Excellence in Claims Handling
Posted on October 29, 2026 by Barry Zalma
Common Problems in a Jewelers’ Block Policy Investigation
If you are not a subscriber you will read from this link until you reach the paywall end of this blog post as the free part of Excellence in Claims Handling. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the button above.
This is a taste of the latest Excellence in Claims Handling Article for subscribers to my substack. Subscribe to my substack at https://lnkd.in/gmmzUVBy
The History of the Jewelers’ Block Policy
The ‘jewelers’ block policy’ had its origin about 1920, and since that time the policy and the proposal upon which it is based have become more or less standard.
The Inland-Marine Insurance Bureau, of which appellant is a member, prescribes contracts and proposals for such policies that are identical for all bureau members. The bureau forms for proposals and policies used in the jewelry business are accepted in Texas.
Under the standardized system of issuing a ‘jewelers’ block policy,’ the merchant executes a proposal which is submitted to the insurance company, and often reviewed by the bureau, for purposes of establishing a rate and approving issuance of the policy. When the rate is ascertained and the policy issued, the policy, with the proposal attached, is sent to the local agent for delivery to the insured. [Great Am. Ins. Co. v. Lang, 416 S.W.2d 541 (Tex. Ct. App. 1967)]
Because many sales in the jewelry business are for cash, jewelers may be tempted to make sales “off the books.” Sales taxes are not recorded or paid. Income is reduced to avoid payment of income taxes. The “cost of goods sold” is recorded as a greater percentage than reality.
Some jewelers refuse to update their inventories to comply with value changes in their merchandise and, therefore, may be carrying gold on their inventory that was purchased many years ago at $100 per ounce and is now selling for $300 (more or less) an ounce. Since the policy limits the liability to actual cash value or the smallest amount appearing on the insured’s books, by not updating his or her records, the insured will, in the event of loss, fail to recover the actual cash value of his loss.
Mysterious Disappearance
A New York court found that a claim is outside the ambit of coverage on the basis of the policies’ exclusionary clause for “unexplained loss, mysterious disappearance or loss or shortage disclosed on taking inventory.”
(c) 2026 Barry Zalma & ClaimSchool, Inc.
Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://lnkd.in/gmmzUVBy, Go to the Insurance Claims Library – https://lnkd.in/gwEYk.
View image
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 ...
Self Insurance is Excess Over Primary Insurance
Post 4572
Posted on October 29, 2026 by Barry Zalma
Employment Plan is Insurance Because it Transferred Risk and Contained Claim, Exclusion, and Priority Provisions.
In Ajay Kolli, & c. et al. v. Kaleida Health, 2026 NY Slip Op 06167, No. 72, New York Court of Appeals (October 22, 2026) Dr. Venkateswara Kolli treated a patient in 2011 while serving as an on-call, per diem physician for Kaleida Health. The patient later sued Dr. Kolli and Kaleida for medical malpractice.
In 2011, decedent Dr. Venkateswara Kolli treated a patient as part of his duties pursuant to an on-call, per diem physician employment agreement with defendant Kaleida Health. The patient subsequently sued Dr. Kolli and Kaleida. Dr. Kolli sought indemnity from his primary medical malpractice insurer, MLMIC Insurance Company (MLMIC), as well as his excess insurer Healthcare Professionals Insurance Company (HPIC).
The underlying medical malpractice action settled after Dr. Kolli’s death. Kaleida, MLMIC, and ...
RICO Suit Against Law Firm & Health Care Pros Fails
Posted on October 28, 2026 by Barry Zalma
UBER AND FEDEX FIGHT FRAUD
Racketeer Influenced and Corrupt Organizations Act (RICO) is Designed to Defeat Fraud Perpetrators
In Uber Technologies, Inc., et al. v. Simon & Simon P.C., et al., Civil Action No. 25-5365, United States District Court, E.D. Pennsylvania (October 13, 2026) Uber Technologies, Inc. and Federal Express Corporation sued attorney Marc Simon, his firm Simon & Simon, P.C., and several medical professionals and practices under the Racketeer Influenced and Corrupt Organizations Act (RICO).
They allege the defendants orchestrated a scheme to generate and litigate fraudulent personal injury claims arising from motor vehicle accidents involving Uber and FedEx drivers. Uber and FedEx incurred defense costs and paid settlements on some claims. The court earlier denied a motion to dismiss, finding proximate causation adequately pleaded. Fact discovery is set to close December 21, 2026.
Discovery showed Uber’s...
No Breach of Contract no Bad Faith
Post 4568
Posted on October 23, 2026 by Barry Zalma
A Party Cannot Designate One Witness While Submitting An Undifferentiated Product Of That Witness And An Undesignated Collaborator.
Post 4568
In Dustin Cain; Amanda Cain v. State Farm Fire and Casualty Company, No. 25-60442, United States Court of Appeals, Fifth Circuit (October 16, 2026) Dustin and Amanda Cain sought homeowners’ insurance benefits after a tree fell on their Mississippi home on August 27, 2022. State Farm concluded that the tree caused only a roof puncture and that other damage resulted from excluded long-term conditions. It paid $10,042.90 and later an additional $3,130.08.
The Cains relied on an engineering report and contractor estimate asserting substantially greater damage, sued for breach of contract and related relief, and designated Sean Fee as their sole expert. Fee’s report and a later repair estimate were jointly authored with Jim Irmiter, but neither document identified which opinions, work, or ...