Failure to Prove Theft Defeats Claim on Commercial Crime Policy
Post 5247
Read the full article at https://lnkd.in/gPDJn8SJ, see the video at https://lnkd.in/ge3b7iPc and at https://lnkd.in/gBuK8eyk, and at https://zalma.com/blog plus more than 5250 posts.
Embezzlement is not Direct Loss by Theft
See the video at and at https://youtu.be/1FLQBIR6oCg
Embezzlement is not Direct Loss by Theft
In Continental Properties Company, Inc., et al v. Hiscox Insurance Company, Inc., No. 2024AP197, Court of Appeals of Wisconsin, District II (December 17, 2025) issued a per curiam opinion, it may not be cited in any court of this state as precedent or authority, except for the limited purposes specified in WIS. STAT. RULE 809.23(3). In an appeal from the circuit court’s grant of summary judgment in favor of defendant Hiscox Insurance Company, Inc. plaintiffs asserted breach of contract and bad faith claims arising from denial of coverage under a commercial crime insurance policy.
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Time Bar Defeats Suits Against Insurer
Post 5247
Read the full article at https://lnkd.in/gupyuD33, see the video at https://lnkd.in/gSV8kf8S and at https://lnkd.in/gBrxCRDt, and at https://zalma.com/blog plus more than 5200 posts.
In Kevin J. Labudde v. The Phoenix Insurance Company, No. 7:21-CV-197-BO-BM, United States District Court, E.D. North Carolina, Southern Division (December 12, 2025) Defendant The Phoenix Insurance Company (Phoenix) moved for summary judgment, moved to exclude the testimony of Donald Dinsmore and Jerome Redmond, and moved to seal certain documents.
FACTS
Kevin J. Labudde’s home was damaged by Hurricane Matthew on October 8, 2016. He discovered additional mold damage in January 2017 and hired a contractor, who filed an insurance claim with Phoenix Insurance Company. Phoenix found hail damage (covered by the policy) but determined the cost was below the deductible and denied coverage for water intrusion and mold, citing policy exclusions for seepage.
Second Claim:
On December 13, 2019, water again ...
CVS Settles Fraud Allegations with the US, Multiple States & Cities
Post 5246
Read the full article at https://lnkd.in/gWPTErTV, see the video at https://lnkd.in/gcmb4USM and at https://lnkd.in/gZcEHcZ9, and at https://zalma.com/blog plus more than 5200 posts.
False Claims Act Claims Resolved by CVS
In United States Of America v. CVS Pharmacy, Inc. et al, Nos. 18 Civ. 3047 (JGK), 19 Civ. 1550 (JGK), 19 Civ. 8454 (JGK), 19 Civ. 11244 (JGK), 20 Civ. 2173 (JGK), 18 Civ. 3047 (JGK), United States District Court, S.D. New York (December 1, 2025) Honolable John G. Koeltl United States District Judge concluded that Relators filed the above-captioned multiple actions against defendant CVS Pharmacy, Inc. (“CVS”) and other entities on behalf of the United States under the qui tam provisions of the False Claims Act, 31 U.S.C. § 3729 et seq., on behalf of 30 states, the District of Columbia, Puerto Rico, and the Virgin Islands under comparable state false claims and insurance fraud laws, and on behalf of six ...
CVS Settles Fraud Allegations with the US, Multiple States & Cities
Post 5246
Read the full article at https://lnkd.in/gWPTErTV, see the video at https://lnkd.in/gcmb4USM and at https://lnkd.in/gZcEHcZ9, and at https://zalma.com/blog plus more than 5200 posts.
False Claims Act Claims Resolved by CVS
In United States Of America v. CVS Pharmacy, Inc. et al, Nos. 18 Civ. 3047 (JGK), 19 Civ. 1550 (JGK), 19 Civ. 8454 (JGK), 19 Civ. 11244 (JGK), 20 Civ. 2173 (JGK), 18 Civ. 3047 (JGK), United States District Court, S.D. New York (December 1, 2025) Honolable John G. Koeltl United States District Judge concluded that Relators filed the above-captioned multiple actions against defendant CVS Pharmacy, Inc. (“CVS”) and other entities on behalf of the United States under the qui tam provisions of the False Claims Act, 31 U.S.C. § 3729 et seq., on behalf of 30 states, the District of Columbia, Puerto Rico, and the Virgin Islands under comparable state false claims and insurance fraud laws, and on behalf of six ...
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 ...
