Zalma on Insurance

New Book from Barry Zalma The Compact Book on Ethics How Ethical Doctrines from the Beginning of the Written Word to the  Present Resulted in the Incorporation of the Covenant of Good Faith Every Person Involved in the Business of Insurance Must Act Ethically in the Business of Insurance Insurance  is, by definition, a business of the utmost good faith. This means that  both parties...

SHOOTING A PERSON IN THE BACK TWICE IS NOT AN ACCIDENT   Great American Alliance Insurance Company ("GAAIC") was granted summary  judgment when the trial court determined that a GAAIC umbrella insurance  policy did not cover an insurance claim made by Star Residential, LLC  ("Star"), and Terraces at Brookhaven, LLC ("Terraces," collectively, the  "Insureds"), based on a sh...

RICO Judgment Allows Disgorgement Damages   DISGORGEMENT IS AKIN TO EXEMPLARY DAMAGES   In Diane Creel and Lynn Creel v. Dr. Says, LLC, et al., Civil Action No. 4:18-CV-00615,  United States District Court, E.D. Texas, Sherman Division (September  27, 2022) the plaintiffs obtained a verdict against Defendants Dr. Yupo  Jesse Chang; MD Reliance, Inc.; Universal Physicians,...

Lies During Litigation do not Violate Policy's Fraud Provision   Mariana Gracia appealed the trial court's grant of final summary  judgment in favor of Security First Insurance Company ("Security  First"). The trial court found Gracia had made affirmative  misrepresentations regarding the pre-loss condition of her property,  warranting forfeiture of coverage under the conc...

Man Bites Dog Story - GEICO Sues Health Care Providers for Fraud https://zalma.com/blog

CIGNA Obtains $14,371,384.95 Judgment Against Fraudulent Health Care  Provider Since police, prosecutors and state insurance fraud investigators are  seldom willing to arrest or prosecute insurance fraud perpetrators it is  necessary for insurers to be proactive and sue those who attempt or  succeed in defrauding insurers.  In Connecticut General Life Insurance Company and...

Physicians Cheat Insurer for Covid Testing

Stupid Plea Bargain Destroys Insurer’s Right to Restitution

Insurers, working without legislative or judicial direction, created a  working definition of the term “actual cash value.” Insurers recognized that ACV in a fire insurance policy was designed to  establish a dollar value for items of destroyed property that were not  new at the time of loss. Since the insurers had no easy means to  establish the used value of property, they se...

In Huntington Ingalls Industries, Inc. et al. v. Ace American Insurance  Company et al, No. 2021-173, 2022 VT 4 Supreme Court of Vermont  (September 23, 2022) the Supreme Court of Vermont reversed a decision  refusing to allow an insured ship builder to recover business  interruption losses as a result of government orders dealing with  Covid-19 and remanded the case to th...

ZIFL - Volume 26 Issue 19   Read the full issue at http://zalma.com/blog/wp-content/uploads/2022/09/ZIFL-10-01-2022-1.pdf  Insurer Proactive Against Fraud CIGNA Obtains $14,371,384.95 Judgment Against Fraudulent Health Care  Provider  Since police, prosecutors and state insurance fraud investigators are  seldom willing to arrest or prosecute insurance fraud perpetrato...

General Contractor Has No Standing  to Allege Insurance Fraud   Steven Hester Hall appealed from an order granting Defendants' motion to  dismiss Hall's claims for insurance fraud, breach of implied covenant  of good faith and fair dealing..   In Steven Hester Hall v. Brunswick Plantation Property Owners  Association, Greg Mayol, Cathy Six, And Community Association M...

Lack of Insurable Interest Makes Life Policy Void from Inception   Policy Acquired as Part of a STOLI Fraud Never Existed as a Matter of  Law   RELEVANT FACTS AND BACKGROUND  On July 11, 2007, the fictitious Mansour Seck Irrevocable Life Insurance  Trust (the "Seck Trust") applied to MetLife Investors USA Insurance  Company (Brighthouse's predecessor) for a $5 million...

