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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Excellence in Claims Handling
Post 5215
Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-4-barry-zalma-esq-cfe-xupzc and at https://zalma.com/blog plus more than 5200 posts.
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.
Insurance Is A Service Business.
The insurance contract is a collection of promises made by the insurer to those persons or entities who understand that they, or their business, face risks of loss that could destroy the viability of a business or the home of a family. Insurers promise to pay to protect the insured against the risks of loss the insured faces.
Since people face a material loss to a house, factory, office, or commercial structure rarely, if at all insurance spreads the risk faced by many so that it can indemnify the few who actually suffer a loss.
...
The California Fair Claims Settlement Practices Regulations
The Reasons Why the California Department of Insurance Imposed the California Fair Claims Settlement Practices Regulations on All Insurers Doing Business in California
Post 5214
Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-3-barry-zalma-esq-cfe-vmwzc, see the full video at and at and at https://zalma.com/blog plus more than 5200 posts.
In 1993, after delaying for five years after receiving direction from the California Supreme Court, the state of California determined that the insurance industry needed to be regulated to stop insurers from treating the people insured badly and without good faith. It created a set of Regulations called the “California Fair Claims Settlement Practices Regulations” (the “Regulations) that were designed to enforce the mandate created by the California Fair Claims ...
Physician Conspired with Bonavilla to Effect Health Insurance Fraud
Post 5212
Read the full article at https://www.linkedin.com/pulse/conviction-health-insurance-fraud-upheld-barry-zalma-esq-cfe-2hnsc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
Dennis Davin Bonavilla was involved in an insurance fraud scheme as an executive of Free Choice Healthcare. The scheme targeted indigent patients, often on government-assisted insurance (Medi-Cal/Medicaid), convincing them to switch to group insurance policies obtained by Free Choice. Patients were falsely represented as employees of sham companies (Drexel Group, Kingmakers) to qualify for these policies.
In The People v. Dennis Davin Bonavilla, 081765, California Court of Appeals, Fourth District, Second Division (October 9, 2025) people identified as patients of Bonavilla and Free Choice Healthcare’s patients signed documents (often without ...
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 ...
Sometimes the Best Court Decision is to Do Nothing
Post 5209
Read the full article at https://www.linkedin.com/pulse/abstention-protects-against-risk-potentially-fact-zalma-esq-cfe-chkzc, and at https://zalma.com/blog plus more than 5200 posts.
In Starr Indemnity & Liability Company v. Scottsdale Insurance Company, No. 24-CV-3309 (PKC) (TAM), United States District Court, E.D. New York (September 30, 2025) the parties C.C.C. and HCC filed actions against Scottsdale in New York state court regarding Scottsdale’s insurance coverage obligations.
FACTS
Underlying Labor Litigation:
Hector David Campoverde sustained injuries from a scaffold fall at a construction site in Brooklyn, New York, on September 14, 2015. Campoverde, an employee of Vazquez Bro Restoration Inc., was working for C.C.C. Renovation Inc., a subcontractor of L&M Builders Group LLC.
LEGAL ISSUES
Declaratory Judgment:
Starr sought a declaratory judgment regarding Scottsdale’s obligations under the 2014-2015 and 2015-2016 policies.
Abstention ...
