Zalma on Insurance

https://zalma.com/blog

https://zalma.com/blog

https://www.zalma.com/blog

https://zalma.com/blog

Claims Commandment Number IV   Thou Shall Understand The Policy  In this the fourth of Fifteen Claims Commandments we deal with the need  for every insurance claims professional to read and understand the terms  and conditions of the policy that made promises to an insured who is  presenting a claim.   Insurance Policies are Contracts  Insurance policies are...

Claims Commandment III - Thou Shall Communicate Often With The Third  Party Insured and the Claimant   Insurance claims is a service business. The claims person – whether  acting for the insurer or the insured – provides a service to the  insured and the insurer. Communication is essential to providing the  service promised by the insurance policy.  In some state...

ZIFL - Volume 26 Issue 21   In this the 21st issue of the 26th year of publication of Zalma's  Insurance Fraud Letter you will find articles that discuss the following  insurance fraud issues:   When an Insured Lies to his Insurer the Claim May Be Denied  In Cesar Benitez v. Universal Property And Casualty Insurance Company,  No. 4D21-3281, Florida Court of Appeals, F...

Thou Shall Always Conduct A Thorough Investigation   This is the second in a series of fifteen claims commandments that I  believe must be followed by every insurance claims professional.   INVESTIGATION   Investigation is a search for truth. It is an art form where facts are  established. It has been defined by the state of California, for  example, as follows:...

Thou Shall Confirm Coverage  How to Confirm Coverage  When I was a young adjuster, I worked for the Fireman’s Fund Insurance  Company. Occasionally confused insureds and brokers would report to the  Fireman’s Fund a claim meant for Fireman’s Insurance of Newark. The  claim would often be adjusted and paid before anyone realized an error  had been made. Notice provisio...

Material Misrepresentation About Prior Health Care Supports Rescission   An ERISA Policy May be Rescinded  In Provident Life & Accident Insurance Company v. Bradley D. Mckinney, No. 3:19-CV-1325  (SVN), United States District Court, D. Connecticut (September 9, 2022)  the USDC was called upon to determine if an insurer can rescind an  ERISA policy.   FACTUAL BACKG...

Insurer May Deny a Claim When Insured Lies on Application   Rescission Requires Return of Premium Denial of Claim Does Not   Cesar Benitez appealed the trial court's entry of final summary judgment  in favor of Universal Property and Casualty Insurance Company  ("Insurer") in a first-party property insurance dispute over a water  damage claim.  In Cesar Benitez v. Uni...

Plaintiffs' and their Counsel's Bad Faith Defeats Suit Against Insurer   No Good Deed Goes Unpunished -   Plaintiffs Abused the Tort of Bad Faith  Julio Palma and Miriam Cortez (the Plaintiffs) appealed an order  granting summary judgment in a bad faith insurance case against Mercury  Insurance Company (Mercury). Mercury insured Frank McKenzie, who killed  Plaint...

Occurrence Must be an Accident   https://zalma.com/blog Beverly Weathersby appealed the trial court's order awarding summary  disposition under MCR 2.116(C)(10) to plaintiff, Meemic Insurance  Company (Meemic), and denying its insured, defendant Randal S. Ritchie,  personal liability coverage under his homeowner's insurance policy.  In Meemic Insurance Company v. Randal S....

Appellants should have filed their action no later than October 3, 2016,  which they did not do.   The October letter stated that UIM coverage is not available under the  policy. Even Appellants' counsel admitted that upon receipt of the  letter in 2012, he interpreted the letter as a denial of coverage.  Therefore, the record supported the finding of a concession by couns...

Insurers Must be Proactive Against Insurance Fraud   Insurers Must Stop the Logarithmic Growth of Insurance Fraud  Fraud is taking more money every year from the insurance buying public.  The Coalition Against Insurance Fraud recently revised its estimates  from $80 billion a year to announce that insurance fraud takes over $308  billion a year from the insurance industry....

