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
Officer Making U-Turn Chasing Criminal May be Immune if Not Done in Reckless Disregard for Safety of Others
Fact Finder Must Establish Basis for Immunity
Post 5236
See the video at https://rumble.com/v72gq5o-governmental-immunity-is-not-absolute.html and at https://youtu.be/CHlEX2ZCc4s and at https://zalma.com/blog plus more than 5200 posts.
In Robert Young v. Officer John Doe et al. No. 2025 CA 0527 (La. App. 1st Cir. November 22, 2025) Robert Young sued Sid J. Gautreaux, III, in his official capacity as Sheriff of East Baton Rouge Parish (the “Sheriff”), and multiple insurance companies. The Sheriff’s Office and an unnamed deputy were not part of the summary-judgment ruling on appeal.
Procedural Posture
The trial court granted Sheriff’s motion for summary judgment, dismissed all claims against the Sheriff with prejudice, holding that La. R.S. 32:24 immunity applied and that Deputy Miller’s conduct did not rise to reckless disregard/gross negligence.
Key Facts
On July 19, 2019, Highway 19 Deputy Kevin ...
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 ...
The National Flood Insurance Program is not Insurance but is a Government Entity
Post 5235
See the video at https://lnkd.in/gTK43frb and at https://lnkd.in/g3hDbN6u and at https://zalma.com/blog plus more than 5200 posts.
A Suit Against the NFPA Must be Filed in Federal Court
In Brian Bevel v. Federal Emergency Management Agency (FEMA) , United States District Court, Middle District of Florida, 8:25-cv-02159-JLB-CPT (November 21, 2025)Judge: John L. Badalamenti resolved the dispute over insurance coverage..
Key Facts
Parties and Claim:
Plaintiff Brian Bevel sued FEMA for breach of an insurance contract under the National Flood Insurance Program (NFIP). The policy insured Bevel’s property in Longboat Key, Florida, against flood damage.
Incident: The property sustained damage on September 26, 2024. Bevel notified FEMA, which investigated but allegedly failed to adjust the loss per policy terms, constituting a material breach.
Procedural History:
Bevel filed the breach-of-contract suit in Florida state circuit court on May 6, 2025, ...
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 ...
