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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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February 04, 2026
To Rescind in Maryland a Misrepresentation Must be Fraudulent

Lie About Criminal Background & Insurer Will Try to Rescind
Post number 5277

Read the full article at https://lnkd.in/gk2N3i_z, See the video at https://lnkd.in/gdRjkdNh and at https://lnkd.in/gTszVnru and at https://zalma.com/blog plus more than 5250 posts.

Pro Se Defendant Admits Misrepresentation but Claimed no Intent to Defraud

In Metropolitan Life Insurance Company v. Sheba S. Gopaul, Civil Action No. 1:21-cv-02454-LKG, United States District Court, D. Maryland (January 15, 2026) Metropolitan Life Insurance Company (“MetLife”) filed a declaratory judgment action against Sheba S. Gopaul, who represented herself (pro se).

FACTUAL BACKGROUND

MetLife alleged that Ms. Gopaul made fraudulent material misrepresentations, misstatements, and/or omissions about her criminal history in her 2015 application for a disability income insurance policy. The company claimed that it would not have issued the policy had it known the true facts.

Ms. Gopaul completed the application on June 18, 2015, and agreed in writing that all statements were true and complete, and that MetLife could rely on them in deciding whether to issue the policy.

Ms. Gopaul submitted an initial claim for disability benefits form to MetLife. In the disability claim, Ms. Gopaul claimed total disability from her occupation as the CEO/CFO of a healthcare company, due to moderate to severe pain in her pelvis, knee and hip when standing, climbing, walking, bending and lifting, due to a series of falls in June and August of 2019, along with postpartum depression and anxiety after delivering a baby in December of 2019.

The crimes misrepresented were the following crimes for which she was convicted: Theft, Prostitution, U/U use of livestock, Grand Larceny-credit cards (Felony), Obtaining Money Under False Pretense and auto theft.

LEGAL ISSUES

The court reviewed the matter as a declaratory judgment action, applying principles governing insurance contracts, including the legal standards for rescission due to material misrepresentation. Under Maryland law, an insurer may rescind a policy if it can prove that a material misrepresentation was made in the application and that the misrepresentation affected the company’s decision to issue the policy.

ANALYSIS

After reviewing the evidence, the court concluded that MetLife had established a basis for some, but not all, of its claims for summary judgment. Specifically, the court found sufficient evidence supporting MetLife’s contention that Ms. Gopaul made material misrepresentations regarding her criminal history, which were significant to MetLife’s decision-making process but did not prove that the misrepresentations were fraudulent.

MetLife contended that it would not have issued the Policy to Ms. Gopaul had it known about these three prior felony convictions and the multiple misdemeanor convictions sounding in fraud, because she would have been deemed an unacceptable insured due to both a medical and financial risk.

MetLife’s Rescission Of The Policy

There must be sufficient evidence favoring the nonmoving party for a jury to return a verdict for that party. If the evidence is merely colorable, or is not significantly probative, summary judgment may be granted.

The Omitted Convictions Are Material

The undisputed material facts show that Ms. Gopaul’s misrepresentations and/or omissions about her criminal history were material, because MetLife would not have issued the Policy had it known about these prior convictions.
Material And Fraudulent Misrepresentations

The burden is on the insurer to establish fraud or misrepresentation by the insured in the application for insurance. The undisputed material facts in this case show that Ms. Gopaul’s misrepresentations and/or omissions about her criminal history were material. But, the Court concluded there is a genuine dispute of material fact as to whether Ms. Gopaul’s misrepresentations and/or omissions about her criminal history were fraudulent.

Made Fraudulent Misrepresentations Regarding Her Criminal History

The Court was not satisfied that the undisputed material facts establish that Ms. Gopaul’s material misrepresentations and/or omissions to MetLife about her criminal history were fraudulent. Ms. Gopaul’s misrepresentations and/or omissions about her criminal history were not established as made for the purpose of defrauding MetLife.

ZALMA OPINION

Making a material misrepresentation in an application is usually sufficient to prove an insurer’s right to rescind. The USDC, perhaps giving the benefits of all doubt to a pro se defendant, found that although she admitted she lied on the application she did not do so to defraud the insurer. A trial before a reasonable jury who do not feel sorry for a pro se defendant should confirm the rescission.

(c) 2026 Barry Zalma & ClaimSchool, Inc.

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00:08:07
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PROSECUTING ATTORNEYS ARE IMMUNE FROM SUIT

Formulaic Recitation Of The Elements Of Civil Conspiracy Are Insufficient
Post number 5320

See the full video at https://lnkd.in/gPACkgWq and at https://lnkd.in/gsaxij7D, and at https://zalma.com/blog plus more than 5300 posts.

In Hassan Fayad v. Liberty Mutual Insurance Company, et al., No. 2:25-cv-10930, United States District Court, E.D. Michigan, Southern Division (March 24, 2026) Plaintiff Hassan Fayad, the owner of several businesses providing transportation, diagnostics, testing, and therapy services, regularly billed insurance companies for these services, was arrested and tried for fraud, convicted, had the conviction overruled and sued the insurers and prosecutors he found responsible.