Judgment in Favor of Insurer Because of Plaintiff’s Sloth Read the full article at https://lnkd.in/gVRkNvR2 and see the full video at https://lnkd.in/gfgqe9nM and at https://lnkd.in/gmGuUhXs and at https://zalma.com/blog plus more than 4300 posts. Judgment in Favor of Insurer Because of Plaintiff’s Sloth See the full video at https://rumble.com/v1j7gb7-untimely-suit-dismissed.html and at Michelle...

Apple Annie Suffered no Direct Physical Damage   It's Time to Quit Trying to Get Business Interruption Payments from  Insurers for Covid  The COVID pandemic and ensuing lock down have generated a host of legal  issues. One of the most momentous, in terms of the potential monetary  liability, is whether businesses ordered by government decree to close  or suspend...

FLOOD EXCLUSION APPLIES TO DEFEAT CLAIM   Insured Admits Loss Caused by Flood Sufficient to Deny Claim Virginia Sosa appealed from the county court’s orders granting summary  judgment in favor of appellee Auto Club Indemnity Co. (“Auto Club”) and  denying Sosa’s motion for new trial. The court granted summary judgment  on several grounds raised by Auto Club, including that...

FLOOD EXCLUSION APPLIES TO DEFEAT CLAIM  Insured Admits Loss Caused by Flood Sufficient to Deny Claim Virginia Sosa appealed from the county court’s orders granting summary  judgment in favor of appellee Auto Club Indemnity Co. (“Auto Club”) and  denying Sosa’s motion for new trial. The court granted summary judgment  on several grounds raised by Auto Club, including that Sosa’...

When You Win it is Best to Shut Up and Accept It  As a young lawyer one of the first things I learned was never argue with  a judge whose tentative ruling is to grant your motion. Insurers often  seek, when there is a dispute of insurance coverage, declaratory relief  from the court about its duty to defend or indemnify the insured.  However, when there is no claim, it is...

Making Sick Horse Well is not a Breach of Horse Mortality Policy  The parties sued over an insurance dispute concerning a champion show  horse named Thomas. Thomas is alive and well, but Thomas's owner, Julie  Greenbank, sued her insurer, Great American Assurance Company, for  failing to provide mortality coverage for Thomas.  In Julie Greenbank v.  Great American Ass...

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Convicted of Acting as a Pill Mill & Doubling as an Insurance Fraud  Scheme   In UNITED STATES OF AMERICA v. PATRICK EMEKA IFEDIBA, NGOZI JUSTINA  OZULIGBO, Nos. 20-13218, 20-13303, United States Court of Appeals,  Eleventh Circuit (August 25, 2022)  Patrick Ifediba and Ngozi Justina  Ozuligbo appealed their convictions for health care fraud and related  crim...

A Lawyer Should Never Sue an Insurer When There is Obviously no Coverage   This case involves an insurance dispute in which Appellant, Benjamin G.  Dusing (Dusing), alleges that a 2016 leased Mercedes was properly  insured by Appellee, Metropolitan Property & Casualty Insurance  Company (Metropolitan). Metropolitan disclaims coverage for the vehicle,  which was destroy...

Michigan Allows Fraudster to Receive PIP Benefits but no UM/UIM Benefits  Plaintiff appealed the trial court’s order granting summary disposition  in favor of defendants Home-Owners Insurance Company (“Home-Owners”),  American Country Insurance Company (ACIC), and Hartford Accident and  Indemnity Company (“Hartford”), with respect to plaintiff’s claims for  uninsured or un...

Substantial Compliance with Statute Transfers Title to Vehicle  SERIOUS INJURY ALWAYS BRINGS LITIGATION

Substantial Compliance with Statute Transfers Title to Vehicle   SERIOUS INJURY ALWAYS BRINGS LITIGATION   When an accident results in serious injuries the lawyers for the injured  parties seek other defendants, no matter how weak the argument may be  to bring in additional defendants.  In Delores Zepeda v. Central Motors, Inc., No. 2021-SC-0204-DG, Supreme  Court of...