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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October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
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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 claims, the basic insurance policies used by the insurer, and assigned to handle minor insurance claims. I had no difficulty with the reading since I was a college graduate and had simultaneously enrolled in a night law school.

After I had learned the basics from the reading and assistance of an experienced claims supervisor I was sent to ride along with experienced adjusters in every type of insurance sold by my employer. I rode, and learned from, a surety adjuster, a workers’ compensation adjuster, first party property adjusters and third party liability adjusters. I was then sent to the insurer’s home office for a full month of classroom training on everything from the effect of traumatic injuries, reconstruction of fire, wind, or water damaged structures, tort law, contract law, and insurance policy interpretation.

After completing the classroom training I was allowed to deal with small claims by telephone under the very close supervision of an experienced claims supervisor and the claims manager.

Eventually I convinced my supervisor that I knew the basics of the insurance claims business, how to investigate a claim, how to interview an insured and independent witnesses and how to evaluate a claim. I was assigned a company car, a Nash Ambassador, and claims to handle in person from small water damages, kitchen fires, and other small claims until my abilities improved and I was able to handle a major claim with the assistance of the manager, supervisor and experienced staff adjusters and consultants. I was also able to apply to my claims work with what I was learning in law school.

It took me more than a year of intensive training and education to be classified as a field claims representative. I was, with the training and experience provided to me, a professional claims adjuster and worked as one until four years later when I passed the California Bar and became a licensed attorney.

Today, I’m much older, worked for five years as an adjuster, and 45 more years as an insurance defense lawyer and insurance coverage lawyer. I have, since 2015, worked as an insurance consultant and expert witness, a blogger, and an author on claims handling, insurance coverage and the tort of bad faith.
Becoming a Claims Expert Witness

After 45 years of practicing law a lawyer I knew asked me to be an expert in one of his cases. I had retained many experts in my legal career but this would be my first time testifying to a federal jury with a judge who would have preferred a different case. Although I was frightened on my first attempt I found I was good at explaining insurance and insurance claims handling to a judge and jury. My first attempt – whether because or in spite of my effort – resulted in a verdict in favor of the lawyer client.

In 2015 I was exhausted at operating a law firm and reduced the firm to just me and a computer. I changed my practice as an insurance consultant and expert the only thing I do. My license to practice law is inactive.

Claims experts are retained by lawyers who are litigating an insurance claim dispute after the litigation commences. I am retained by both insurance defense lawyers and policyholder’s lawyers. I have learned that the adjusters who dealt with claims when I did have either retired or died. I now see the work of inexperienced, minimally trained and often incompetent insurance adjusters because their work, or failure to work, were involved in situations that caused the insurer for whom they worked, get sued.

Today I spend most of my time reviewing claims files from counsel litigating insurance claims disputes, write this daily blog, write and update insurance claims books, and testify as an expert witness on behalf of counsel for policyholders and insurers.

Part 2 will deal with the Modern American Claims Adjuster.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

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16 hours ago
Mediation in State Court Resolves Action in USDC

Failure to Respond to Motion to Dismiss is Agreement to the Motion
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Read the full article at https://lnkd.in/gP52fU5s, see the video at https://lnkd.in/gR8HMUpp and at https://lnkd.in/gh7dNA99, and at https://zalma.com/blog plus more than 5250 posts.

In Mercury Casualty Company v. Haiyan Xu, et al., No. 2:23-CV-2082 JCM (EJY), United States District Court, D. Nevada (January 6, 2026) Plaintiff Mercury Casualty Company (“plaintiff”) moved to dismiss. Defendant Haiyan Xu and Victoria Harbor Investments, LLC (collectively, “defendants”) did not respond.

This case revolves around an insurance coverage dispute when the parties could not be privately resolved, litigation was initiated in the Eighth Judicial District Court of Nevada. Plaintiff subsequently filed for a declaratory judgment in this court.

On or about April 15, 2025, the state court action was dismissed with prejudice pursuant to a stipulation following mediation. Plaintiff states that the state court dismissal renders its ...

00:04:26
January 12, 2026
Go to Jail, Go Directly to Jail, Do Not Pass Go

Overwhelming Evidence of Insurance Fraud Sustains Conviction - One Fraud Fails in Minnesota

Post 5258

See the video at https://lnkd.in/g62ycvAN and at https://lnkd.in/gPXVMpKx and at https://zalma.com/blog plus more than 5250 posts.

