Zalma on Insurance
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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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May 26, 2026
He Who Acts as His Own Lawyer Has an Idiot for a Client

Arsonist Tried To Represent Himself, Failed, and Sought Habeas Relief

Post number 5357

Read the full article at https://www.linkedin.com/pulse/he-who-acts-his-own-lawyer-has-idiot-client-barry-zalma-esq-cfe-d4bwc, See the full video at and at and at https://zalma.com/blog.

Karacson’s Arson for Profit Attempt Required Skill & Experience to Succeed

In Steve Ellis Karacson v. David Shaver, Warden, No. 25-1089, United States Court of Appeals, Sixth Circuit (May 20, 2026) Steve Karacson was convicted in Michigan state court of arson and insurance fraud after evidence showed he burned his own insured home. Investigators found multiple points of origin, gasoline odor, and evidence tying him to the scene, including cell-phone location data and a receipt showing he had purchased a gas can and gloves shortly before the fire.

FACTS

Karacson initially had appointed counsel, but his relationships with both appointed attorneys ...

00:08:55
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May 11, 2026
Severe Punishment for Failure to Obey Court Orders

Foolish to Repeatedly Disobey Court Orders

All That Remains For Trial Is Plaintiff’s Damages On Each Of These Claims And Establishing Proximate Causation Of Those Damages.

Post number 5348

See the full video at and at and at https://zalma.com/blog plus 5300 posts.

In Linh Wang v. Esurance Insurance Company, No. C24-0447-JCC, United States District Court, W.D. Washington, Seattle (May 1, 2026) John C. Coughenour, United States District Judge, found that throughout this case, culminating with its briefing on Plaintiff’s renewed motion and that Defendant has subjected Plaintiff to unnecessary motion practice for clearly discoverable information and made dubious representations (including to the Court).

FACTUAL BACKGROUND

This case involves an underinsured/uninsured motorist insurance bad faith claim arising from a 2017 motor vehicle collision. The plaintiff, Linh Wang, alleges that Esurance Insurance ...

00:08:27
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May 08, 2026
Ambiguous Contract to Repair not an Assignment

The Right to Negotiate with Insurer is Not an Assignment of Claims

Post number 5347

Read the full article at https://www.linkedin.com/pulse/ambiguous-contract-repair-assignment-barry-zalma-esq-cfe-2xppc, see the full video at https://rumble.com/v79is1s-ambiguous-contract-to-repair-not-an-assignment.html and at and at https://zalma.com/blog plus more than 5300 posts.

Nebraska Requires an Actual Assignment to Allow Contractor to Sue Insurer

In Millard Gutter Company, a corporation doing business as Millard Roofing and Gutter v. Farmers Mutual Insurance Company of Nebraska, also known as Farmers Mutual Insurance, also known as Farmers Mutual, No. A-24-818, Court of Appeals of Nebraska (May 5, 2026) Millard sued Farmers as an assignee of Jane Anzalone who had hired Millard Gutter to repair the roof of her home and agreed to allow Millard Gutter to coordinate with her insurer, Farmers Mutual, concerning reimbursement for repairs authorized under her insurance policy.

FACTUAL BACKGROUND

In ...

00:08:02
July 03, 2026
Buying Insurance After the Accident is Fraud

It is a Crime to Lie to Your Insurer That Accident Happened After Policy Inception

Post number 5386

Posted on July 3, 2026 by Barry Zalma

Conviction for Fraud Affirmed Because Evidence Overwhelming

In State Of Washington v. Saleem Mumin Robinson, No. 87244-3-I, Court of Appeals of Washington, Division 1 (June 29, 2026) Saleem Robinson was involved in an automobile collision on May 18, 2021. The other driver, Mohamed Waggeh, photographed Robinson’s documents and later reported the collision to GEICO, identifying the time as approximately 12:40 p.m.

That same day, at 6:06 p.m., more than five hours after the accident, Robinson purchased Progressive insurance for the vehicle involved in the collision.

The next morning, Robinson called Progressive to report the claim and stated that the accident occurred around 6:15 p.m. Progressive recorded that call without advising Robinson that it was being recorded. Progressive later conducted a special investigative unit investigation the claim because it was submitted shortly ...

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July 02, 2026
Failure to Comply With Policy Conditions Defeats Claim

Deprive Insurer of the Ability to Properly and Timely Investigate Claim & Recover Nothing

Posted on July 2, 2026 by Barry Zalma

Post number 5385

No Contract Claim No Bad Faith Claim

In South Alexander Development I, LLC v.Markel American Insurance Co., Civil Action No. 23-1436-JWD-SDJ, United States District Court, M.D. Louisiana (June 24, 2026) South Alexander Development I, LLC (SADI) owned and operated a solar farm in Springfield, Louisiana that allegedly sustained significant Hurricane Ida damage.

After SADI submitted a claim, MAIC ultimately paid $1,099,614.02 for undisputed physical damage plus the $210,000 income-loss policy limit. SADI later sued for breach of contract and statutory bad faith, contending MAIC failed to fully investigate and adjust the claim; MAIC sought summary judgment, arguing SADI failed to cooperate and withheld material repair-cost information.

LAW:

Louisiana insurance policies are interpreted as contracts according to their plain meaning, and the insured bears the burden ...

post photo preview
July 02, 2026
Failure to Comply With Policy Conditions Defeats Claim

Deprive Insurer of the Ability to Properly and Timely Investigate Claim & Recover Nothing

Posted on July 2, 2026 by Barry Zalma

Post number 5385

No Contract Claim No Bad Faith Claim

In South Alexander Development I, LLC v.Markel American Insurance Co., Civil Action No. 23-1436-JWD-SDJ, United States District Court, M.D. Louisiana (June 24, 2026) South Alexander Development I, LLC (SADI) owned and operated a solar farm in Springfield, Louisiana that allegedly sustained significant Hurricane Ida damage.

After SADI submitted a claim, MAIC ultimately paid $1,099,614.02 for undisputed physical damage plus the $210,000 income-loss policy limit. SADI later sued for breach of contract and statutory bad faith, contending MAIC failed to fully investigate and adjust the claim; MAIC sought summary judgment, arguing SADI failed to cooperate and withheld material repair-cost information.

LAW:

Louisiana insurance policies are interpreted as contracts according to their plain meaning, and the insured bears the burden ...

post photo preview
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