FACTUAL BACKGROUND

By January 2020, Liberty Mutual, Progressive, Allstate, and Esurance suspected fraudulent activity and filed a complaint with the Michigan Department of Attorney General (MDAG). The insurers alleged that Fayad and others billed Michigan auto insurance policies for profit without actually providing medically ...

00:08:00
April 09, 2026
Everyone Must Agree to Removal to Federal Court

Federal Courts Have Limited Jurisdiction

When all Parties Refuse Removal There is No Jurisdiction

Post number 5319

Read the full article at https://lnkd.in/gp6Z-JYY, see the full video at https://lnkd.in/gAum322y and at https://lnkd.in/gRPzCjmt and at https://zalma.com/blog plus more than 5300 posts.

In Beth Mayhew and Matthew Mayhew v. Vladimir Sadovyh, et al., No. 2:26-CV-04029-WJE, United States District Court, W.D. Missouri (April 6, 2026) Mayhew was involved in a trailer-truck accident with Vladimir Sadovyh, who was employed by Nova First, LLC and Globex Transport, Inc. Both companies owned the tractor-trailer involved.

FACTUAL BACKGROUND

Chubb and Mohave Transportation Insurance Company jointly issued an insurance policy covering Nova First, Globex, and Sadovyh, with EMA Risk Services acting as a third-party administrator.

Beth Mayhew sued Nova First, Globex, and Sadovyh for negligence in Missouri state court, and following a jury trial, a nuclear judgment was awarded to the Mayhews totaling ...

00:04:01
April 09, 2026
IVF is not Excluded Sexual Conduct

Ordinary Negligence is What Medical Professi0nal Liability Insures

Post number 5319

See the full video at https://lnkd.in/gxKjDztW and at https://lnkd.in/gnxkxS42, and at https://zalma.com/blog plus more than 5300 posts.

Sexual Conduct Exclusion Doesn’t Apply When Doctor Negligently Uses His Own Sperm

In Integris Insurance Company v. Narendra B. Tohan, No. AC 47222, Court of Appeals of Connecticut (April 7, 2026) Integris Insurance Company, a medical professional liability insurer, initiated a declaratory action to determine its duty to defend and indemnify Narendra B. Tohan, a physician licensed in Connecticut, in a separate negligence action alleging medical misconduct.

FACTUAL BACKGROUND

In 2019, Kayla Suprynowicz and Reilly Flaherty (civil action plaintiffs), who were strangers for most of their lives, discovered through a genetic testing company that they are half siblings.

INSURANCE POLICY

The policy defines “Professional Services” in relevant part as “any professional medical services within the ...

00:07:58
April 02, 2026
Zalma’s Insurance Fraud Letter – April 1, 2026

ZIFL – Volume 30, Issue 7 – April 1, 2026

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post number 5314

Posted on April 1, 2026 by Barry Zalma

Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th 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/ This issue contains the following articles about insurance fraud:

No One is Above the Law – Not Even a Police Officer

Police Officer Convicted for Fraud in Reporting an Accident Affirmed
Police Officer Should never Lie about Results of Chase

In State Of Ohio v. Anthony Holmes, No. 115123, 2026-Ohio-736, Court of Appeals of Ohio, Eighth District, Cuyahoga (March 5, 2026) a police officer appealed criminal conviction as a result of lies about a high speed chase.

Read the following article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-04-01-2026-1.pdf...

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

ZIFL – Volume 30, Issue 7 – April 1, 2026

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post number 5314

Posted on April 1, 2026 by Barry Zalma

Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th 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/ This issue contains the following articles about insurance fraud:

No One is Above the Law – Not Even a Police Officer

Police Officer Convicted for Fraud in Reporting an Accident Affirmed
Police Officer Should never Lie about Results of Chase

In State Of Ohio v. Anthony Holmes, No. 115123, 2026-Ohio-736, Court of Appeals of Ohio, Eighth District, Cuyahoga (March 5, 2026) a police officer appealed criminal conviction as a result of lies about a high speed chase.

Read the following article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-04-01-2026-1.pdf...

March 31, 2026
Insurance Fraud Costs Everyone

Posted on March 30, 2026 by Barry Zalma

Insurance Fraud, a Way to Reduce Violent Crime
Post number 5313

A Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story helps to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ­­­Perpetrators than any Other Crime.

She Taught Her Customers The Swoop And Squat:

Recently the California Insurance Department’s Fraud Division arrested a young woman in Los Angeles County for operating an insurance fraud school. She advertised her classes in the “Penny Saver” an advertising sheet distributed free to the public and a print version of Facebook, X Craig’s list. She had operated for several years teaching methods of committing automobile insurance fraud. Only after a police officer enrolled in one of her classes was she arrested.

Her defense ...

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