ZIFL – Volume 28, Issue 20
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Read the full article at https://lnkd.in/gt5Kyumz, See the full 18 page issue of ZIFL at https://lnkd.in/gBUgEBmP, and at https://zalma.com/blog plus more than 5200 posts.
Zalma’s Insurance Fraud Letter (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 https://lnkd.in/gVT5G9s
The Contents of the October 15, 2025 Issue of ZIFL Includes:
Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th 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 15, 2025 Issue of ZIFL Includes:
Insurer’s Attempt to Obtain Summary Judgment Against Fraudsters Fails
To Prove Fraud Admissible Evidence is Required
Allegations That Health Care Providers Assist in No Fault Fraud Escape MSJ for Lack of Evidence
In Nationwide General Insurance Company, et al v. Billeesha Brown, et al, 2025 NY Slip Op 33374(U), Motion Seq. No. 003, Supreme Court, Nassau County (September 15, 2025).
See the full 18 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/10/ZIFL-10-15-2025.pdf
Guilty of Arson & Fraud on Public
GoFundMe Request Based on Fake Claim of Racial Animus
Avonte Ahikim Hartsfield burned down his own food truck and falsely reported that he was the victim of arson in October 2021.
In The People v. Avonte Ahikim Hartsfield, D084114, California Court of Appeals, Fourth District, First Division (September 24, 2025) affirmed the conviction.
See the full 18 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/10/ZIFL-10-15-2025.pdf
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty seventh 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. The saga of MMA has become a never-ending story.
See the full 18 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/10/ZIFL-10-15-2025.pdf
Ethical Behavior for the Fraud Investigator
The concept of ethical behavior refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues, all of which are essential to the lawyer.
See the full 18 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/10/ZIFL-10-15-2025.pdf
“Post Loss Underwriting” is an Oxymoron
Some plaintiffs’ lawyers contend that rescission is, rather than an equitable remedy of mistake, misrepresentation, concealment or fraud, is really “post loss underwriting.”
See the full 18 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/10/ZIFL-10-15-2025.pdf
Public Policy and Rescission
Rescission, by definition, is an equitable remedy. That means the result when asserting the remedy must be fair to the persons or entities involved.
When a policy is rescinded, it is considered void ab initio and is considered never to have existed. Finding no public policy that forbade rescission the Michigan Supreme Court allowed rescission.
See the full 18 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/10/ZIFL-10-15-2025.pdf
Health Insurance Fraud Convictions
St Mary’s Health Obtains $510,000,000 Verdict Against UHS
Universal Health Services of Delaware, Inc. (UHS) and its affiliates were found liable in a landmark verdict with significant implications for the healthcare industry a Washoe County, Nevada jury awarded Saint Mary’s Health Network over $510 million in damages.
See the full 18 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/10/ZIFL-10-15-2025.pdf
The Interview Is an Essential Form of Fact Gathering for Fraud Investigation
The beginning of a thorough insurance fraud investigation is the interview of the insured and, if a third party claim, the claimant. The interview is often informal. It can be recorded with an audio recording device; it can be recorded with a handwritten statement signed by the witness or it can be recorded by a certified shorthand reporter.
See the full 18 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/10/ZIFL-10-15-2025.pdf
Convictions of Other Than Health Insurance Fraud
Public Adjuster, Already in Prison, Sentenced to Another 19 Years Concurrent
Andrew Aga, sometimes known as Andrew Mitchell, a public adjuster who pleaded guilty in March to defrauding Brotherhood Mutual Insurance Co. and a Georgia church out of millions of dollars has been sentenced to 19 years in prison.
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. Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
See the full video at and at and at https://zalma.com/blog plus more than 5200 posts.
Private Limitation In Accordance With Statute Defeats a Claim
Post 5204
There is No Good Reason to Delay Filing Suit
In Christian Care Center v. American Alternative Insurance Corporation, Civil Action No. 4:25-CV-00321-O, United States District Court, N.D. Texas, Fort Worth Division (October 6, 2025) a private limitation of action provision effective barred the suit.
KEY FACTS:
Plaintiff and Defendant:
The case involves an insured, the Christian Care Center (Plaintiff) and its insurer American Alternative Insurance (Defendant) in a coverage dispute.
Loss Event:
Plaintiff’s property sustained damage due to a storm on April 27, 2020.
