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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September 10, 2025
Insurer Liable but Only for $1 Damages

Life Insurer Took Advantage of Plaintiff But Damages not Proved

Post 5187

Read the full article at https://www.linkedin.com/pulse/insurer-liable-only-1-damages-barry-zalma-esq-cfe-chbnc, see the full video at https://rumble.com/v6yoz9y-insurer-liable-but-only-for-1-damages.html and at https://youtu.be/OaX51GsfLcg, and at https://zalma.com/blog plus more than 5150 posts.

In Malcolm Wiener v. AXA Equitable Life Insurance Company, No. 24-1316, United States Court of Appeals, Fourth Circuit (September 3, 2025) the Fourth Circuit’s opinion addressed the sufficiency of evidence for a jury’s damages award in a negligence case involving AXA Equitable Life Insurance and Malcolm Wiener. AXA was found liable for negligence yet the court affirmed the trial court’s conclusion that the jury lacked sufficient evidence to reasonably calculate Wiener’s damages beyond minimal damages.

AXA liable for negligence but damages unsupported:

The court affirmed AXA’s negligence liability but ruled the jury’s $16 million damages award was unsupported due to insufficient evidence on Wiener’s expected remaining lifespan.

Damages require reasonable certainty under North Carolina law:

Under North Carolina law, damages must be proved with reasonable certainty, requiring specific and complete evidence to allow a jury to reasonably conclude the amount. Speculative damages are not permitted.

Two key data points needed for damages calculation:

To calculate damages for increased insurance premiums, the jury needed evidence of (1) additional annual premiums Wiener would pay, and (2) his expected remaining lifespan after 2014. Wiener provided evidence only for the first.

Insufficient evidence on Wiener’s expected lifespan:

The jury lacked adequate medical or actuarial evidence to determine Wiener’s remaining lifespan, with only general health remarks and a video call observation offered, which the court found speculative.

Nominal damages awarded due to lack of damage proof:

Since Wiener established causation and injury but failed to prove damages with reasonable certainty, the court held nominal damages of $1 were appropriate.

Jury’s use of death benefit as damages measure rejected:

Wiener’s argument that the $16 million death benefit of a hoped-for replacement policy could serve as damages was rejected as it confused the injury type; the injury was increased cost, not loss of policy termination.

Prior rulings and procedural posture:

The case had prior appeals affirming negligence liability but remanding for damages evaluation. The district court granted AXA’s Rule 50(b) motion to reduce damages, which the appellate court affirmed, declining to address a conditional new trial motion.

In the second time the case come before the Fourth Circuit on appeal. The first time, the parties disputed, among other things, whether there was sufficient evidence for a jury to find AXA liable for causing Malcolm Wiener’s inability to find a life insurance policy. The Fourth Circuit held that there was but remanded to have the district court determine whether the jury had sufficient evidence to calculate the amount of Wiener’s damages. The district court found the evidence lacking.

DISCUSSION

With AXA’s liability settled, the sole question on appeal is whether the jury had sufficient evidence to determine that Wiener suffered $16 million in damages.

The Jury Lacked Sufficient Evidence To Calculate Damages

Taking the evidence in the most favorable light to the party opposing the motion the Fourth Circuit asked whether a reasonable jury could have arrived at its conclusion. Under North Carolina law, proof of damages must be made with reasonable certainty. Although absolute certainty is not required, damages may not be awarded where the evidence permits no more than speculation.

The evidence fell short. The injury is that Wiener could not obtain insurance at a reasonable price because AXA’s erroneous MIB codes prevented carriers from issuing a policy at the standard rate. In other words, Wiener would have had to pay increased premiums over the rest of his life to receive the same permanent life insurance coverage through death.

AXA argued that we cannot assume that Wiener could have obtained a policy at the standard rate in the absence of erroneous MIB codes. Wiener’s expected remaining lifespan in 2014. North Carolina courts have rejected damages awards from juries that had more medical information than the jury did here. Wiener needed to put forth evidence directly establishing his expected remaining lifespan. Because he did not, the jury should not be permitted to speculate how long, in their opinion, they think Wiener’s life will continue in the future.

