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.
When You Do the Crime You Must Do the Time
Post 5224
Read the full article at https://lnkd.in/ghNVD-f9, see the video at https://lnkd.in/gPCxMn5T and at https://lnkd.in/ga6ZVGDz, and at https://zalma.com/blog plus more than 5200 posts.
When a Person is Convicted of a Crime The Hardship Inflicted on His Family is the Result of His Actions Alone
In United States v. Tarek Abou-Khatwa, CRIMINAL No. 18-cr-67 (TSC), United States District Court, District of Columbia (October 24, 2025) after Defendant Tarek Abou-Khatwa was convicted in November 2019 on 22 counts related to a sophisticated health insurance fraud scheme as head of an insurance-brokerage firm, initially Tarek was sentenced to 70 months in prison.
Home Confinement:
After less than 16 months in prison, Tarek was placed on home confinement under the CARES Act. He was later remanded to prison for violating the conditions of his home confinement order.
Motion for Sentence Reduction:
Tarek filed for sentence reduction under 18 U.S.C. § 3582(c)(2) ...
Motion for Summary Judgment Requires Evidence Establishing Defenses
Post 5223
Read the full article at https://www.linkedin.com/pulse/motion-summary-judgment-fail-because-insurer-failed-zalma-esq-cfe-jhfsc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
In Michael Tillema, Kim Til- Lema v. Meridian Security Insurance Company, No. SA-24-CV-00661-JKP, United States District Court, W.D. Texas, San Antonio Division (October 7, 2025) Plaintiffs Michael Tillema and Kim Til-Lema claimed coverage from Meridian Security Insurance Company for benefits for alleged wind and hail damage from a storm on April 26, 2022.
Meridian Security Insurance Company denied the claim, citing inspection reports and weather data indicating no hail event occurred on the alleged date. Plaintiffs hired an independent contractor, who also found no hail within one mile of the property on the ...
Hertz Succesfully Refuses to Pay Alleged Fraudulent Health Care Providers
Post 5222
Read the full article at https://www.linkedin.com/pulse/man-bites-dog-story-hertz-sues-alleged-fraudsters-zalma-esq-cfe-efbgc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
Proactive Victim of Fraud Defeats Health Care Providers
In Hertz Vehicles, LLC v. Alignment Chiropractic, P.C., et al, Index No. 157368/2024, 2025 NY Slip Op 33627(U), Motion Seq. No. 001, NYSCEF Doc. No. 46, Supreme Court, New York County (September 30, 2025) Plaintiff alleged it is not obligated to pay no-fault benefits for the medical treatment of defendants for injuries while occupants of a 2023 Hyundai, owned and self-insured by Hertz.
FACTUAL BACKGROUND
Plaintiff moved for a default judgment against defendants Alignment Chiropractic, P.C., and many other alleged health care providers.
Plaintiff also ...
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 ...