In State of Minnesota v. Mark John Jenni, No. A25-0111, Court of Appeals of Minnesota (January 5, 2026) dealt with an insurance coverage issue because Mr. Jenni, in July 2023, obtained an insurance policy with Liberty Mutual Insurance for a home in Park Rapids, Hubbard County, Minnesota based on false representations, only to find himself charged with insurance fraud.

FACTS

On his application, Jenni stated that the property was his primary residence, that he had purchased it in 2023, that it was not under construction or renovation, and that there had been no recent insurance claims or cancellations on the property. About a month after securing coverage, Jenni filed a claim for a reported burglary involving over $80,000 in stolen tools and property damage. He did not report the ...

00:08:12
January 08, 2026
Public Adjuster Immediately Retained but Insurer Not Notified

Insured Must Give Prompt Notice of Loss
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Read the full article at https://lnkd.in/gBXRbKXD, see the video at https://lnkd.in/g4DKfUDz and at https://lnkd.in/g65V_RQ7 and at https://zalma.com/blog plus more than 5250 posts.

Once The Insured Knows There is Damage It is Obligated to Report the Loss to the Insurer

In Greater St. Stephen Ministries, Inc. v. Mt. Hawley Insurance Company, No. 24-cv-3130 (AS), United States District Court, S.D. New York (January 2, 2026) resolved a case brought by a church against an insurance company for denying coverage after Hurricane Ida. After discovery, the insurance company moved for summary judgment because it claimed the insured breached a material condition of the policy.

BACKGROUND

Greater St. Stephen Ministries, Inc., a church located in Louisiana, owned property that suffered damage from Hurricane Ida on August 29, 2021. The property was insured under a policy with Mt. Hawley Insurance Company, which required the insured to provide “prompt notice” of any loss or damage, ...

00:09:19
December 31, 2025
“Sudden” is the Opposite of “Gradual”

Court Must Follow Judicial Precedent
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Read the full article at https://www.linkedin.com/pulse/sudden-opposite-gradual-barry-zalma-esq-cfe-h7qmc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.

Insurance Policy Interpretation Requires Application of the Judicial Construction Doctrine

In Montrose Chemical Corporation Of California v. The Superior Court Of Los Angeles County, Canadian Universal Insurance Company, Inc., et al., B335073, Court of Appeal, 337 Cal.Rptr.3d 222 (9/30/2025) the Court of Appeal refused to allow extrinsic evidence to interpret the word “sudden” in qualified pollution exclusions (QPEs) as including gradual but unexpected pollution. The court held that, under controlling California appellate precedent, the term “sudden” in these standard-form exclusions unambiguously includes a temporal element (abruptness) and cannot reasonably be construed to mean ...

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December 29, 2025
Doctor Accused of Insurance Fraud Sues Insurer Who Accused Him

Lack of Jurisdiction Defeats Suit for Defamation

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Posted on December 29, 2025 by Barry Zalma

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He Who Represents Himself in a Lawsuit has a Fool for a Client

In Pankaj Merchia v. United Healthcare Services, Inc., Civil Action No. 24-2700 (RC), United States District Court, District of Columbia (December 22, 2025)

FACTUAL BACKGROUND
Parties & Claims:

The plaintiff, Pankaj Merchia, is a physician, scientist, engineer, and entrepreneur, proceeding pro se. Merchia sued United Healthcare Services, Inc., a Minnesota-based medical insurance company, for defamation and related claims. The core allegation is that United Healthcare falsely accused Merchia of healthcare fraud, which led to his indictment and arrest in Massachusetts, causing reputational and business harm in the District of Columbia and nationwide.

Underlying Events:

The alleged defamation occurred when United ...

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December 15, 2025
Zalma’s Insurance Fraud Letter – December 15, 2025

Zalma’s Insurance Fraud Letter

Read the full article at https://lnkd.in/dG829BF6; see the video at https://lnkd.in/dyCggZMZ and at https://lnkd.in/d6a9QdDd.

ZIFL Volume 29, Issue 24

Subscribe to the e-mail Version of ZIFL, it’s Free! https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D

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/

Zalma’s Insurance Fraud Letter

Merry Christmas & Happy Hannukah

Read the following Articles from the December 15, 2025 issue:

Read the full 19 page issue of ZIFL at ...

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