Insurance Claim:
Plaintiff submitted a claim to Defendant on February 2, 2022, which was denied on July 29, 2022.
Lawsuit:
Plaintiff sued alleging breach of contract and violations of Chapters 541 ...
See the full video at and at and at https://zalma.com/blog plus more than 5200 posts.
Private Limitation In Accordance With Statute Defeats a Claim
Post 5204
There is No Good Reason to Delay Filing Suit
In Christian Care Center v. American Alternative Insurance Corporation, Civil Action No. 4:25-CV-00321-O, United States District Court, N.D. Texas, Fort Worth Division (October 6, 2025) a private limitation of action provision effective barred the suit.
KEY FACTS:
Plaintiff and Defendant:
The case involves an insured, the Christian Care Center (Plaintiff) and its insurer American Alternative Insurance (Defendant) in a coverage dispute.
Loss Event:
Plaintiff’s property sustained damage due to a storm on April 27, 2020.
Insurance Claim:
Plaintiff submitted a claim to Defendant on February 2, 2022, which was denied on July 29, 2022.
Lawsuit:
Plaintiff sued alleging breach of contract and violations of Chapters 541 ...
Insured May Intervene to Assert Bad Faith Claim Not Assigned
Post 5203
See the full video at https://rumble.com/v7013x8-insured-cant-assign-bad-faith-claim.html and at https://youtu.be/e8OApzn6YZs, and at https://zalma.com/blog plus more than 5200 posts.
Judge Requires Conflict Between Different District Courts in Louisiana Requires Conflict to be Resolved on Appeal
In Allstate Construction, Inc. v. Ohio Security Insurance Company, Civil Action No. 23-01295-BAJ-SDJ, United States District Court, M.D. Louisiana (September 30, 2025) Vina Cleaners, the insured, assigned its claim against Ohio Security to Allstate Construction but did not assign its rights to sue for the tort of bad faith so it intervened in Allstate Construction’s suit.
Background and Procedural History:
In an insurance dispute following damage caused by Hurricane Ida to Vina Cleaners’ property. Vina Cleaners was insured under a commercial policy with the Defendant, Ohio Security Insurance Company. Vina Cleaners assigned its rights ...
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 ...
Oregon Statute Does Not Reverse Preempt Federal Arbitration Act
Post 5208
Read the full article at https://www.linkedin.com/pulse/federal-arbitration-provision-applied-barry-zalma-esq-cfe-9kjmc and at https:/zalma.com/blog plus more than 5200.
Litigation Over Costs to Clean Superfund Site Forced to Arbitration
Federal Arbitration Provision Applied
Read the full article at https://www.linkedin.com/pulse/federal-arbitration-provision-applied-barry-zalma-esq-cfe-9kjmc and at https:/zalma.com/blog plus more than 5200.
Oregon Statute Does Not Reverse Preempt Federal Arbitration Act
Post 5208
Litigation Over Costs to Clean Superfund Site Forced to Arbitration
In Pacificorp et al v. St. Paul Surplus Lines Insurance Company, et al, No. 3:25-cv-00163-AB, United States District Court, D. Oregon (October 7, 2025) Plaintiff PacifiCorp sued its excess liability insurers, for failing to indemnify costs related to the Portland Harbor Superfund Site only to have the suit stayed and arbitration compelled. This case tried to change the...
Insured Must Reside in Dwelling to Obtain Homeowners Insurance Claim Benefits
Post 5206
Read the full article at https://www.linkedin.com/pulse/estoppel-does-apply-where-plaintiff-deceived-insurer-barry-ifgdc and at https://zalma.com/blog plus more than 5200 posts.
In Donald Jackson v. Spinnaker Insurance Company, Civil Action No. 22-1244, United States District Court, W.D. Pennsylvania (October 7, 2025) where Plaintiff, in his Proposed Jury Instructions and Jury Verdict Slip and his Trial Brief asserted for the first time an entitlement to equitable estoppel on grounds that Defendant’s “own rules and procedures . . . required [Defendant, through its property inspector] to confirm that the insured had moved in and begun to reside in the insured premises.”
Plaintiff asserted that Defendant’s exercise of its right to inspect the property and failure to confirm, and/or communicate its assessment of, his residency induced his justified reliance. He further asserts that were he aware that his use of the property was ...
