ZIFL – Volume 30, Issue 6
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post number 5304
Posted on March 16, 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:
There is no Statutory Right to Defraud an Insurer
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.
Read the full 21 page article at http://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-03-15-2026.pdf
Fraud and Artificial Intelligence
According to Gallagher Bassett’s 2026 Carrier Report, 64% of North American carriers report increased claims complexity over the past year. Medical inflation remains the most frequently cited driver of rising costs, with 56% of respondents identifying it as the top contributor. Longer recovery durations, extended wage replacement periods and a growing number of psychological injury claims are adding pressure to adjusters already managing heavier caseloads.
Gallagher Bassett’s findings were drawn from a global survey of carrier executives, underwriting leaders and claims professionals, with data and market analysis across North America, Europe, Asia‑Pacific and the U.K. Insights include quantitative survey responses and qualitative input from leaders responsible for claims, risk and operational strategy.
Read the full 21 page article at http://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-03-15-2026.pdf
Allianz Reveals Case Of Broker Abusing Position As Over 34,000 Fraud Cases Identified In 2025
From the Insurance Times, A Copywritten Article you read at Link :
https://www.insurancetimes.co.uk/news/allianz-reveals-case-of-broker-abusing-position-as-over-34000-fraud-cases-identified-in-2025/1457999.article?utm_id=34468&adredir=1
Introduction :
“Fraudsters are continually changing their tactics and we need to match their efforts with greater speed and agility than ever before,’ says director of fraud”
Read the full 21 page article at http://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-03-15-2026.pdf
Press Release from the California Department of Insurance
Owners Of One Of The Largest Towing Businesses In Southern California Arrested In Nearly 6 Million Dollar Fraud Scheme
LOS ANGELES, — Brothers and tow company owners, Mark Hassan, 46, of Corona Del Mar, and Ahmed Hassan, 35 of Walnut, were arrested today on multiple counts of felony insurance fraud after allegedly underreporting employee payroll and paying portions of employees’ wages in cash to defraud workers’ compensation insurance companies out of nearly 6 million dollars of insurance premiums.
Read the full 21 page article at http://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-03-15-2026.pdf
Health Insurance Fraud Convictions
Long Island Medical Doctor Sentenced to 7 Years in Prison for Operating Oxycodone Pill Mill Out of her Great Neck Office
Dr. Roya Jafari-Hassad was sentenced by United States District Judge Gary R. Brown to 7 years’ imprisonment for prescribing oxycodone pills without a legitimate medical purpose and fraudulently billing insurance providers for procedures which were never performed. In addition to the term of imprisonment, Judge Brown imposed a fine of $150,000 and ordered Jafari-Hassad to pay restitution in the amount of $152,765.
Read about 31 convictions and the full 21 page article at http://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-03-15-2026.pdf
Other Than Health Insurance Fraud Cases
Tragic death uncovers alleged insurance fraud by Oxnard licensed agent
Fake Coverage Left Recreational Soccer Leagues And School District Exposed
Gonzalo Lorona, 58, a licensed insurance agent of Oxnard, California has been charged with 37 felony counts, including insurance fraud and grand theft, after a California Department of Insurance investigation found he allegedly stole client premium payments and issued fraudulent insurance certificates leaving organizations uninsured and at financial risk.
Read the full 21 page article at http://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-03-15-2026.pdf
How Not to Commit Arson
This is 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, one of many, is designed to help insurance people 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.
Most people do not understand how hard it is to set fire to a house that will destroy the entire dwelling and its contents. Most residences simply do not have sufficient combustibles in the right place to allow for a sustained fire. Many homes, especially the more modern ones, have fail-safe devices everywhere that make accidental fires a thing of the past.
Adapted from my book Insurance Fraud Costs Everyone Available as a Kindle Book and Available as a Paperback from Amazon.com.
Read the full 21 page article at http://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-03-15-2026.pdf
WHAT IS NEEDED TO DETER INSURANCE FRAUD?