The jury was not given sufficient evidence to determine Wiener’s expected remaining lifespan. And without that data point, the jury could not calculate Wiener’s damages with reasonable certainty. That leaves Wiener to recover nominal damages of $1.

ZALMA OPINION

Although the District Court and the Fourth Circuit agreed that AXA took advantage of the plaintiff in how it calculated its premium, since they did not prove Wiener’s life expectancy the calculation of damages failed and he was only entitled, after two appeals, to $1 in damages. The lawyers, if on a contingency, earned $0.40 to $0.45 cents of the damages. This case establishes that even if an insurance company does wrong does not mean that the plaintiff will get rich with large compensatory damages and punitive damages.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:08:20
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Videos
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July 22, 2026
The Real Cost of Fraud

The Largest Residential Burglary of All Time
Post 5407

Fraud & the Fear of Bad Faith Suits
Posted on July 22, 2026 by Barry Zalma

See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.

After ...

00:12:33
July 20, 2026
Search Warrant Produces Evidence of Insurance Fraud

Chutzpah is not Enough
Post 5397

Posted on July 20, 2026 by Barry Zalma

See the video and at https://lnkd.in/gNUs2XzT and at https://lnkd.in/g2MawyzX

Magistrate Issues a Search Warrant if there is a Fair Probability that Contraband or Evidence of a Crime will be Found in a Particular Place.

In United States Of America v. Frank Suess, et al., CRIMINAL No. 3:24-308, United States District Court, M.D. Pennsylvania (July 16, 2026) a federal grand jury indicted Frank Suess, Melissa Driscoll, and others in a 55-count health care fraud and anti-kickback prosecution arising from an alleged scheme involving medically unnecessary prescription “foot baths.”

As part of the investigation, the FBI obtained an August 19, 2022 warrant to search Driscoll’s Sterling Pharmacy Yahoo email account for emails from January 1, 2018 through December 31, 2020. Driscoll moved to suppress the resulting evidence, arguing that the warrant lacked probable cause, was overbroad, and rested on material misstatements and omissions.

LAW:

The ...

00:08:22
July 17, 2026
The Great Jewel Theft

Fraud Shouldn’t Pay

Post 5396

See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA

This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ¬¬¬Perpetrators than any Other Crime.

The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.

One month after the policy was ...

00:09:42
9 hours ago
Plaintiff Sues Because State Employees Stigmatized Her

Day Care Owner Loses Subsidies Because She Criticized State

Post 5421

Posted on August 11, 2026 by Barry Zalma

First Amendment Right Will be Allowed to Go to Trial

In Betsey J. Grant v. Maine State Department Of Heath And Human Services, No. 1:25-cv-00490-JAW, United States District Court, D. Maine (August 6, 2026), Betsey J. Grant, a licensed childcare provider and operator of Tiny Tikes Daycare in Trenton, Maine, sued Maine DHHS and several employees after she publicly criticized DHHS before Maine’s Government Oversight Committee and alleged that officials retaliated against her.

She claimed DHHS imposed and extended a conditional license, published stigmatizing information, interfered with subsidies and program funding, removed her from a food program, rescinded an expansion grant, and used biased or falsified evidence in licensing proceedings. Following the March 10, 2023, GOC testimony, Ms. Grant alleges that foster children's subsidies (approximately $30,000) were withheld; she was removed from the ...

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August 05, 2026
It Doesn’t Pay to Lie in an Application for Insurance

Rescission for Material Misrepresentation
Post 5418

Posted on August 5, 2026 by Barry Zalma

An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.

In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units. After an underlying personal injury action was filed, Union Mutual determined that the property actually contained three apartment units and rescinded the policies on the ground that the defendants had made a material misrepresentation in the applications.
LAW:

A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true ...

post photo preview
August 05, 2026
It Doesn’t Pay to Lie in an Application for Insurance

Rescission for Material Misrepresentation
Post 5418

Posted on August 5, 2026 by Barry Zalma

An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.

In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units.

LAW:

A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true facts been disclosed. To establish materiality as a matter of law, the insurer must submit documentation of its underwriting practices, such as manuals, guidelines, bulletins, or rules addressing similar risks.

DISCUSSION/ANALYSIS:

As a result, the...

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