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January 27, 2026
State Regulatory Action does not Eliminate Effect of Exclusion

See the video at https://lnkd.in/grQRRWa5 and at https://lnkd.in/gH8gtAr2, and at https://zalma.com/blog plus more than 5250 posts.

Insurance Policy Exclusions Must be Enforced as Written
Post number 5272

Pollution With a State Permit is Still Excluded

In Griffith Foods International, Inc., et al. v. National Union Fire Insurance Company Of Pittsburgh, Pa, No. 131710, Supreme Court of Illinois, 2026 IL 131710 (January 23, 2026) Griffith Foods International, Inc., and its successor Sterigenics U.S., LLC, operated a medical-equipment sterilization facility in Willowbrook, Illinois. Local residents alleged that for over 35 years, the facility emitted ethylene oxide (EtO), which they claimed caused cancer and other serious illnesses.

The policyholders sought a declaration that National Union Fire Insurance Company of Pittsburgh, PA, was obligated to defend them in the underlying mass tort litigation, based on two CGL policies issued for the facility between September 1983 and September 1985.

The two policies required the insurer to “defend any suit against the insured seeking damages on account of *** bodily injury” that “occur[red] during the policy period” and “personal injury” arising out of “offenses committed during the policy period.” The CGL policies included a standard pollution exclusion, which is the subject of this appeal. The pollution exclusion bars coverage for “bodily injury or property damage arising out of the discharge, dispersal, release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants or pollutants into or upon land, the atmosphere or any water course or body of water.”

THE QUESTION FROM THE SEVENTH CIRCUIT

“In light of the Illinois Supreme Court’s decision in [American States Insurance Co. v. Koloms, 177 Ill.2d 473 (1997)] what relevance, if any, does a permit or regulation authorizing emissions (generally or at any particular levels) play in assessing the application of a pollution exclusion within a standard-form commercial general liability policy?”

LEGAL ISSUE

The key legal issue was the interpretation of the pollution exclusion in the CGL policies, which excludescoverage for bodily injury or property damage resulting from the release of pollutants, including toxic chemicals and gases, into the environment.

ANALYSIS

The Court reasoned that the pollution exclusion is triggered by the nature of the contaminant released and the resulting injury, not by whether the release was authorized or regulated. Past decisions confirmed that the exclusion applies regardless of compliance with permits or regulatory standards. Thus, the presence of a permit or regulation authorizing emissions does not influence the scope or application of the exclusion; coverage is barred so long as the injury results from pollutants as defined in the policy.

OPINION

The Supreme Court of Illinois, responding to the certified question from the Seventh Circuit, held that a permit or regulation authorizing emissions — whether generally or at specific levels — does not affect the interpretation or application of the pollution exclusion clause in a standard-form commercial general liability (CGL) insurance policy. The Court’s answer was clear: such regulatory authorizations are irrelevant when determining coverage under the pollution exclusion.

The plain language of the pollution exclusion states that coverage is barred for litigation involving “the discharge, dispersal, release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants or pollutants into or upon land, the atmosphere or any water course or body of water.”

The fact that the IEPA permitted the EtO emissions does not change this analysis. The pollution exclusion says nothing about permitted or authorized pollution, and courts must not inject terms and conditions different from those agreed upon by the parties.

In addition, the pollution exclusion in CGL policies was drafted in response to the insurance industry’s concerns about increasing, costly environmental litigation. Declining to apply the pollution exclusion simply because the pollution was permitted by the State would undermine the pollution exclusion’s very purpose. In sum, in determining whether the pollution exclusion in a CGL policy applies, the Supreme Court held that it is irrelevant whether the underlying pollution is permitted or not.

CONCLUSION

For the foregoing reasons, the Supreme Court answered the certified question as follows: “a permit or regulation authorizing emissions (generally or at any particular levels) has no relevance in assessing the application of a pollution exclusion within a standard form commercial general liability policy.”

ZALMA OPINION

The Supreme Court of Illinois interpreted the insurance policies as they are written and refused to add language that was not in the policy to provide coverage for the alleged polluters. The polluters claimed having a permit changed the fact that they polluted the atmosphere. No coverage because the exclusion was clear and unambiguous.

(c) 2026 Barry Zalma & ClaimSchool, Inc.

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September 18, 2026
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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.

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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...

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September 17, 2026
Convicted on 29 Tax-Refund-Fraud Counts

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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 ...

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September 14, 2026
Court Enforces Fifth Amendment & Refuses to Compel Answers

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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 ...

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October 02, 2026
Announcement About False Claims Act Settlement Results in Damages Suit

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Post 4855

Posted on October 2, 2026 by Barry Zalma

In Abbas Mohammadi et al. v. William M. Tong et al., No. AC 47598, Court of Appeals of Connecticut (September 29, 2026) Abbas Mohammadi owned and operated Columbia Dental, P.C., which provided dental services through multiple Connecticut offices; Columbia Oral Maxillofacial Imaging, LLC served as the billing entity.

From April 2012 to February 27, 2013, Columbia Dental employed Brittany Ames Mahoney as a dental assistant. During her employment, Mahoney claimed to have discovered certain billing irregularities, including, but not limited to, false and fraudulent reimbursement claims submitted to the Department of Social Services for services rendered to Medicaid beneficiaries. Mahoney filed a complaint and an affidavit in the United States District Court for the District of...

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October 01, 2026
Zalma’s Insurance Fraud Letter – October 1, 2026

Another Anniversary for Barry Zalma, Inc

Posted on October 1, 2026 by Barry Zalma
From October 1, 1979 – 2026

Post 4854

Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/09/ZIFL-10-01-2026.pdf Forty seven years ago today I left the world of the employed and became an entrepreneur by opening my own law firm. The law practice was incorporated shortly thereafter as Barry Zalma, Inc.

When I opened for business on October 1, 1979, I had no clients and no certainty that I would have any in the future. I had borrowed money from the bank to carry me through the first six months and was concerned about my ability to pay the loan with my third child about to be born.

Much to my surprise and pleasure, on October 1, 1979, at 8:10 a.m., the best claims handler in the London market, Alan Warboys, called from London and provided me with my first case as an independent lawyer to represent Certain Underwriters at Lloyd’s, London. He, and the Lloyd’s Underwriters he represented, showed faith in me as a lawyer and insurance expert. Alan is now, although ...

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September 30, 2026
Suing for Services Provided, and Paid for, is Fraud

Defendants Successfully Moved for Summary Judgment

Post 4854

Posted on September 30, 2026 by Barry Zalma

In Jeffrey Wayne Phillips v. Creative Website Studios, et al., No. 5:23-CV-568-BO-BM, United States District Court, E.D. North Carolina, Western Division (September 28, 2026) the Court needed to rule on the order and memorandum and recommendation (“M&R”) of the Magistrate.

Jeffrey Wayne Phillips had contracted with Creative Website Studios and SR Telecommunications for website and hosting services. He alleged that defendants repeatedly billed him for hosting periods he had already paid for and later took down his website. Phillips claimed the outage prevented him from bidding on U.S. government security contracts and sought roughly $300 million in consequential damages.
LAW

Under North Carolina law, fraud requires a false material representation or concealment, intent and effect of deception, resulting damage, and reasonable reliance. Obtaining property by false pretenses similarly requires an ...

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