Not All Expert Testimony must be Scientifically Reliable
Post number 5284
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In Church Mutual Insurance Company, S.I. v. Chabad Of New Mexico, No. 1:24-cv-00090-MIS-SCY, United States District Court, D. New Mexico (February 10, 2026) the USDC dealt with a declaratory judgment filed by Church Mutual that it owes no duty to cover Chabad’s claims because the property was “vacant” for more than sixty consecutive days before the acts of arson, and therefore no coverage is owed pursuant to the Policy’s “Vacancy” loss condition.
FACTUAL BACKGROUND
Church Mutual Insurance Company, S.I. (“Church Mutual”) renewed an insurance policy for Chabad of New Mexico (“Chabad”) covering real property in Rio Rancho, New Mexico. The policy included a “Vacancy” loss condition, stating that if the building was vacant for more than 60 consecutive days prior to a loss, Church Mutual would not pay for losses caused by certain events, including vandalism.
The claims adjuster assigned to investigate the fires stated that “while the building was not actively being used, there remained sufficient contents in the structure for the Insured to continue their normal operations.”
The interpretation and construction of an insurance policy is a question of law for the Court and one that the Court performed when it ruled on the Parties’ cross-motions for summary judgment on the issue of coverage concluding that Chabad’s building was not “vacant” under the unambiguous terms of the Policy and that therefore Chabad was entitled to summary judgment on the issue of coverage as to both fires. As such, the Court finds that this argument was moot.
Chabad sought to introduce expert testimony regarding insurance industry standards, customs and practices and about how Church Mutual Insurance Company deviated from those standards in its handling of the property damage claims of” Chabad. Chabad hired Stuart Setcavage who purports to be “an expert in the field of insurance industry claim handling, policy interpretation and coverage analysis.”
As to the Vacancy provision, Mr. Setcavage states: “Claim professionals are trained to know that the vacancy condition of the building combines suspension of coverage for certain perils with reduction in coverage for others . . . The approach . . . eliminates coverage only for the perils most affected by vacancy, and it reduces coverage for damage by other perils. ”
Church Mutual sought to exclude the expert testimony of S. Setcavage.
ANALYSIS/DISCUSSION:
The Court denied Church Mutual’s Corrected Motion to Exclude the testimony of S. Setcavage. The judge found that the motion did not warrant exclusion and permitted the testimony to be presented at trial.
Mr. Setcavage noted that “neither the perils of arson nor fire are specifically identified” in the Vacancy provision, and opines that “the intent of the policy was to reduce coverage by 15% for perils not specifically listed, not eliminate it altogether.” Mr. Setcavage further opined that Church Mutual is attempting to redefine ‘vacancy’ to include factors not set forth in the policy. Church Mutual now wants vacant to mean unused.
District courts evaluating the reliability of non-scientific expert testimony do not have to focus on whether the expert employed an objective standard or methodology and can instead focus on the reliability of the expert’s personal knowledge or experience.
Here, Mr. Setcavage has offered opinions that may assist the jury in deciding whether Church Mutual has engaged in bad faith insurance conduct. In fact, the claim handling or investigation is indicia of a pre-determination to deny payment for these claims. The Court was satisfied that Mr. Setcavage’s proposed expert testimony was both reliable and relevant, in that it will assist the trier of fact.
Church Mutual Insurance Company’s Corrected Motion to Exclude the Testimony of S. Setcavage, was denied.
ZALMA OPINION
Insurance claims handling expert witnesses are not scientists, do not deal with scientific or engineering realities but rather are presented to explain to a jury that actions of an insurer in dealing with a claim, were conducted within the custom and practice of the insurance industry and whether the insurer fulfilled or failed to fulfill the standards of the industry. For that reason, since the court had ruled that the insurer’s attempt to apply a vacancy condition to apply to perils not identified the court concluded the expert would help the jury understand whether the tort of bad faith was involved.
(c) 2026 Barry Zalma & ClaimSchool, Inc.
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Arrest for Insurance Fraud is not a Violation of Constitutional Rights
Court Give Plaintiffs Acting as their Own Lawyer a Second Chance
Post number 5310
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In Arin Sutton et al v. Lori Pozuelos et al., No. 5:25-cv-03544-MRA-MAR, United States District Court, C.D. California (March 20, 2026) Plaintiffs Darin Sutton and Youtha Baker, proceeding pro se and in forma pauperis, initiated a civil rights action under 42 U.S.C. § 1983 against multiple defendants, including Lori Pozuelos, in the United States District Court for the Central District of California.
FACTUAL BACKGROUND
Plaintiffs allege violations of their constitutional rights, though the complaint’s factual allegations are stated in general terms and lack specific detail as to the actions of each defendant.
Plaintiffs are independent contractors who completed work in Missouri. ...
Suit Against Police Agency Dismissed
Post number 5309
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Conclusory Allegations, Unwarranted Deductions Of Facts Or Legal Conclusions Masquerading As Facts Will Not Prevent Dismissal.
In Hunter Seaborn Mackenzie Black v. Robert J. Perrault, Jr. and The Florida Department Of Financial Services, No. 8:25-cv-01466-WFJ-CPT, United States District Court, M.D. Florida, Tampa Division (March 19, 2026) Defendant Florida Department of Financial Services' (“DFS”) moved to Dismiss Count II of the Amended Complaint.. Plaintiff Hunter Seaborn Mackenzie Black (“Black”) has responded in opposition.
BACKGROUND
Plaintiff Hunter Seaborn Mackenzie Black was an independent salesman for a licensed roofing contractor, conducting door-to-door roofing sales in Florida. Defendant Florida Department of Financial Services ...
Fraudsters Fight Over Ownership of the Subject of Their Fraud
Post number 5308
Read the full article at https://www.linkedin.com/pulse/honor-among-thieves-barry-zalma-esq-cfe-2nchc, see the full video at and at and at https://zalma.com/blog plus more than 5300 posts.
Convicted Fraudsters Try to Cheat Each Other
After failing to defraud insurers about the loss of a diamond ring the two admitted fraudsters sought possession of the seized ring which was neither lost nor stolen but was seized by the state.
In State Of North Carolina v. Kevin Ray Reece and Debra Lee Goldman, No. COA25-569, Court of Appeals of North Carolina (March 18, 2026) two fraudsters disputed the ownership of a platinum-banded diamond ring seized during a criminal investigation as the subject of Insurance Fraud.
FACTUAL BACKGROUND
Kevin Ray Reece pleaded guilty to two counts of felony obstruction of justice related to the ring and requested its return...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
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Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
