See the full video at https://lnkd.in/g8PFPHuh and at https://lnkd.in/gkvM9jvK and at https://zalma.com/blog plus more than 5150 posts.
Suits Between Insurance Agents Excluded by E&O Policy
Post 5197
In Laurence Ziff, individually, and the Ziff agency, LLC v. Allianz Global Risks U.S. Insurance Company f/k/a Fireman’s Fund Insurance Company, Civil Action No. 24-10529, United States District Court, D. New Jersey (September 23, 2025) Laurence Ziff and The Ziff Agency, LLC are insurance brokers sued Defendant Allianz Global Risks U.S. Insurance Company for defense and indemnity to a lawsuit alleging defamation.
FACTS:
Insurance Policy:
Plaintiffs purchased several insurance policies from Defendant, including the policy at issue, which provided “Company Sponsored Life Insurance Agents Errors and Omissions Liability Coverage”.
Plotkin Lawsuit:
The lawsuit arose from a dispute where David Plotkin and Richard Urbealis sued Plaintiffs in New Jersey state court, alleging defamatory statements made by Plaintiff Ziff during a meeting related to the sale of life insurance policies.
Exclusion K:
Defendant denied coverage based on Exclusion K, which disclaims liability for any claim arising out of disputes with other insurance agents or brokers.
LEGAL PRINCIPLES:
Motion to Dismiss:
Defendant filed a motion to dismiss the Amended Complaint for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6).
Exclusion K Interpretation:
The court found that Exclusion K was unambiguous and applicable, as it excluded coverage for disputes between insurance agents and brokers, including those concerning commissions, fees, and client lists.
ANALYSIS
Exclusionary clauses in insurance policies are narrowly construed. The insurer has the burden to prove that an exclusion applies. If there is more than one possible interpretation of the language, courts apply the meaning that supports coverage rather than the one that limits it. If the words used in an exclusionary clause are clear and unambiguous, a court will not engage in a strained construction to support the imposition of liability.
Defendant argued that the Plotkin Lawsuit was a dispute between insurance agents and brokers and that therefore Exclusion K must apply. Plaintiffs concede that Plotkin and Urbealis are “insurance agents” but contend that Plotkin and Urbealis did not sue Plaintiffs as insurance brokers or insurance agents and did not act as insurance brokers or insurance agents in the placement of the life insurance policies at issue.
Contrary to the allegations the record clearly demonstrated that Urbealis and Plotkin were acting as insurance agents when trying to sell life insurance policies to Kurtz. Since the language of Exclusion K is unambiguous and applies here Plaintiffs were not entitled to coverage under the Policy and failed to state a claim upon which relief could be granted under Rule 12(b)(6).
CONCLUSION
Defendant’s motion to dismiss was granted because a court may dismiss a claim with prejudice when leave to amend would be futile. Because Plaintiffs failed to identify any way in which they would be entitled to coverage under the Plan, amending their complaint for a second time would be futile so the case was dismissed.
ZALMA OPINION
Insurance policies are contracts whose terms and conditions, when brought to a court, are interpreted by the court. The Allianz policy excluded disputes between agents and brokers in language that was clear and unambiguous and the dispute was a result of claims made by insurance agents or brokers against the insured insurance agent. No coverage was obvious.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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ZIFL-Volume 29 Number 22
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post 5228
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/
Read the full 20 page issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-11-15-2025-1.pdf
Man Bites Dog Story – Hertz Sues Alleged Fraudsters
Hertz Successfully Refuses to Pay Alleged Fraudulent Health Care Providers
Proactive Victim of Fraud Defeats Health Care Providers
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty eighth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be ...
Expert May Not Testify About STOLI for Lack of Experience
Post 5227
Read the full article at https://lnkd.in/g8MPwJxM, see the video at https://lnkd.in/gx6rzPH3 and at https://lnkd.in/gumfUqXv, and at https://zalma.com/blog plus more than 5200 posts.
Insurer Needs to be Careful When Retaining an Expert With No Experience About the Key Issue in the Case.
In Ameritas Life Insurance Corp. v. Wilmington Savings Fund Society, FSB, United States District Court for the District of Delaware (Civil Action No. 23-236-GBW), Judge: Gregory B. Williams (November 7, 2025) Ameritas Life Insurance Corp. (“Ameritas”) sought to void a $3 million life insurance policy on the life of Marvin Flaks (the “Policy”) as a stranger-originated life insurance (“STOLI”) policy lacking an insurable interest under Delaware law.
Defendant Wilmington Savings Fund Society, FSB (“Wilmington Savings”), as securities intermediary and counterclaim-plaintiff, opposed and sought to enforce the Policy.
Motion at Issue:
Wilmington Savings’ Daubert ...
Policy Terms Control Right to Return of Overpayments
Post 5226
See the video at https://lnkd.in/gxtJVDse and at https://lnkd.in/gGBxEHHH, and at https://zalma.com/blog plus more than 5200 posts.
An Insurer that Claims it Paid More than it Owed Admits to an Incompetent Claims Staff
In Scott A. Saveraid Trust for Scott A. Saveraid Revocable Trust v. QBE Specialty Insurance Company 2:25-cv-394-SPC-DNF, United States District Court for the Middle District of Florida, Fort Myers Division, Judge: Sheri Polster Chappell, U.S. District Judge (Date: November 7, 2025)
Key Facts
The plaintiff, Scott A. Saveraid Trust (the “Trust”), owns real property in Fort Myers Beach, FL. The Trust purchased a homeowners insurance policy (the “Policy”) from defendant QBE Specialty Insurance Company (“QBE”). In September 2022, the property sustained damage from Hurricane Ian, a covered peril under the Policy.
The Trust filed a claim with QBE, which investigated and paid $307,622.32 for dwelling coverage and $20,600 for loss of use. QBE alleges the ...
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 ...
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 ...
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 ...
