Excellence in Claims Handling
Post 5215
Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-4-barry-zalma-esq-cfe-xupzc 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.
Insurance Is A Service Business.
The insurance contract is a collection of promises made by the insurer to those persons or entities who understand that they, or their business, face risks of loss that could destroy the viability of a business or the home of a family. Insurers promise to pay to protect the insured against the risks of loss the insured faces.
Since people face a material loss to a house, factory, office, or commercial structure rarely, if at all insurance spreads the risk faced by many so that it can indemnify the few who actually suffer a loss.
The Development of the Insurance Claims Professional
Insurers have created, over the last few centuries, professional claims personnel who they trained to interpret the terms and conditions of the policy of insurance.
A professional and experienced adjuster will save the insurer millions by resolving disputes, paying claims owed promptly and fairly, and by so doing avoid litigation.
A competent and effective claims adjuster is the best advertisement an insurer can have since a claim, adjusted promptly, in good faith, and to the satisfaction of the insured will cause the insured to brag to his friends and neighbors how well he was treated and convince his contacts to change their insurer.
Satisfying an insured that the promises made by the policy were fairly and completely kept is the key to the insurer’s desire to provide the services promised by the policy and avoid the expense and bad publicity of litigation. The satisfied insured will never even consider suing the insurer for breach of contract.
Conversely, barely competent, incompetent or inadequate claims personnel will seldom resolve claims fairly and to the satisfaction of the insured or claimant. Inadequate claims personnel will often force insureds and claimants to public insurance adjusters and lawyers. The adjustment of the claims will be protracted, experts and lawyers will be needed by the insured and the insurer and unnecessary expenses will be incurred.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Expert May Not Testify About STOLI for Lack of Experience
Post 5227
Read the full article at https://lnkd.in/g8MPwJxM, see the video at https://lnkd.in/gx6rzPH3 and at https://lnkd.in/gumfUqXv, and at https://zalma.com/blog plus more than 5200 posts.
Insurer Needs to be Careful When Retaining an Expert With No Experience About the Key Issue in the Case.
In Ameritas Life Insurance Corp. v. Wilmington Savings Fund Society, FSB, United States District Court for the District of Delaware (Civil Action No. 23-236-GBW), Judge: Gregory B. Williams (November 7, 2025) Ameritas Life Insurance Corp. (“Ameritas”) sought to void a $3 million life insurance policy on the life of Marvin Flaks (the “Policy”) as a stranger-originated life insurance (“STOLI”) policy lacking an insurable interest under Delaware law.
Defendant Wilmington Savings Fund Society, FSB (“Wilmington Savings”), as securities intermediary and counterclaim-plaintiff, opposed and sought to enforce the Policy.
Motion at Issue:
Wilmington Savings’ Daubert ...
Policy Terms Control Right to Return of Overpayments
Post 5226
See the video at https://lnkd.in/gxtJVDse and at https://lnkd.in/gGBxEHHH, and at https://zalma.com/blog plus more than 5200 posts.
An Insurer that Claims it Paid More than it Owed Admits to an Incompetent Claims Staff
In Scott A. Saveraid Trust for Scott A. Saveraid Revocable Trust v. QBE Specialty Insurance Company 2:25-cv-394-SPC-DNF, United States District Court for the Middle District of Florida, Fort Myers Division, Judge: Sheri Polster Chappell, U.S. District Judge (Date: November 7, 2025)
Key Facts
The plaintiff, Scott A. Saveraid Trust (the “Trust”), owns real property in Fort Myers Beach, FL. The Trust purchased a homeowners insurance policy (the “Policy”) from defendant QBE Specialty Insurance Company (“QBE”). In September 2022, the property sustained damage from Hurricane Ian, a covered peril under the Policy.
The Trust filed a claim with QBE, which investigated and paid $307,622.32 for dwelling coverage and $20,600 for loss of use. QBE alleges the ...
Insured Refused to Pay Additional Premium for Assault & Battery Coverage
Post 5225
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Exclusion for Assault & Battery Enforced
In Golden Bear Insurance Company v. The Levee Bar & Grill, LLC et al., No. 4:24-CV-00764-DGK (W.D. Mo. Nov. 7, 2025) the bar was sued because of an assault and battery by an intoxicated patron and sought defense and indemnity from its insurer. Golden Bear (GB) denied the claim because of an assault and battery exclusion in its policy.
FACTUAL BACKGROUND
Underlying Incident and Lawsuit:
On or about an unspecified date in 2024, Defendant Adrian Hubbard (“Hubbard”), a patron at The Levee, became intoxicated after being overserved alcohol. He was removed from the bar without incident but later engaged in a brief altercation outside, bumping a female security guard. An unknown employee of The Levee (“John Doe”), perceiving a threat to himself or the guard, struck Hubbard in the head, ...
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 ...