No UM/UIM Coverage Supports Denial & Starts Running of Limitations   Statute of Limitations Ran From Denial of Claim   In Glenna L. Novak And Estate Of Jeffery Leonard Novak, A/K/A Estate Of  Jeffery L. Novak By And Through Glenna L. Novak, Executrix v. Mutual  Benefit Insurance Company, No. 1592 MDA 2021, No. J-S23016-22, Superior  Court of Pennsylvania (October 14, 2...

When You Sue & Lose You Can’t Sue the Same Defendants Again   In DAB Three, LLC, et al. v. Sandra Fitzpatrick, Allen Fischer et al. v.  Lawyers Title Corporation et al., No. AC 44393, Court of Appeals of  Connecticut (October 18, 2022) the plaintiff attempted to avoid the  effect of the doctrine of res judicata.  FACTS   After a suit to recover damages for fraudul...

Pedestrian's No Fault Claim Belongs to Insurer Assigned  Insurers are professional litigants.  They are sued and sue often.  Usually they avoid suing other insurer for fear of making precedents  that will effect the entire industry. In Beth Bracy, Plaintiff, and ZMC  Pharmacy, LLC, Riverview Macomb Home & Attendant Care, and Michigan  Spine and Pain, Intervening P...

Trade Dress Infringement is Different From Trademark Infringement  In State Farm Fire And Casualty Company v. Jason Hines, Individually and  doing business as Dedicated Business Systems International LLC;  Dedicated Business Systems International, LLC; Tri-State Communication  Services LLC, doing business as U.S. Voice and Data, LLC Jason Hines;  Dedicated Business Systems...

No Duty to Defend or Indemnify Intentional Acts or Person not Insured   Norma Hudson and the Hudson Revocable Trust (the Trust) appealed from a  summary judgment entered in favor of Farm Bureau Mutual Insurance  Company of Arkansas, Inc. (Farm Bureau). In the summary-judgment order,  the trial court found as a matter of law that Farm Bureau had no duty of  defense or indem...

137 Years in Prison for Insurance Fraud & Arson   How to Deter Insurance Fraud   A prisoner seeking relief from a lengthy sentence failed after multiple  efforts as a pro se applicant. In Ali Darwich v. Warden Lewisburg USP;  Attorney General United States Of America, No. 22-2280, United States  Court of Appeals, Third Circuit (October 14, 2022), Ali Darwich, a  f...

It is Frivolous to File Same Suit Against Another Defendant After First  is Dismissed   Dimitri Enterprises, Inc. ("Dimitri") and its attorney, Richard J.  Flanagan, appealed from the district court's June 24, 2021 order  imposing $24,675.00 in sanctions pursuant to Federal Rule of Civil  Procedure 11. Dimitri, a roofing contractor, filed this lawsuit in  connection w...

ZIFL - 10/15/2022 available at  http://zalma.com/blog/wp-content/uploads/2022/10/ZIFL-10-15-2022-1.pdf   Short teases about the articles in this issue can be read at  ZIFL-10-15-2022   Ethics & Insurance Fraud  Insurance fraud is a crime in most jurisdictions. In California it is a  felony subject to five years in prison upon conviction. By definition a &nbsp...

Insurance Coverage Dispute Alone Not Bad Faith   The tort of bad faith requires, for an insured to recover, that the  insurer act intentionally to deprive the insured of the benefits of the  policy of insurance.   Garo Alexanian (d/b/a) Vet Mobile and Companion Animal Network, Inc.  (“CAN,” and together with Alexanian, “Plaintiffs”) sued GEICO and  Travelers &nbs...

Hitting Plaintiff on Head with Metal Pole is a Battery & Even With  Assault & Battery Coverage Exclusion Applies   Paul Semien ("Semien"), appealed the district court's dismissal of his  breach of contract claim for defense and indemnity against the  Burlington Insurance Company ("Burlington") after he was injured by a  convenience store employee who hit him on the...