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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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April 09, 2026
IVF is not Excluded Sexual Conduct

Ordinary Negligence is What Medical Professi0nal Liability Insures

Post number 5319

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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 customary scope of the insured’s practice specialty or classification ….” The policy further obligates the plaintiff, among other things, to “defend the insured against any claim or suit which includes . . . allegations of professional negligence for which coverage is provided under this policy.” It excluded sexual conduct.

The plaintiff claimed that the sexual conduct exclusion applies because “procreation is quintessentially sexual.” That contention overlooked the fact that procreation was the purpose of the professional services rendered in this case. As the underlying complaint makes clear, the civil action concerns the defendant’s provision of fertility services to the civil action plaintiffs’ parents through IVF procedures, which undoubtedly are medical procedures.

The professional service at issue is not the defendant’s production of sperm. It is, instead, the fraudulent use of his sperm to inseminate his patients. Although that suit alleged that the defendant negligently mixed his own sperm with that of Gary Suprynowicz to impregnate Kayla’s mother, it also alleges that he negligently failed to offer her parents “the choice of sperm donor” and negligently utilized sperm that contained a genetic disease. The Court of Appeal was unable to see how either of the latter two negligence allegations implicate the sexual conduct exclusion in any way.

The trial court granted summary judgment in favor of Integris Insurance Company, finding that the policy exclusions applied and that there was no coverage for the alleged misconduct. Tohan appealed this decision to the Connecticut Court of Appeals.

LEGAL ISSUES

The dispute centers on the interpretation of the medical professional liability insurance policy and whether the underlying complaint alleged facts potentially within the scope of coverage.

The trial court examined two principal issues: (1) whether the underlying complaint contained allegations that could trigger coverage, and (2) whether exclusions in the policy clearly and unambiguously barred coverage for all allegations and concluded there was no coverage for defense or indemnity.

DISCUSSION AND ANALYSIS

Providing IVF services to Kayla’s parents plainly is within the customary scope of the defendant’s practice specialty and thus constitutes “professional services” as that term is defined in the policy. The fact that the defendant may have negligently used his own sperm while providing those professional services, as the civil action plaintiffs allege in their complaint, does not alter that conclusion.

CONCLUSION

The Court of Appeals found that the trial court erred by concluding that the policy exclusions applied to every allegation without ambiguity.

The Court of Appeals concluded that the defendant’s fraudulent artificial insemination of his patients with his own sperm involved the provision of professional, medical services requiring special skill and knowledge. In this case, it is the operation itself, i.e., the insemination (and, ironically, its success), that is the proximate cause of the harms alleged in the underlying civil actions. As a result, the plaintiff’s policy extends coverage to claims arising from the defendant’s misconduct.

The civil action plaintiffs did not allege in count one that the defendant was aware that his sperm contained a genetic disease or that he knowingly used sperm that contained a genetic disease when providing IVF services to Kayla’s parents and that specific allegation constitutes an ordinary claim of negligence on the part of the defendant, and one that is not sexual in nature.

ZALMA OPINION

Since the good doctor never had any contact with the plaintiff’s mother but merely performed his specialty, inseminating her eggs with sperm from the father mixed with the doctor’s sperm. There was no excluded sexual conduct, just professional in vitro fertilization of the mother’s egg – a medical procedure not excluded.

(c) 2026 Barry Zalma & ClaimSchool, Inc.

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00:07:58
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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
37 minutes ago
Justice Should not Require Court to Give Patience to Criminal Petitioner

Court Allows itself to be Abused by Convicted Murderer and Insurance Fraudster

A Prisoner Has a Limited Right to file a Habeas Petition but Must do so Properly

Post number 5387

Posted on July 6, 2026 by Barry Zalma

Court Allows itself to be Abused by Convicted Murderer and Insurance Fraudster

A Prisoner Has a Limited Right to file a Habeas Petition but Must do so Properly
Post number 5387

In Tami Duvall v. State Of Indiana, No. 1:25-cv-01239-SEB-TAB, United States District Court, S.D. Indiana, Indianapolis Division (July 1, 2026) Indiana prisoner Tami Duvall filed a habeas petition under 28 U.S.C. § 2254 challenging her 2011 Indiana convictions for murder, insurance fraud, and obstruction of justice.

Law:

Federal Rule of Civil Procedure 15(a) governs amendment of pleadings, allowing amendment as of course within specified time limits and otherwise permitting amendment with leave of court when justice so requires.

Federal Rule of Civil Procedure 12(f) permits the Court to strike redundant matter. Rule 5 of the Rules ...

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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 ...

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