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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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June 03, 2026
Go to Jail, Do Not Pass Go

Arsonist Who Tried to Defraud Insurer Failed to Avoid Jail
Post number 5364

Posted on June 3, 2026 by Barry Zalma

Arson is a Violent and Dangerous Crime Deserving Serious Punishment

The People of the State of New York v. Zef Gjurashaj, 2026 NY Slip Op 03320, No. 2023-03675, Ind. No. 70463/21, Supreme Court of New York, Second Department (May 27, 2026) the defendant owned a restaurant that was destroyed by fire on September 6, 2017. Prosecutors alleged that he and a codefendant conspired to intentionally set the fire in order to obtain financial benefit.

At the time of the fire, the defendant’s wife was present in the restaurant, and the indictment alleged that she was not a participant in the crime. After a jury trial, the defendant was convicted of first-degree arson, second-degree conspiracy, two counts of first-degree reckless endangerment, second-degree insurance fraud, and fifth-degree criminal tax fraud.

LAW

The appellate court applied several key legal principles:

1. Preservation doctrine (CPL 470.05[2]) Issues are generally not reviewable on appeal unless properly objected to at trial. [First-degree arson (Penal Law § 150.20)
2. Accessorial liability (Penal Law § 20.00): A person can be held criminally liable for conduct carried out with another.
3. Legal sufficiency standard: Evidence is reviewed in the light most favorable to the prosecution.
4. Weight of the evidence review (CPL 470.15[5]): The appellate court independently reviews the record but gives deference to the jury’s credibility determinations.
5. Summation misconduct standard: Prosecutorial comments warrant reversal only if they are improper and so pervasive or egregious as to deprive the defendant of a fair trial.
6. Sentence review: A sentence will not be disturbed unless it is excessive.

DISCUSSION / ANALYSIS

The court rejected the defendant’s arguments on appeal.

First, the claim that the jury charge on first-degree arson was defective was held unpreserved, because defense counsel affirmatively stated that he had no objection to the charge. The court added that, in any event, the charge adequately conveyed the governing law.

Second, the defendant challenged the legal sufficiency of the evidence concerning whether he knew facts making his wife’s presence a reasonable possibility and whether she was a nonparticipant. The court held that the first argument was unpreserved, because the trial motion to dismiss did not specifically raise that point. However, the court found that the second argument—whether the wife was a participant—was preserved. On the merits, the court held that the evidence, viewed in the light most favorable to the prosecution, was sufficient to establish that the wife was not a participant in the arson.

Third, on the weight of the evidence, the appellate court conducted its independent review and concluded that the verdict was not against the weight of the evidence. The court emphasized its deference to the jury’s ability to assess witness credibility and found that the jury was justified in finding guilt beyond a reasonable doubt.

Fourth, the defendant argued that the prosecutor’s summation misstated the law and evidence and improperly bolstered credibility. The court found this issue unpreserved because defense counsel did not object or seek curative instructions. Even so, the court held that most of the challenged comments were permissible rhetorical responses or fair comment on the evidence, and any improper remarks were not so serious as to deny the defendant a fair trial.

The New York Court accords great deference to the jury’s opportunity to view the witnesses, hear the testimony, and observe demeanor Upon reviewing the record here, the court was satisfied that the verdict of guilt was not against the weight of the evidence.

Finally, the court held that the sentence was not excessive.

CONCLUSION

Contrary to the defendant’s contentions, the jury was justified in finding the defendant guilty beyond a reasonable doubt without engaging in the selective dissection of the integrated testimony of a single witness as to whom credibility, or incredibility, could only be a constant factor. The Appellate Division affirmed the judgment of conviction. Most of the defendant’s appellate arguments were either unpreserved or without merit, and the court found the evidence legally sufficient, the verdict supported by the weight of the evidence, the prosecutor’s remarks not reversible error, and the sentence appropriate.

