Court Must Follow Judicial Precedent
Post 5252
Read the full article at https://www.linkedin.com/pulse/sudden-opposite-gradual-barry-zalma-esq-cfe-h7qmc, see the video at and at https://youtu.be/21x4jb_n0bI, and at https://zalma.com/blog plus more than 5250 posts.
Insurance Policy Interpretation Requires Application of the Judicial Construction Doctrine
In Montrose Chemical Corporation Of California v. The Superior Court Of Los Angeles County, Canadian Universal Insurance Company, Inc., et al., B335073, Court of Appeal, 337 Cal.Rptr.3d 222 (9/30/2025) the Court of Appeal refused to allow extrinsic evidence to interpret the word “sudden” in qualified pollution exclusions (QPEs) as including gradual but unexpected pollution. The court held that, under controlling California appellate precedent, the term “sudden” in these standard-form exclusions unambiguously includes a temporal element (abruptness) and cannot reasonably be construed to mean ...
Insurer’s RICO Claim Against Fraudulent Health Insurance Claims Proper
Post number 5268
Read the full article at https://www.linkedin.com/pulse/allstate-works-take-profit-out-crime-fraud-barry-zalma-esq-cfe-xu89c, See the video at and at and at https://zalma.com/blog plus more than 5250 posts.
Allstate Properly Asserted Fraud Claims Against Hospital and Doctors
In Allstate Indemnity Company et al. v. Memorial Heights Emergency Center et al., No. 25-20020 (5th Cir. Jan. 14, 2026) the Plaintiffs, a group of Allstate insurance entities, brought suit against several Defendants who own, manage, and operate Memorial Heights Emergency Center in Houston, Texas to recover monies paid to the listed fraud perpetrators only to have its case dismissed by the trial court and seek reversal at the Fifth Circuit.
FACTUAL BACKGROUND
In 2018, the Defendants entered into agreements with personal injury attorneys to refer ...
Fraudster Tries to Reduce His Sentence by Continuing His Fraud
Post number 5267
Read the full article at https://lnkd.in/gn6SUUqV, see the video at https://lnkd.in/g4PiYrAp and at https://lnkd.in/giHCPFAw, and at https://zalma.com/blog plus more than 5250 posts.
In Spite of Defendants Claims He Will Spend Serious Time in Prison
In United States Of America v. Henry Ford, Criminal Action No. 23-130, United States District Court, E.D. Pennsylvania (January 5, 2026) Henry Ford (no relation to the creator of the Model T), also known as “Cleothus Lefty Jackson,” was indicted and pled guilty to one count of securities fraud and aiding and abetting, along with seven counts of wire fraud.
FACTUAL BACKGROUND
Defendant falsely represented to victims that a business he controlled, Fallcatcher, had “pilot approvals in writing” with two large insurance companies and that several states “want the [Fallcatcher] technology” [Count Five]. In reality, Fallcatcher did not have any pilot programs with insurance companies and the ...
Fraudster Tries to Reduce His Sentence by Continuing His Fraud
Post number 5267
Read the full article at https://lnkd.in/gn6SUUqV, see the video at https://lnkd.in/g4PiYrAp and at https://lnkd.in/giHCPFAw, and at https://zalma.com/blog plus more than 5250 posts.
In Spite of Defendants Claims He Will Spend Serious Time in Prison
In United States Of America v. Henry Ford, Criminal Action No. 23-130, United States District Court, E.D. Pennsylvania (January 5, 2026) Henry Ford (no relation to the creator of the Model T), also known as “Cleothus Lefty Jackson,” was indicted and pled guilty to one count of securities fraud and aiding and abetting, along with seven counts of wire fraud.
FACTUAL BACKGROUND
Defendant falsely represented to victims that a business he controlled, Fallcatcher, had “pilot approvals in writing” with two large insurance companies and that several states “want the [Fallcatcher] technology” [Count Five]. In reality, Fallcatcher did not have any pilot programs with insurance companies and the ...
Lack of Jurisdiction Defeats Suit for Defamation
Post 5250
Posted on December 29, 2025 by Barry Zalma
See the video at and at
He Who Represents Himself in a Lawsuit has a Fool for a Client
In Pankaj Merchia v. United Healthcare Services, Inc., Civil Action No. 24-2700 (RC), United States District Court, District of Columbia (December 22, 2025)
FACTUAL BACKGROUND
Parties & Claims:
The plaintiff, Pankaj Merchia, is a physician, scientist, engineer, and entrepreneur, proceeding pro se. Merchia sued United Healthcare Services, Inc., a Minnesota-based medical insurance company, for defamation and related claims. The core allegation is that United Healthcare falsely accused Merchia of healthcare fraud, which led to his indictment and arrest in Massachusetts, causing reputational and business harm in the District of Columbia and nationwide.
Underlying Events:
The alleged defamation occurred when United ...
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 ...
