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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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 ...
Chutzpah is not Enough
Post 5397
Posted on July 20, 2026 by Barry Zalma
See the video and at https://lnkd.in/gNUs2XzT and at https://lnkd.in/g2MawyzX
Magistrate Issues a Search Warrant if there is a Fair Probability that Contraband or Evidence of a Crime will be Found in a Particular Place.
In United States Of America v. Frank Suess, et al., CRIMINAL No. 3:24-308, United States District Court, M.D. Pennsylvania (July 16, 2026) a federal grand jury indicted Frank Suess, Melissa Driscoll, and others in a 55-count health care fraud and anti-kickback prosecution arising from an alleged scheme involving medically unnecessary prescription “foot baths.”
As part of the investigation, the FBI obtained an August 19, 2022 warrant to search Driscoll’s Sterling Pharmacy Yahoo email account for emails from January 1, 2018 through December 31, 2020. Driscoll moved to suppress the resulting evidence, arguing that the warrant lacked probable cause, was overbroad, and rested on material misstatements and omissions.
LAW:
The ...
Fraud Shouldn’t Pay
Post 5396
See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA
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.
The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.
One month after the policy was ...
Guilty of Misprison of a Felony Admitted by Owner of Insurers
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Second Trial of Coram Nobis Relief Fails
Post 5422
Coram Nobis is an Extraordinary Remedy
In United States Of America v. David Judd Disiere, Criminal Action No. 99-151-SDD-SDJ, United States District Court, M.D. Louisiana (August 10, 2026 David Judd Disiere was convicted in 2000 after pleading guilty to misprision of a felony under 18 U.S.C. § 4 in connection with allegations involving a scheme to influence the resolution of an investigation into insurance companies he owned.
He was sentenced to probation and a fine, did not directly appeal, and completed probation in 2003. After an earlier unsuccessful postconviction challenge, Disiere filed a second petition for writ of error coram nobis in 2024, claiming his plea was coerced by prosecutors’ threats relating to an employee allegation, that those threats were concealed from the court, that his counsel was ineffective, and that the factual basis did...
Day Care Owner Loses Subsidies Because She Criticized State
Post 5421
Posted on August 11, 2026 by Barry Zalma
First Amendment Right Will be Allowed to Go to Trial
In Betsey J. Grant v. Maine State Department Of Heath And Human Services, No. 1:25-cv-00490-JAW, United States District Court, D. Maine (August 6, 2026), Betsey J. Grant, a licensed childcare provider and operator of Tiny Tikes Daycare in Trenton, Maine, sued Maine DHHS and several employees after she publicly criticized DHHS before Maine’s Government Oversight Committee and alleged that officials retaliated against her.
She claimed DHHS imposed and extended a conditional license, published stigmatizing information, interfered with subsidies and program funding, removed her from a food program, rescinded an expansion grant, and used biased or falsified evidence in licensing proceedings. Following the March 10, 2023, GOC testimony, Ms. Grant alleges that foster children's subsidies (approximately $30,000) were withheld; she was removed from the ...
Rescission for Material Misrepresentation
Post 5418
Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units. After an underlying personal injury action was filed, Union Mutual determined that the property actually contained three apartment units and rescinded the policies on the ground that the defendants had made a material misrepresentation in the applications.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true ...