ZALMA OPINION

Arsonists are not nice people. Arson is a violent crime where innocent people are injured or killed by the fire. He tried to avoid the conviction and the court saw through his arguments that were either unpreserved or legally insufficient. The defendant’s contention that the prosecutor mischaracterized the law and evidence and improperly bolstered his own credibility during summation was unpreserved for appellate review. Since the majority of the challenged comments at trial were within the broad bounds of rhetorical comment permissible in closing arguments and constituted a fair response to arguments made by defense counsel in summation or a fair comment on the evidence the grounds stated by the defendant were ineffective and the judgment of conviction stood and the arsonist would serve his sentence.

(c) 2026 Barry Zalma & ClaimSchool, Inc.

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July 22, 2026
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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 ...

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July 20, 2026
Search Warrant Produces Evidence of Insurance Fraud

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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 ...

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July 17, 2026
The Great Jewel Theft

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 ...

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Personal Jurisdiction Requires Minimum Contacts With Texas

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Post 5408

Posted on July 23, 2026 by Barry Zalma

In New Jersey Manufacturers Insurance Company v. Changan Chu, No. 14-25-00965-CV, Court of Appeals of Texas, Fourteenth District (July 21, 2026) NJM issued an automobile insurance policy in New Jersey to Changan Chu while Chu was a New Jersey resident.

Chu was injured in an auto-pedestrian collision in Harris County, Texas, allegedly caused by an uninsured driver. Chu sued the driver and NJM, seeking a declaration that his UM/UIM coverage was in force and provided $300,000 in limits. NJM filed a special appearance supported by affidavit evidence showing it was a New Jersey corporation with its principal place of business in New Jersey, had no offices, agents, employees, advertising, registration, or insurance business in Texas, and did not insure any person, property, or risk located in Texas. Chu did not file evidence opposing the special appearance.

LAW

A Texas court may exercise ...

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July 21, 2026
Commit Fraud and Suffer Consequences

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Post 5398

Posted on July 21, 2026 by Barry Zalma

Cross-Claim Against Fraudsters Successful

In Dual Diagnosis Treatment Center, Inc., et al. v. Health Net, Inc., et al., Health Net Life Insurance Company, B331260, California Court of Appeals, Second District, Third Division (July 16, 2026) a trial verdict in favor of Health Net and against Sovereign, a network of mental health and substance use disorder treatment centers, and Health Net, Inc., Health Net of California, Inc., Health Net Life Insurance Company, and Managed Health Network, Inc. (collectively, Health Net) was appealed to the California Court of Appeals.

FACTUAL BACKGROUND

Between 2014 and 2016, Sovereign submitted claims to Health Net for medical care provided to more than 400 patients. Health Net paid some claims but rejected many others. Sovereign, as the patients' assignee, sued Health Net for breach of contract, insurance bad faith, and breach of the Employee Retirement Income Security Act of 1974 (ERISA)....

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July 16, 2026
Swoop & Squat Fails

The Only Solution to Fraud is to Take the Profit Out of the Crime
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Post number 5395

Posted on July 16, 2026 by Barry Zalma

In Vivian Maritza Triana Marin, Sebastian Arroyave Penagos, and Daniel Arroyave Penagos v. Marc J. Paynter and Transport Marc Paynter Inc., No. 23-CV-6498, United States District Court, E.D. New York (July 10, 2026) Plaintiffs sued Defendants in diversity after a rear-end collision on the Whitestone Expressway in Queens, New York. Plaintiffs were in a Subaru driven by Vivian Maritza Triana Marin, while Defendant Marc J. Paynter drove a Transport Marc Paynter Inc. tractor-trailer.

Facts:

Dashcam footage from Defendants’ vehicle showed Plaintiffs’ vehicle braking suddenly in the left lane despite an open roadway ahead. Marin could not identify a specific reason for braking, the passenger plaintiffs did not know why she braked, and a non-party witness testified that Plaintiffs’ vehicle stopped abruptly for no apparent reason.

The Accident occurred when ...

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