There is no Privity Between Adjuster & an Insured
A Claim Against an Insurer for Wrongful Conduct Cannot Be Maintained Against Its Adjuster
Post number 5321
See the video at https://lnkd.in/gH6wPd45 and at https://lnkd.in/gB-7JpHZ and at https://zalma.com/blog plus more than 5300 posts.
In Lambert v. SafePort Insurance Company, et al., Civil Action No. 25-1446 (E.D. La. Apr. 2, 2026) (Morgan, J.) Plaintiff Lisa Lambert held a homeowner’s insurance policy issued by SafePort Insurance Company covering her property against windstorms and wind damage. After two separate windstorms damaged her home (the “First Wind Claim” and “Second Wind Claim”), she promptly reported both losses and attempted to mitigate damages.
FACTUAL BACKGROUND
SageSure Insurance Managers LLC acted as the claims adjuster/manager for SafePort. In both instances:
A field adjuster inspected the property and denied coverage, attributing the damage to “foundation settling as a result of earth movement” (an excluded peril that allegedly caused water pooling on the roof).
After the second denial, an engineer retained by SageSure allegedly inspected the property, initially identified a different roof type and damage cause, but the final engineering report was altered (at the direction of SageSure and/or SafePort) to match the field adjuster’s earth-movement denial rationale.
Plaintiff alleged the alterations and misrepresentations were intentional and part of a scheme to wrongfully deny valid wind-damage claims.
PROCEDURAL BACKGROUND
Plaintiff sued both SafePort and SageSure asserting seven causes of action including Breach of contract, Breach of the duty of good faith and fair dealing. Fraud / intentional misrepresentation, Conspiracy to commit fraud, Unfair trade practices in the business of insurance, Insurance fraud, and Negligent misrepresentation
SageSure moved under Fed. R. Civ. P. 12(b)(6) to dismiss all claims against it with prejudice. Plaintiff expressly conceded in briefing that she was “not suing SageSure for breach of contract.”
LAW
General Pleading Standard (Rule 12(b)(6))
A complaint must contain sufficient factual matter, accepted as true, to state a claim that is “plausible on its face.” Legal conclusions, threadbare recitals, and naked assertions are disregarded. Dismissal is proper if the face of the complaint shows a bar to relief.
Fraud / Conspiracy Pleading Standard (Rule 9(b))
Fraud and conspiracy-to-defraud claims must be pled with particularity: the “who, what, when, where, and how” of the alleged fraud. Collective/group pleading that fails to distinguish each defendant’s role is insufficient. Malice and intent may be pled generally, but the circumstances of fraud must be specific.
DISCUSSION / ANALYSIS
The Court addressed each claim in turn and found all deficient as to SageSure:
Breach of Contract
SageSure is not the insurer; the policy declarations name SafePort. Claim dismissed (and plaintiff conceded it).
Breach of Duty of Good Faith & Fair Dealing
Statutes apply only to insurers. SageSure is an adjuster/manager, not the insurer and there was no privity.
Insurance Fraud (La. R.S. § 22:1924)
Criminal statute; no private right of action.
Unfair Trade Practices in Insurance
No private right of action.
Fraud / Intentional Misrepresentation
Negligent Misrepresentation
Louisiana law generally imposes no tort duty on an independent adjuster for claims handling. Plaintiff pled no facts fitting any narrow exception.
Failed Rule 9(b) particularity: allegations lumped SageSure, SafePort, adjusters, and the engineer together without identifying specific fraudulent statements, speakers, dates, or locations.
Independently fatal: no allegation of justifiable reliance. Plaintiff never pled she took or refrained from any action because of the alleged misrepresentation
All deficiencies were incurable on the current pleading, so dismissal was with prejudice.
CONCLUSION
SageSure’s Motion to Dismiss was granted. All seven claims against Sagesure were dismissed with prejudice. The case proceeds solely against the actual insurer, SafePort Insurance Company.
ZALMA OPINION
Insurance adjusters act as agents of insurers but are not insurers. The insured who claims the contract was breached and the insurer acted wrongfully against the insured does not allow the insured to sue the adjuster because there is no privity between the insured and the adjuster. The plaintiff could maintain her action against the insurer but not the adjuster.
(c) 2026 Barry Zalma & ClaimSchool, Inc.
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Policy Limits Demand Accepted Settles Claim
Post 5434
Posted on August 26, 2026 by Barry Zalma
See the full video at https://lnkd.in/g-ZtsSgK and at https://lnkd.in/ghMBdYWR
A Contingent Offer Accepted Ends the Dispute
In Farmers Insurance Exchange, a California Reciprocal Insurance Exchange, The Superior Court For The County Of San Bernardino, Kathleen Ann Wood, E087128, California Court of Appeals, (July 9, 2026) Farmers Insurance Exchange insured Doyle Archer under an automobile policy with bodily injury limits of $15,000 per person and $30,000 per accident.
