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 30, 2025
Unambiguous Policy Language Applied

Only Vehicles Listed on Policy as a “Covered Auto” Are Entitled to Defense or Indemnity

Post 5198

See the full video at https://rumble.com/v6zn0p0-unambiguous-policy-language-applied.html and at https://youtu.be/gWtoQfgbsok, and at https://zalma.com/blog plus more than 5150 posts.

ATV Not a Covered Auto

In Acuity, a Mutual Insurance Company v. Peak View Roofing Co., Jeffrey Pierce, and Ty Smith, Civil Action No. 24-cv-01300-MDB, United States District Court, D. Colorado (September 23, 2025) resolved an insurance coverage dispute concerning the duty of the insurer to defend a civil lawsuit.

KEY FACTS:

Parties Involved:

The case involves Plaintiff Acuity, Defendant Smith, Defendant Pierce, and Peak View Roofing Co. (PVRC).

Underlying Action:

Defendant Smith alleges he was injured on August 19, 2022, while riding as a passenger in a 2018 Polaris Rzr ATV owned by Bluethread Services, LLC d/b/a Peak View Roofing, LLC and operated by Defendant Pierce.

Insurance Policy:

The Rzr was insured under the Policy as “equipment” rather than a “business auto”. Plaintiff Acuity sought a determination that it has no duty to defend or indemnify Pierce or PVRC .

LEGAL PRINCIPLES:

Contract Interpretation:

An insurance policy is a contract that should be interpreted in line with well-settled principles of contract interpretation. Courts should give the words in the contract their plain and ordinary meaning unless contrary intent is evidenced in the policy. Courts construe coverage provisions liberally in favor of the insured to provide the broadest possible coverage.

Policy Terms:

The policy specifically states that coverage applies only to those autos shown as covered autos. The Rzr is listed as “Scheduled Contractor’s Equipment” under the Policy’s Commercial Inland Marine Coverage and is not, therefore, a covered auto.

Undisputed Material Facts

The Rzr was not listed on the Policy as a “Business Auto.” The Rzr is listed in the Policy as “Scheduled Contractor’s Equipment” under the Policy’s Commercial Inland Marine Coverage. The Contractor’s Equipment Coverage Form does not include coverage for bodily injury or create a duty of defense or indemnity on the part of Acuity.

ANALYSIS

Whether there is a genuine dispute as to a material fact depends upon whether the evidence presents a sufficient disagreement to require submission to a jury or conversely, whether the evidence is so one-sided that one party must prevail as a matter of law.

Here, the threshold question was whether the Court should look beyond the explicit terms of the Policy-which lists the Rzr as equipment-in an attempt to uncover some underlying intent to include the Rzr as a covered auto. The Court saw no basis for doing so.

While it is true that a court should look to the parties’ intent to resolve “ambiguities” in an insurance policy, this is not a case of ambiguity. Indeed, there can be no dispute over the meaning of certain Policy terms. The language is explicit and clear, the Rzr is covered as equipment. Courts may not force an ambiguity in order to resolve it against the insurer.

Based on the undisputed Policy language and declarations, the Rzr was equipment, not a covered auto at the time of the accident. Therefore, Plaintiff does not have a duty to defend or indemnify Defendant Pierce or PVRC in the Underlying Action.

Plaintiff Acuity’s Motion for Summary Judgment Pursuant to F.R.C.P. 56 was granted.

ZALMA OPINION

If the plaintiff’s wanted the Rzr ATV to be considered a covered auto they only needed to ask Acuity to insure it as such not as “equipment.” Since the plaintiff intended to insure the ATV as equipment accidents causing injury due to the operation of the Rzr there was no coverage for defense or indemnity under the auto liability insurance.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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00:07:50
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September 18, 2026
Expert May Only Testify to What Experience Supports

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...

00:03:10
September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

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 ...

00:05:23
September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

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 ...

00:05:14
9 hours ago
Convicted of Felony Fraud You Lose the Right to Vote

Payment of Fines & Completion of Probation Reinstates Right to Vote

Post 4576

Posted on November 5, 2026 by Barry Zalma

To Restore Voting Rights The Felon Must Pay Fines of $546.00

In Florida Supreme Court Mediator Ethics Advisory Committee, ETH F-26-377, No. F-26-377 (October 29, 2026) citizen unnamed and to Ron Desantis Governor, Cord Byrd the Secretary of State Florida Division of Elections provided an advisory opinion to a convicted felon about his right to vote:

To: [redacted] We received your request for an advisory opinion. You indicate that you have one or more felony convictions and request whether you are eligible to vote, including whether you have any outstanding legal financial obligations under section 98.0751, Florida Statutes, and, if so, a statement of the amount that must be paid to make you eligible to vote, and an explanation of how the amount was calculated.

The Division hereby responds to your request pursuant to its legal authority under section 106.23(2), Florida Statutes, and Florida ...

November 04, 2026
Castro Valdez Had an Available Administrative Appeal and Failed to Establish a Ground for Excusing

Administrative Review Permits the Agency to Apply its Expertise

Post 4574

In Erwin Jordan Castro Valdez v. Warden, Otay Mesa Detention Center, No. 26-cv-06147-BAS-JLB, United States District Court, S.D. California (October 30, 2026) Castro Valdez, a Cuban national paroled into the United States, was arrested on June 23, 2026, for alleged insurance fraud, grand theft, and making a false report to law enforcement. In his first habeas action, the district court ordered a bond hearing within fourteen days to determine whether the changed circumstances justified revoking his parole.

An Immigration Judge subsequently denied bond because of his pending state criminal case. Castro Valdez filed a second petition under 28 U.S.C. § 2241, challenging that determination and requesting immediate release without first appealing to the Board of Immigration Appeals (BIA).

LAW

According to the supplied text, § 2241 does not expressly require administrative exhaustion, but courts impose exhaustion as a prudential requirement. ...

November 03, 2026
Jury Found Prudential to be the Victim of Fraud

Insured’s Ordered to Pay Insurer for Fraud by the Insureds

Post 4573

Posted on November 3, 2026 by Barry Zalma

In The Prudential Insurance Company Of America v. Carol Gardina and George Gardina, No. 6:23-cv-1125-JSS-DCI, United States District Court, M.D. Florida, Orlando Division (October 22, 2026).

THE JURY TRIAL AND VERDICT

Plaintiff sued Defendants for numerous causes of action stemming from its allegations that Defendants fraudulently collected benefits under their long-term care insurance policies. Plaintiff's case proceeded to a nine-day jury trial, after which the jury found Defendants liable for fraudulent misrepresentation, fraudulent concealment, and civil conspiracy.

The jury also found Defendant Carol Gardina liable to Plaintiff for $1,930,129 in compensatory damages and Defendant George Gardina liable to Plaintiff for $12,496 in compensatory damages and $20 in punitive damages. Thereafter, the court entered judgment in Plaintiff's favor and awarded Plaintiff $1,930,129 in compensatory damages from...

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