand for relief against him. They explain why, in Gemini’s view, Scott was terminated and request that he preserve documents and return company equipment. The letters Gemini sent do not request monetary payment or legal remedies. Instead, they assert a cause for Scott’s termination and outline expectations for his post-employment conduct. Viewed in the light most favorable to Scott, these letters are anticipatory posturing for a future dispute-an intention to “[review] certain workplace conduct by [Scott].” But they are not present demands for relief.
Scott’s November 2019 letter did not identify circumstances that would lead to a claim against him. Instead, it mostly reflects his demands against Gemini over a putative wrongful termination. Scott was not one of the specified officers who could provide a notice of circumstances under the policy when he sent his November letter.
The district court correctly rejected Scott’s arguments that his documents reflected a “claim,” or, in the alternative, a “notice of circumstances” for a future claim.
Court’s Decision:
The district court held that no “Claim” as defined in the policy was made against Scott during the policy period and that Scott did not provide a “notice of circumstances” to trigger coverage. The court also noted that the letters from Gemini did not request monetary payment or legal remedies but instead asserted a cause for Scott’s termination and outlined expectations for his post-employment conduct. The Eleventh Circuit affirmed the USDC.
ZALMA OPINION
Insurance is nothing more than a contract like any other contract. It is interpreted by dealing with the usual meaning of the words used. Letters accusing a fired CEO of misconduct and demanding the return of company property was not a claim nor was the fired CEO’s request for detail was a “claim” as defined by the policy. The threat, if made to an intelligent corporate officer or insurance consultant should have resulted in a potential “claim” but the insured did not advise the insurers of the potential claim.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Montana County Attorney Admits to Insurance Fraud & Is Only Suspended from Practice for 60 Days
Post 5251
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A Lawyer Who Commits Insurance Fraud and Pleas to a Lower Charge Only Suspended
In The Matter Of: Naomi R. Leisz, Attorney at Law, No. PR 25-0150, Supreme Court of Montana (December 23, 2025) the Montana Office of Disciplinary Counsel (ODC) filed a formal disciplinary complaint with the Commission on Practice (Commission) against Montana attorney Naomi R. Leisz.
On September 25, 2025, Leisz tendered a conditional admission and affidavit of consent. Leisz acknowledged the material facts of the complaint were true and she had violated the Montana Rules of Professional Conduct as alleged by ODC.
ADMISSIONS
Leisz admitted that in April 2022, her minor son was involved in a car accident in which he hit a power pole. Leisz’s son ...
Montana County Attorney Admits to Insurance Fraud & Is Only Suspended from Practice for 60 Days
Post 5251
Read the full article at https://lnkd.in/gnBaCjmv, see the video at https://lnkd.in/gfpVsyAd and at https://lnkd.in/gC73Nd8z, and at https://zalma.com/blog plus more than 5250 posts.
A Lawyer Who Commits Insurance Fraud and Pleas to a Lower Charge Only Suspended
In The Matter Of: Naomi R. Leisz, Attorney at Law, No. PR 25-0150, Supreme Court of Montana (December 23, 2025) the Montana Office of Disciplinary Counsel (ODC) filed a formal disciplinary complaint with the Commission on Practice (Commission) against Montana attorney Naomi R. Leisz.
On September 25, 2025, Leisz tendered a conditional admission and affidavit of consent. Leisz acknowledged the material facts of the complaint were true and she had violated the Montana Rules of Professional Conduct as alleged by ODC.
ADMISSIONS
Leisz admitted that in April 2022, her minor son was involved in a car accident in which he hit a power pole. Leisz’s son ...
Insurer’s Exclusion for Claims of Assault & Battery is Effective
Post 5250
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Bar Fight With Security is an Excluded Assault & Battery
In The Cincinnati Specialty Underwriters Insurance Company v. Mainline Private Security, LLC, et al., Civil Action No. 24-3871, United States District Court, E.D. Pennsylvania (December 16, 2025) two violent attacks occurred in Philadelphia involving young men, Eric Pope (who died) and Rishabh Abhyankar (who suffered catastrophic injuries). Both incidents involved security guards provided by Mainline Private Security, LLC (“Mainline”) at local bars. The estates of the victims sued the attackers, the bars, and Mainline for negligence and assault/battery. The insurer exhausted a special limit and then denied defense or indemnity to Mainline Private Security.
INSURANCE COVERAGE
Mainline had purchased a commercial ...
Court Must Follow Judicial Precedent
Post 5252
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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 ...
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 ...
Zalma’s Insurance Fraud Letter
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ZIFL Volume 29, Issue 24
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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:
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