FACTUAL BACKGROUND
Archer rear-ended Kathleen Ann Wood at a red light, causing Wood to assert a bodily injury claim against him. Wood’s counsel sent Farmers a pre-litigation settlement demand offering to resolve Wood’s claim for the available policy limits, stating that if the $100,000 demand exceeded the policy, the offer was for the policy limits.
Farmers timely responded in writing, agreed to pay Wood the $15,000 per-person policy limit, and provided the requested ...
Policy Limits Demand Accepted Settles Claim
Post 5434
Posted on August 26, 2026 by Barry Zalma
See the full video at https://lnkd.in/g-ZtsSgK and at https://lnkd.in/ghMBdYWR
A Contingent Offer Accepted Ends the Dispute
In Farmers Insurance Exchange, a California Reciprocal Insurance Exchange, The Superior Court For The County Of San Bernardino, Kathleen Ann Wood, E087128, California Court of Appeals, (July 9, 2026) Farmers Insurance Exchange insured Doyle Archer under an automobile policy with bodily injury limits of $15,000 per person and $30,000 per accident.
FACTUAL BACKGROUND
Archer rear-ended Kathleen Ann Wood at a red light, causing Wood to assert a bodily injury claim against him. Wood’s counsel sent Farmers a pre-litigation settlement demand offering to resolve Wood’s claim for the available policy limits, stating that if the $100,000 demand exceeded the policy, the offer was for the policy limits.
Farmers timely responded in writing, agreed to pay Wood the $15,000 per-person policy limit, and provided the requested ...
The Largest Residential Burglary of All Time
Post 5407
Fraud & the Fear of Bad Faith Suits
Posted on July 22, 2026 by Barry Zalma
See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help 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.
After ...
Qui Tam Relators are not officers of the United States
Posted on September 4, 2026 by Barry Zalma
Attempt to use Constitution to Stop a Qui Tam False Claims Act Case
Post 5486
FCA’s Qui Tam Provisions do not Violate the Appointments Clause.
In United States Of America, Clarissa Zafirov, ex rel; Dr. v. Florida Medical Associates, LLC, d.b.a. Vipcare, Physician Partners, LLC, Anion Technologies, LLC, Freedom Health, Inc., Optimum Healthcare, Inc., Physician Partners Specialty Services, LLC, et al., No. 24-13581, United States Court of Appeals, Eleventh Circuit (September 1, 2026).
The False Claims Act (“FCA”) allows the Attorney General to bring civil suits against perpetrators of fraud against the government. This case involves another portion of the FCA-the qui tam provisions-which allow people, called relators, who have knowledge about fraud against the government to pursue a case against the perpetrator of the fraud.
Dr. Clarissa Zafirov filed a qui tam action under the False Claims Act on behalf of...
Posted on September 3, 2026 by Barry Zalma
You Only Get One Chance to Sue
Post 5484
In David Cromp v. Johnny Harkrider, Monique Harkrider, and their Marital Community, dba Able Plumbing Plus, No. 61678-5-II, Court of Appeals of Washington, Division 2 (August 25, 2026) David Cromp hired Able Plumbing Plus in 2018 to install plumbing, including two toilets, at his residence. In 2019, both toilets allegedly leaked, causing damage. Insurance claims were submitted through Able’s contractor policy, but the insurer eventually denied the claims.
Cromp sued Able in 2022 for breach of contract based on the allegedly defective toilet installation. During that case, Cromp attempted to add claims related to Able’s conduct during the insurance claim process, including fraud, bad faith, tortious conduct, and bond-related claims, but the superior court denied leave to amend. The 2022 breach-of-contract claim was later dismissed with prejudice on summary judgment as time-barred.
On the same day the 2022 case was dismissed, Cromp filed a ...
Habeas Corpus Petition Granted
Post 5483
Posted on September 2, 2026 by Barry Zalma
Over Staying Visa & Charge of Insurance Fraud Still Entitled to Habeas Relief and a Bond Hearing
In Hernan Guillermo Palomino-Crespo v. Warden, Glades County Detention Center et al., No. 2:26-cv-02322-SPC-NPM, United States District Court, M.D. Florida, Fort Myers Division (August 26, 2026) Hernan Guillermo Palomino-Crespo’s Amended Petition for Writ of Habeas Corpus, the government’s response and Palomino-Crespo’s reply.
FACTUAL BACKGROUND
Palomino-Crespo is a native and citizen of Colombia who lawfully entered the United States on a B-2 non-immigrant visa on February 24, 2017. He resides in Miami, Florida with his wife and two minor children, owns and operates a residential restoration and remodeling business, and files U.S. tax returns.
On June 4, 2026, the State of Florida charged Palomino-Crespo with insurance fraud.
Palomino-Crespo claimeds he did not meet the requirements for mandatory detention under § ...
