ZIFL Volume 29, Issue 23
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Subscribe at https://lnkd.in/gfpn78FM
Read the full article at https://lnkd.in/gczbPSKn and at https://zalma.com/blog plus more than 5200 posts.
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/
Read the full 21 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-12-01-2025.pdf
Roofers, Insurance, Hurricanes and Fraud
Homeowners Defrauded by Roofer Litigate for Years to Get Their Money Back
In Gary v. Hollier’s Specialty Roofing, Inc., 23-260 (La. App. 3 Cir. 12/27/23), 389 So. 3d 109 Ryan Gary and Rebecca Gary (the Garys), homeowners who suffered roof damage from Hurricane Delta sued Hollier’s Specialty Roofing, Inc. (Hollier Roofing), a roofing contractor who took the money and refused to complete the repair of the roof.
Read the full article and the 21 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-12-01-2025.pdf
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty eighth installment of the saga of McClenny, Moseley & Associates (MMA) 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.
Fifth Amendment to Case Management Order No. 1 – September 17, 2025
Read the full article and the 21 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-12-01-2025.pdf
Health Insurance Fraud Convictions
ICYMI: Back Charges, Pleas, Sentencings and Settlements During the Recent Government Shutdown
From the U.S. Attorney’s Office, Eastern District of Missouri. During the lapse in government funding, the U.S. Attorney’s offices in St. Louis and Cape Girardeau were working hard to continue their mission. Here are just some of the things that happened that we weren’t able to discuss at the time:
Wed. Oct. 1
Starr Lumos, 54, admitted committing over $201,000 in fraud by pretending to be disabled and unable to work. Despite those claims, she was working multiple jobs and running multiple businesses, including an event planning company. Lumos is scheduled to be sentenced in January and faces up to 10 years in prison and/or a fine of up to $250,000.
Read the full 17 page article and the 21 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-12-01-2025.pdf
Convictions of Other Than Health Insurance Fraud
Kansas Man Sentenced for Insurance Fraud
Macario Butler, age 28, pleaded guilty on November 7, 2025 in Johnson County District Court to one misdemeanor count of insurance fraud and one count of attempted theft.
Read the full article and the 21 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-12-01-2025.pdf
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. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in for more than 44 years as an insurance coverage and claims handling lawyer and more than 58 years in the insurance business. He is available at http://www.zalma.com and [email protected].
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. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support
Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog. He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.
Read the full 21 page issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/11/ZIFL-12-01-2025.pdf
Marine Insurer May Dispose of Vessel to Avoid Waste
Post 5249
Read the full article at https://lnkd.in/gfn_UHdp, see the video at https://lnkd.in/gDWVccnr and at https://lnkd.in/gv9nsBqk, and https://zalma.com/blog plus more than 5200 posts.
In Western World Insurance Company v. The Estate Of Shawn Arsenault, No. 25-cv-13413-PGL, United States District Court, D. Massachusetts (December 17, 2025) the USDC was asked to resolve a marine insurance dispute after the sinking of the F/V Seahorse, a commercial fishing vessel, off Cape Cod on June 8, 2025. The vessel’s owner and operator, Shawn Arsenault, died in the incident.
Western World Insurance Company issued a hull insurance policy for the vessel. With no personal representative yet appointed for the estate, the insurer cannot determine the proper payee for the insurance proceeds.
The insurer paid for the vessel’s recovery and removal, and the vessel is now with a salvage company, incurring substantial storage fees. The insurer determined the loss is covered under the ...
Marine Insurer May Dispose of Vessel to Avoid Waste
Post 5249
Read the full article at https://lnkd.in/gfn_UHdp, see the video at https://lnkd.in/gDWVccnr and at https://lnkd.in/gv9nsBqk, and https://zalma.com/blog plus more than 5200 posts.
In Western World Insurance Company v. The Estate Of Shawn Arsenault, No. 25-cv-13413-PGL, United States District Court, D. Massachusetts (December 17, 2025) the USDC was asked to resolve a marine insurance dispute after the sinking of the F/V Seahorse, a commercial fishing vessel, off Cape Cod on June 8, 2025. The vessel’s owner and operator, Shawn Arsenault, died in the incident.
Western World Insurance Company issued a hull insurance policy for the vessel. With no personal representative yet appointed for the estate, the insurer cannot determine the proper payee for the insurance proceeds.
The insurer paid for the vessel’s recovery and removal, and the vessel is now with a salvage company, incurring substantial storage fees. The insurer determined the loss is covered under the ...
Admitting to the Crime of Battery Establishes Intent
Read the full article at https://www.linkedin.com/pulse/punching-person-head-occurrence-barry-zalma-esq-cfe-8fegc, see the video at and at and at https://zalma.com/blog plus more than 5200 posts.
“Everybody has a plan until they get punched in the mouth.” – Mike Tyson
In Jesse De Chacon and Laura Greer v. Caesars Entertainment Corp., Caesars Atlantic City and Bally's Atlantic City, and Michael Nieves and United Services Automobile Association, No. A-2376-23, Superior Court of New Jersey, Appellate Division (December 16, 2025)’’ the appellate court was asked to resolve a dispute over coverage for a battery by its insured on the plaintiff.
KEY FACTS
The Incident:
On September 16, 2018 at Bally's Casino in Atlantic City, New Jersey, Michael Nieves punched Jesse De Chacon once in the head after De Chacon allegedly harassed and grabbed ...
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 ...
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 ...
