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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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 ...
Inadequately Briefed Issues Defeats Appeal
Post 4852
Issues on Appeal Must be Adequately Briefed
Posted on September 25, 2026 by Barry Zalma
In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.
According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair. The defendant denied negligence and alleged comparative negligence. After a two-day jury trial in November 2023, the jury returned a defense verdict.
The trial court denied Ojekwe’s motion to set aside the verdict and for a new trial, and he appealed.
LAW
A trial court’s refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of ...
Inadequately Briefed Issues Defeats Appeal
Post 4852
Issues on Appeal Must be Adequately Briefed
Posted on September 25, 2026 by Barry Zalma
In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.
According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair.
LAW
Refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of discretion.
Appellate claims receiving only cursory treatment, without record citations, supporting authority, or legal analysis, are inadequately briefed.
DISCUSSION
Improper opening remarks.
Defense counsel referred to Ojekwe’s national origin,...
Psychiatrist Who Was Convicted of Fraud Asked the First Circuit to Reduce his Punishment
Post 4851
Posted on September 24, 2026 by Barry Zalma
Fraud to Private and Public Health Insurers Doesn’t Pay
In United States v. Gustavo Kinrys, Nos. 24-1592, 24-1716, United States Court of Appeals, First Circuit (September 21, 2026) Gustavo Kinrys, a Massachusetts psychiatrist, submitted fraudulent claims to private and public health insurers from 2015 through 2018, including bills for more than 1,000 sessions when he or the purported patient was outside the country. When insurers requested supporting records, he delayed through a fictitious office manager and created false documentation.
A jury convicted Kinrys on fourteen counts. The district court imposed a 99-month sentence, calculated intended loss at slightly more than $19 million based on billed amounts, ordered $6,537,309.59 in restitution, and ordered $6,527,391.19 in forfeiture.
At sentencing, the district court calculated Kinrys’s base offense level to be ...
