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 13, 2026
Expert’s Personal Knowledge or Experience Can Assist Jury

Not All Expert Testimony must be Scientifically Reliable
Post number 5284

Read the full article at https://lnkd.in/gcS7tWC8; see the video at https://lnkd.in/g7N27nuK and at https://lnkd.in/gcYh2sZG, and at https://zalma.com/blog plus more than 5250 posts.

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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00:07:40
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12 hours ago
There is no Statutory Right to Defraud an Insurer

Counterclaim Seeking Payment of its Fraudulent Bills Fails

Post number 5297

Read the full article at https://www.linkedin.com/pulse/statutory-right-defraud-insurer-barry-zalma-esq-cfe-03c3e, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.

Fraudsters Attempt to Use Statute to Force Payment Fails 

In Connecticut General Life Insurance Co. et al. v. East Coast Advanced Plastic Surgery, LLC, No. 25 Civ. 1686 (PAE), United States District Court, S.D. New York (February 24, 2026) a dispute between Connecticut General Life Insurance Company and its subsidiary Cigna Health and Life Insurance Company (collectively, "Cigna" ) and East Coast Advanced Plastic Surgery, LLC ("ECAPS" ), a New Jersey-based medical practice specializing in post-mastectomy breast reconstruction.

Cigna alleged that ECAPS engaged in fraudulent billing practices, resulting in excessive payments for services rendered ...

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March 04, 2026
Limitation Defeats Suit Against Insurer

Supreme Court of Alabama Grants a Rare Request for Mandate

Read the full article at https://www.linkedin.com/pulse/limitation-defeats-suit-against-insurer-barry-zalma-esq-cfe-eychc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.

Statute of Limitations Demands Summary Judgment for Insurer

Post number 5296

In Ex parte Alfa Mutual Insurance Company and Jeffery Dimoff, In re Kinsman Investments, LLC v. Alfa Mutual Insurance Company and Jeffery Dimoff, No. SC-2025-0478, Supreme Court of Alabama (February 27, 2026) a rare Petition for Writ of Mandamus was granted and the trial court was ordered to enter summary judgment on behalf of Alfa.

Facts

Kinsman Investments, LLC (“Kinsman”) owned an apartment complex in Mobile, Alabama, which suffered significant damage from Hurricane Katrina in August 2005. At the time, the property was insured by Alfa Mutual Insurance Company (“Alfa”). Jeffery...

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March 03, 2026
Production of Claims File Required Regardless of Privilege

Claims File Created During the Pendency of a Lawsuit is Discoverable Regardless of Privilege

Read the full article at https://www.linkedin.com/pulse/production-claims-file-required-regardless-privilege-barry-ehroc, see the video at and at and https://zalma.com/blog plus more than 5250 posts.

In Melissa Eddy, and Alexis Eddy v. Farmers Property Casualty Insurance Company, f.k.a. Metropolitan Property and Casualty Insurance Company, APPEAL NO. C-230298, Court of Appeals of Ohio, First District, Hamilton County, 239 N.E.3d 1003, 239 N.E.3d 1000, 2024-Ohio-1047 (March 22, 2024) ruled on discovery issues with regards to the privileges asserted by Farmers.

Facts

In February 2020, Melissa Eddy was injured in a car accident while her husband, Alexis Eddy, was driving. The accident was caused by another driver, Pamela Shooner. Melissa sustained neck injuries that required surgery. At the time, the Eddys held an ...

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February 24, 2026
Declaring a Policy Void

Contract Breaches that Allow Multiple Different Grounds to Make a Policy Void

More from Excellence in Claims Handling Substack for Subscribers Only. You can Subscribe to my substack at https://barryzalma.substack.com/subscribe
Posted on February 24, 2026 by Barry Zalma

You’re reading from the free part of Excellence in Claims Handling until you reach the paywall. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the “subscribe” link below.

If an insured breaches one or more material warranties and increases the risk covered by the policy, the contract may be voided by the insurer, depending on the jurisdiction. It is, therefore, essential that every claims investigation include efforts to establish compliance with every warranty.

In Cummings v. Fire Insurance Exchange, 292 Cal. App. 3d 1407, 249 Cal. Rptr. 568 (1988), the Court of Appeal ...

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February 19, 2026

Passover for Americans
Posted on February 19, 2026 by Barry Zalma
“The Passover Seder For Americans”

For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lost the ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah. Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and wonder how did all these wonderful things come into being. Jews believe the force we call G_d created the entire universe and everything in it. Jews feel G_d is all seeing and knowing and although we can’t see Him, He is everywhere and in everyone.We understand...

February 19, 2026

Passover for Americans

Posted on February 19, 2026 by Barry Zalma

Read the full article at https://www.linkedin.com/pulse/passover-americans-barry-zalma-esq-cfe-5vgkc.

Available at https://www.amazon.com/Passover-Seder-American-Family-Zalma-ebook/dp/B0848NFWZP/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=1584364029&sr=8-4

“The Passover Seder For Americans”

For more than 3,000 years Jewish fathers have told the story of the Exodus of the enslaved Jews from Egypt. Telling the story has been required of all Jewish fathers. Americans, who have lived in North America for more than 300 years have become Americans and many have lostthe ability to read, write and understand the Hebrew language in which the story of Passover was first told in the Torah.

Passover is one of the many holidays Jewish People celebrate to help them remember the importance of G_d in their lives. We see the animals, the oceans, the rivers, the mountains, the rain, sun, the planets, the stars, and the people and ...

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