Insurers must train their staff to recognize the elements of both the crime of insurance fraud and the elements of the civil tort of insurance fraud. If well trained, insurance personnel collecting information about a potential insurance fraud, will know the type and quality of information that either a prosecutor or a civil defense lawyer will need to prove fraud was attempted.
Read the full 21 page article at http://zalma.com/blog/wp-content/uploads/2026/03/ZIFL-03-15-2026.pdf
Barry Zalma
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455.
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law for more than 44 years as an insurance coverage and claims handling lawyer and more than 58 years in the insurance business. He is available at http://www.zalma.com and [email protected]. Go to Zalma’s Insurance Fraud Letter at https://zalma.com/zalmas-insurance-fraud-letter-2/,
Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.
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.
Law
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...
150 Months in Prison for Tax Fraud
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 ...
Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution
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 ...
Theft of Confidential Information
Post 4581
Posted on November 12, 2026 by Barry Zalma
In People Center, Inc. v. Deel, Inc., et al., No. 25-cv-02576-CRB (LJC), United States District Court, N.D. California (November 7, 2026) People Center, doing business as Rippling, and Deel compete in payroll and human-resource management software. Rippling alleges that Deel and its executives recruited Rippling employee Keith O’Brien, based in Ireland, to disclose confidential information and trade secrets.
THE IRISH SUIT
Rippling sued O’Brien in Ireland and Deel in the United States. O’Brien subsequently retained separate counsel, supplied an affidavit describing the alleged espionage, and entered into a Cooperation Agreement with Rippling. In exchange for his cooperation, Rippling agreed to provide financial assistance, indemnification, and conditional dismissal of the Irish proceedings. The agreement also permitted renewed proceedings or a monetary judgment upon a material breach.
The Irish proceedings against O’Brien were dismissed...
A Proposed Amended Complaint That Includes New Factual Allegations to Remedy Pleading Deficiencies
Posted on November 11, 2026 by Barry Zalma
After Dismissal Fraud Victim May Amend Complaint After Dismissal
Post 4580
If A Proposed Amendment Is Not Clearly Futile, Then Denial Of Leave To Amend Is Improper
In John Hancock Life & Health Insurance Company v. Caring Connections LLC, Arthur Feldheim, and Blime a/k/a Vera Feldheim, Civ. No. 25-7574 (MAS)(JBD), United States District Court, D. New Jersey (November 6, 2026) John Hancock sued Caring Connections LLC, Arthur Feldheim, and Blime a/k/a Vera Feldheim on June 5, 2025, asserting thirteen claims, including fraud, breach of contract, and aiding and abetting fraud.
On March 26, 2026, this Court entered an order granting Caring Connections’ motion to dismiss and granting in part and denying in part the Feldheims’ motion to dismiss. The dismissed claims were dismissed without prejudice, and John Hancock timely sought leave to amend.
They also argued that the New ...
Is Exhaustion Required to Seek Declaratory Relief From an Excess Insurer?
Post 4578
Posted on November 9, 2026 by Barry Zalma
In Fox Paine & Company, LLC, et al. v. Twin City Fire Insurance Company et al., S287404, 593 P.3d 832, 593 P.3d 838, 346 Cal.Rptr.3d 541, Supreme Court of California, (July 27, 2026) the Supreme Court noted that Insurance is sometimes procured in a series of layers, with an insured acquiring a primary insurance policy that provides an initial layer of coverage for loss or liability and an excess insurance policy or policies that provide additional coverage in the event the underlying coverage is exhausted. Usually, the first layer of coverage must be exhausted before the excess layers are available to the insured.
Exhaustion
Fox and Paine’s investment-firm dispute generated extensive litigation and competing insurance claims. Their insurance tower consisted of a $10 million primary policy and four $10 million excess layers.
The Fox Parties alleged that insurers paid their rivals, withheld information,...
