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.
Convicted Criminal Seeks to Compel Receiver to Protect his Assets
Post number 5291
See the video at and at and at https://www.zalma.com/blog plus more than 5250 posts.
The Work of a Court Appointed Receiver is Constitutionally Protected
In Simon Semaan et al. v. Robert P. Mosier et al., G064385, California Court of Appeals, Fourth District, Third Division (February 6, 2026) the Court of Appeals applied the California anti-SLAPP statute which protects defendants from meritless lawsuits arising from constitutionally protected activities, including those performed in official capacities. The court also considered the doctrine of quasi-judicial immunity, which shields court-appointed receivers from liability for discretionary acts performed within their official duties.
Facts
In September 2021, the State of California filed felony charges against Simon Semaan, alleging violations of Insurance Code section 11760(a) for making...
When There are Two Different Other Insurance Clauses They Eliminate Each Other and Both Insurers Owe Indemnity Equally
Post number 5289
In Great West Casualty Co. v. Nationwide Agribusiness Insurance Co., and Conserv FS, Inc., and Timothy A. Brennan, as Administrator of the Estate of Pat- rick J. Brennan, deceased, Nos. 24-1258, 24-1259, United States Court of Appeals, Seventh Circuit (February 11, 2026) the USCA was required to resolve a dispute that arose when a tractor-trailer operated by Robert D. Fisher (agent of Deerpass Farms Trucking, LLC-II) was involved in a side-impact collision with an SUV driven by Patrick J. Brennan, resulting in Brennan’s death.
Facts
Deerpass Trucking, an interstate motor carrier, leased the tractor from Deerpass Farms Services, LLC, and hauled cargo for Conserv FS, Inc. under a trailer interchange agreement. The tractor was insured by Great West Casualty Company with a $1 million policy limit, while the trailer was insured by Nationwide Agribusiness Insurance Company with a $2 million ...
Opiod Producer Seeks Indemnity from CGL Insurers
Post number 5288
Read the full article at https://lnkd.in/guNhStN2, see the full video at https://lnkd.in/gYqkk-n3 and at https://lnkd.in/g8U3ehuc, and at https://zalma.com/blog plus more than 5250 posts.
Insurers Exclude Damages Due to Insured’s Products
In Matthew Dundon, As The Trustee Of The Endo General Unsecured Creditors’ Trust v. ACE Property And Casualty Insurance Company, et al., Civil Action No. 24-4221, United States District Court, E.D. Pennsylvania (February 10, 2026) Matthew Dundon, trustee of the Endo General Unsecured Creditors’ Trust, sued multiple commercial general liability (CGL) insurers for coverage of opioid-related litigation involving Endo International PLC a pharmaceutical manufacturer.
KEY FACTS
Beginning as early as 2014, thousands of opioid suits were filed by governments, third parties, and individuals alleging harms tied to opioid manufacturing and marketing.
Bankruptcy & Settlements
Endo filed Chapter 11 in August 2022; before bankruptcy it ...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lost the ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah. Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and wonder how did all these wonderful things come into being. Jews believe the force we call G_d created the entire universe and everything in it. Jews feel G_d is all seeing and knowing and although we can’t see Him, He is everywhere and in everyone.We understand...
Passover for Americans
Posted on February 19, 2026 by Barry Zalma
Read the full article at https://www.linkedin.com/pulse/passover-americans-barry-zalma-esq-cfe-5vgkc.
“The Passover Seder For Americans”
For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lostthe ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah.
Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and ...
You Get What You Pay For – Less Coverage Means Lower Premium
Post number 5275
Posted on January 30, 2026 by Barry Zalma
See the video at and at
When Experts for Both Sides Agree That Two Causes Concur to Cause a Wall to Collapse Exclusion Applies
In Lido Hospitality, Inc. v. AIX Specialty Insurance Company, No. 1-24-1465, 2026 IL App (1st) 241465-U, Court of Appeals of Illinois (January 27, 2026) resolved the effect of an anti-concurrent cause exclusion to a loss with more than one cause.
Facts and Background
Lido Hospitality, Inc. operates the Lido Motel in Franklin Park, Illinois. In November 2020, a windstorm caused one of the motel’s brick veneer walls to collapse. At the time, Lido was insured under a policy issued by AIX Specialty Insurance Company which provided coverage for windstorm damage. However, the policy contained an exclusion for any loss or damage directly or indirectly resulting from ...
