ZIFL Volume 29, Issue 19
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Read the full article at https://lnkd.in/gXNZQBRy, sSee the full video at https://lnkd.in/gygJwCG9 and at https://zalma.com/blog.
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/
The Contents of the October 1, 2025 Issue of ZIFL Includes:
Another Anniversary -- October 1, 1979 - 2025 -
Forty five years ago today I left the world of the employed and became an entrepreneur by opening my own law firm. The law practice was incorporated shortly thereafter as Barry Zalma, Inc. When I opened for business on October 1, 1979, I had no clients and no certainty that I would have any in the future. I had borrowed money from the bank to carry me through the first six months and was concerned about my ability to pay the loan with my third child about to be born.
Much to my surprise and pleasure, on October 1, 1979, at 8:10 a.m., the best claims handler in the London market, Alan Warboys, called from London and provided me with my first case as an independent lawyer to represent Certain Underwriters at Lloyd’s, London. He, and the Lloyd’s Underwriters he represented, showed faith in me as a lawyer and insurance expert. Alan is now, and will forever be, my first client and a good friend.
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
Lie on an Application About Primary Residence is Ground for Rescission
Plaintiff Homesite Insurance Company's (Homesite) moved for Summary Judgment seeking a judicial declaration that it is entitled to rescission of Defendant Zhen Jiang's homeowners' insurance policy and enter summary judgment in its favor on Mr. Jiang's bad faith counterclaims.
In Homesite Insurance Company v. Zhen Jiang, No. CV-21-00554-TUC-JGZ, United States District Court, D. Arizona (September 16, 2024) the USDC explained an insurer's right to rescission.
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty sixth 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 an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
August 19, 2024
Several MMA cases received an identical order as was found in Robert v. Hartford Cas. Ins. Co., CIVIL 6:22-CV-05480 (W.D. La. Aug 19, 2024) where the court ordered dismissal of the case and ordered that “plaintiff reserves all rights against former counsel, McClenny Moseley & Associates, PLLC, and the resolution of the attorney fee, expense, and costs issue."
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
Intentional Arson Even for Mental Health Assistance Requires Jail
Hunter Hipp pleaded guilty to first-degree arson after intentionally setting fires in the kitchen and living room of his apartment. He notified the district court in writing of his intent to move "for a dispositional and/or durational departure from the presumptive sentence," and at sentencing he argued exclusively that he was particularly amenable to probation.
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
Insurance Fraud is a Serious Crime
Why Insurance Fraud is not Taken Seriously by Police & Prosecutors
State insurance departments near the turn of the century recognized that insurance fraud is a serious crime taking multiple billions of dollars from the insurance industry. Local police and prosecutors were not concerned, even after insurance fraud was made a felony, because no one suffered physical injury or death. Insurance fraud just cost a lot of money to insurers who were perceived as extremely wealthy and more victimizers than victim.
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
Health Insurance Fraud Convictions
Behavioral Healthcare Company Executive Pleads Guilty to Healthcare Fraud
Miguel Saravia, 42, of Hanson, pleaded guilty to six counts of health care fraud. U.S. District Court Judge Allison D. Burroughs scheduled sentencing for Jan. 2, 2025.
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
The Public Adjuster & Fraud
In Chubb & Son Inc. v. Consoli, 283 A.D. 2d 297, 726 N.Y.S. 2d 398 (N.Y. App. Div. 05/22/2001), a public adjuster was involved in a scheme with one of Chubb’s adjusters to intentionally inflate a claim and then pay Chubb’s adjuster to approve the claim. The insureds’ public adjuster was later convicted on charges of mail and tax fraud and Chubb’s representative was found guilty of defrauding Chubb.
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
Convictions of Other Than Health Insurance Fraud
Ghost Broker Sentenced
Mohamed Choudhary, 33, who sold invalid insurance policies and tried to take out car insurance for himself by covering up his driving offences and using a fake no-claims discount certificate was sentenced to two years in prison, suspended for two years at Inner London Crown Court on 13 September 2024. He is subject to a six-month curfew, which runs daily from 9pm to 6am and is monitored by an electronic tag. He must also complete 150 hours of unpaid work and pay £1,630 in costs.
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
Insurance Policy Appraisals and Fraud
The activities of the appraisers in California and most states are limited to decide the amount of loss and the value of the property in question. (Jefferson Insurance Company of New York v. Superior Court, 3 Cal. 3d 398, 90 Cal. Rptr. 608 (1970).) The appraisers cannot make decisions outside the limited scope of the policy language. They cannot find that the insured did not own the property, that the insured had no interest in it, that the insured was not entitled to recovery under policy exclusions, that the insured presented a fraudulent claim, or that the loss exceeds the policy limits.
(c) Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected].
Read the full article and the full 25 pages of this issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/09/ZIFL-10-01-2025.pdf
The Professional Claims Handler
Post 5218
Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-8-barry-zalma-esq-cfe-zdwsc, see the full video at https://rumble.com/v70zl4s-the-zalma-philosophy-of-claims-handling-part-8.html and at https://youtu.be/MIYcF71ffRQ, and at https://zalma.com/blog plus more than 5200 posts.
Claims Commandment X – Thou Shall Not Pretend to be a Lawyer
Some experienced and professional claims people know the law in their area of expertise better than most lawyers.
Adjusters should be adjusters and leave lawyering to lawyers. Similarly, lawyers should be lawyers and never try to be adjusters.
Claims Commandment XI – Thou Shall Empathize With the Claimant
Everyone presenting a claim is unhappy, disturbed, shocked, injured and needs help.
Empathy is identification with and understanding of another’s situation, feelings, and motives. It is the ability to understand another person’s circumstances, point of view, thoughts, and feelings....
HOW TO CREATE AN EXCELLENCE IN CLAIMS HANDLING PROGRAM
See the full video at https://rumble.com/v70wb2i-the-zalma-philosophy-of-claims-handling-part-6.html and at https://youtu.be/tL5nDKPEs40 and at https://zalma.com/blog plus more than 5200 posts.
Post 5217
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.
An Excellence in Claims Handling program begins with a statement in the insurer’s claims manual or statement of professionalism that it is dedicated to providing excellence in claims handling to every insured who presents a claim.
The excellence in claims handling program should include, at a minimum:
A series of lectures supported by text materials explaining:
A definition of insurance.
How to read and understand an insurance policy.
How to interview an insured, witness, or claimant.
How to assist an insured in the insured’s obligation to ...
The Professional Claims Handler
Post 5216
Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-5-barry-zalma-esq-cfe-jde8c, see the full video at https://rumble.com/v70q4x8-the-zalma-philosophy-of-claims-handling-part-5.html and at https://youtu.be/6b9tZQsEkB4, 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.
Standards to be a Professional Claims Adjuster
The Insurance claims professional should be a person who:
1. Can read and understand the insurance policies issued by the insurer.
2. Understands the promises made by the policy.
3. Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
4. Are competent investigators.
5. Have empathy and recognize the difference between empathy and sympathy.
6. ...
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 ...
