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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November 05, 2025
Not Nice to Shop the Federal Court to Avoid State Court

Who’s on First? State or Federal Court

Post 5222

Read the full article at https://lnkd.in/gWj97cFs, see the video at https://lnkd.in/gtS6CpUX and at https://lnkd.in/gQEAeyHc,

Conflict Between State & Federal Court Requires Abstention

See the video at https://lnkd.in/gtS6CpUX and at https://lnkd.in/gQEAeyHc,

Conflict Between State & Federal Court Requires Abstention

Hector David Campoverde was injured at a Brooklyn construction site in 2015. Campoverde was an employee of Vazquez Bro Restoration Inc., a subcontractor for C.C.C. Renovation Inc., which was itself a subcontractor for general contractor L&M Builders Group LLC. 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) was asked to determine whether one or more of the involved insurers is obligated to indemnify Campoverde, and in what order Camporverde can receive indemnity, from one or more insurer.

Underlying Incident:

Campoverde sued the property owners and L&M, alleging violations of New York Labor Law.

Insurance Coverage:

L&M’s primary insurer was Houston Casualty Company (“HCC”), with excess coverage provided by Starr.

State Court Actions:

In 2022, C.C.C. and HCC filed consolidated actions in New York state court against Scottsdale and its agents.

Federal Action:

On May 3, 2024, Starr filed a federal declaratory judgment action against Scottsdale, seeking declarations regarding coverage under the Scottsdale policies and claims of unjust enrichment.

Application of Law:

The court found significant overlap between the federal and state actions, with the core issue — Scottsdale’s coverage obligations — actively litigated in state court. Exercising federal jurisdiction risked contradictory findings and inefficiency.

Abstention is Appropriate in this Matter

The Court noted that the state court may come to differing conclusions as to whether Scottsdale had an insurance policy in effect on the date of the accident.

The Court choose to stay, rather than dismiss, this action. Therefore, Defendant’s motion to dismiss was denied, but its request for a stay, in the alternative, was granted.

ZALMA OPINION

Federal Courts have limited jurisdiction and do not like it when a litigant brings an action in federal court to have a quick federal jurisdiction different than the decision eventually reached in the state court. The District court refused to be a party to legal and procedural shenanigans and stayed its case until after the conclusion of the state court so that there will be only one state of facts about the applicable insurance policies.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.

Subscribe to my substack at https://lnkd.in/gmmzUVBy

Go to X @bzalma; Go to the InsuranceClaims Library – https://lnkd.in/gwEYk.
(c) 2025 Barry Zalma & ClaimSchool, Inc.

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September 18, 2026
Expert May Only Testify to What Experience Supports

Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.

Posted on September 18, 2026 by Barry Zalma

See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html

In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.

The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.

Law

The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...

00:03:10
September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

150 Months in Prison for Tax Fraud
Post 4846

Posted on September 17, 2026 by Barry Zalma

See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.

FACTS

In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS

Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.

The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...

00:05:23
September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution

Post 5489

Posted on September 14, 2026 by Barry Zalma

Fraudster Refuses to Answer Questions About His Alleged Fraud

See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr

In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.

Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.

After Great American ...

00:05:14
4 hours ago

Excellence in Claims Handling
Posted on October 29, 2026 by Barry Zalma

Common Problems in a Jewelers’ Block Policy Investigation

If you are not a subscriber you will read from this link until you reach the paywall end of this blog post as the free part of Excellence in Claims Handling. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the button above.

This is a taste of the latest Excellence in Claims Handling Article for subscribers to my substack. Subscribe to my substack at https://lnkd.in/gmmzUVBy

The History of the Jewelers’ Block Policy

The ‘jewelers’ block policy’ had its origin about 1920, and since that time the policy and the proposal upon which it is based have become more or less standard.

The Inland-Marine Insurance Bureau, of which appellant is a member, prescribes contracts and proposals for such policies that are ...

5 hours ago
A Self-Insurance Plan Constitutes “Insurance”

Self Insurance is Excess Over Primary Insurance

Post 4572

Posted on October 29, 2026 by Barry Zalma

Employment Plan is Insurance Because it Transferred Risk and Contained Claim, Exclusion, and Priority Provisions.

In Ajay Kolli, & c. et al. v. Kaleida Health, 2026 NY Slip Op 06167, No. 72, New York Court of Appeals (October 22, 2026) Dr. Venkateswara Kolli treated a patient in 2011 while serving as an on-call, per diem physician for Kaleida Health. The patient later sued Dr. Kolli and Kaleida for medical malpractice.

In 2011, decedent Dr. Venkateswara Kolli treated a patient as part of his duties pursuant to an on-call, per diem physician employment agreement with defendant Kaleida Health. The patient subsequently sued Dr. Kolli and Kaleida. Dr. Kolli sought indemnity from his primary medical malpractice insurer, MLMIC Insurance Company (MLMIC), as well as his excess insurer Healthcare Professionals Insurance Company (HPIC).

The underlying medical malpractice action settled after Dr. Kolli’s death. Kaleida, MLMIC, and ...

October 28, 2026

RICO Suit Against Law Firm & Health Care Pros Fails

Posted on October 28, 2026 by Barry Zalma

UBER AND FEDEX FIGHT FRAUD

Racketeer Influenced and Corrupt Organizations Act (RICO) is Designed to Defeat Fraud Perpetrators

In Uber Technologies, Inc., et al. v. Simon & Simon P.C., et al., Civil Action No. 25-5365, United States District Court, E.D. Pennsylvania (October 13, 2026) Uber Technologies, Inc. and Federal Express Corporation sued attorney Marc Simon, his firm Simon & Simon, P.C., and several medical professionals and practices under the Racketeer Influenced and Corrupt Organizations Act (RICO).

They allege the defendants orchestrated a scheme to generate and litigate fraudulent personal injury claims arising from motor vehicle accidents involving Uber and FedEx drivers. Uber and FedEx incurred defense costs and paid settlements on some claims. The court earlier denied a motion to dismiss, finding proximate causation adequately pleaded. Fact discovery is set to close December 21, 2026.

Discovery showed Uber’s...

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