Zalma on Insurance

Explaining the Need for Professional Liability Claims Adjusters    https://zalma.com/blog Adjusting liability insurance claims requires skill, patience, knowledge  of insurance, basic knowledge of tort and contract law, and knowledge  and experience as an investigator.  To properly and effectively perform  the duties of a liability claims adjuster, he or she must be c...

October 1, 1979 - 2021 – Another Anniversary – Thank You     https://zalma.com/blog Forty-one years ago today I left the world of the employed and became an  entrepreneur by opening my own law firm. The law practice was  incorporated shortly thereafter as Barry Zalma, Inc. When I opened for  business on October 1, 1979, I had no clients and no certainty that I  w...

Investigating the Extent of a Property Loss   https://zalma.com/blog To aid the insured in his or her obligation to prove the loss, the  adjuster must, on the first visit, establish with the insured a detailed  scope of loss. This means that the adjuster and the insured (or the  insured with his or her Public Insurance Adjuster (PA)) must walk  through the insured’s h...

Explaining how to Obtain a Subrogation Recovery    https://zalma.com/blog  Equity allows creative remedies for wrongs that do not fit within the  confines of traditional tort or contract remedies (i.e., with cash). The  ancient maxim “for every wrong there is a remedy” (California Civil  Code § 3523) applies to subrogation rights. The maxims were adopted from  th...

How an Individual Can Help the Government Defeat Fraud   https://zalma.com/blog  If an individual has knowledge that a false claim was submitted to the  government, that person can elect to become a whistleblower and retain  an attorney who will draft a complaint and a disclosure statement.  The  whistleblower will file these two documents under seal in US district &n...

Explaining the Need to Gather Evidence to Prove Fraud    https://zalma.com/blog Direct evidence is proof that tends to show existence of a fact in  question without the intervention of the proof of any fact.  It includes  testimony that tends to prove or disprove a fact in issue directly,  such as eye-witness testimony or a confession.  Sometimes, direct evidence...

Explaining the False Claims Act and How Insurers Can Take Advantage of  it to Deter Fraud    https://zalma.com/blog The False Claims Act, also known as the “Lincoln Law,” dates back to the  Civil War. President Lincoln signed the act into law in 1863 because  war profiteers were selling the Union Army shoddy supplies at inflated  prices. The original law included qui...

Retaining an Attorney by a Claims Person   https://zalma.com/blog  In instances where insurance claims may entail litigation, insurers must  move quickly to engage counsel. When an attorney is retained to defend a  person insured, the fact should be documented in writing by the  attorney, the adjuster, and the insured who is to be defended.  Before an insurer retains...

Explaining Evaluation & Settlement    https://zalma.com/blog Case evaluation is necessary to the efficient operation of a third party  liability claims department.   The evaluation should be completed as soon as reasonably practical after  the completion of a thorough investigation. A quick resolution and  payment of the claim will result in a lower amount of sett...

A podcast About the Birth & Growth of the Tort of Bad Faith    https://zalma.com/blog Fletcher v. Western Life  In Fletcher v. Western Life Ins. Co., 10 Cal. App. 3d 376, 89 Cal. Rptr.  78 (1970), the plaintiff, Fletcher was, at the time of trial, a  41-year-old father of 8 children, seven of whom were still in school.  Defendants’ conduct was premeditated, contin...

A Video from ZIFL - 9/15/2021 -  https://zalma.com/blog New Articles on Insurance Fraud Cease And Desist Orders Issued to Four Companies Allegedly  Selling Home Warranties Without a License The California Department of  Insurance announced September 7, 2021 that it has issued Cease and  Desist Orders, effective immediately, to four companies who allegedly engaged in selling hom...

To understand the connection between ethics and quality service it is  important to understand the meaning of ethical values in the insurance  context.  https://zalma.com/blog The ethical insurer and its ethical claims and underwriting  staff must treat the insureds and claimants with whom they come in  contact honestly, fairly and with utmost good faith. The contact must...

A Video Explaining Expected, Intended or Fortuity in Insurance  https://zalma.com/blog The Fortuity Doctrine arises from the basic concept upon which insurance  is founded: that insurance covers risks, not losses that were planned,  intended, or anticipated by the insured. It has always been the view of  insurers that losses that were expected by the insured could not be  ...

False Swearing & Insurance Fraud    In common language the “false swearing” provision of an insurance policy  merely means that if the insured lies under oath the policy is void  whether the lie is in a proof of loss or at an examination under oath.  In Texas and Oklahoma, false swearing is explained this way:  Where an insured knowingly and willfully overestimate...

A Video Revealing The Birth of the Tort of Bad Faith in Comunale  https://zalma.com/blog The California supreme court in Comunale v. Traders & General Ins.  Co. (1958) 50 Cal.2d 654, 328 P.2d 198, held the insurer liable for  amounts over the policy limit because of its wrongful refusal to settle  the underlying action.  The opinion distinguishes the consequences of a...

A Video Recitation of Crisci v. Security Ins. Co. of New Haven, Conn.   https://zalma.com/blog  A jury awarded Mrs. DiMare $100,000 and her husband $1,000. After an  appeal (DIMARE V. CRESCI, 58 CAL.2D 292, 23 CAL.RPTR. 772, 373 P.2D 860)  the insurance company paid [66 Cal.2d 429] $10,000 of this amount, the  amount of its policy. The DiMares then sought to collect the ba...

Insurance Fraud Perpetrators are Creative We All Do it Fraud   https://zalma.com/blog The California Court of Appeal, in Cassim v. Allstate Insurance Co., 94  P.3d 513, 33 Cal.4th 780, 16 Cal. Rptr.3d 374 (Cal. 07/29/2004), was  faced with a trial verdict of bad faith against an insurer that it found  was based upon prejudicial final argument leading the jury to believe  t...

A Video Explaining Duty to Defend and the Four Corners Rule  https://zalma.com/blog Some states apply a rule of interpretation of the duty to defend a  liability claim by limiting their review to the facts alleged in the  lawsuit and the wording of the insurance policy.  They refuse to consider any evidence extrinsic to the allegations of the  suit.  If any of the all...

Fraud Must be Defeated Even in the Face of Claims of Bad Faith  https://zalma.com/blog It has been said that where fear enters, reason flees. Doubt, with its  wavering in opinion and judgment, comes from a fear of the unknown. It  is an unrealistic viewpoint that develops from defects in knowledge or  evidence. But when a subject or situation is studied and understood, the &nbs...

California Legislature Wants to Make Application Fraud a Crime   https://zalma.com/blog Application fraud in California is only recognized with regard to  workers’ compensation policies. The proposed new statute provides it  will be a crime for any fraud in any insurance application. Why it’s Difficult to Fire a Government Employee Insurance Fraud Conviction Requires Dismissal of Go...

A Video Explaining Why a Claims Made Policy's Notice Require is not  Subject to the Notice Prejudice Rule    https://zalma.com/blog Claims made and claims made and reported policies contain a date certain  notice requirement.   Applying the notice-prejudice rule to the date-certain notice  requirement in a claims-made policy would alter the parties' agreed  alloc...

A Video Explaining the Contractual Right of an Insurer to Declare a  Policy Void   https://zalma.com/blog   A life insurance policy procured with the intent to benefit persons  without an insurable interest in the life of the insured does violate  the public policy of New Jersey, and such a policy is void at the  outset. [Sun Life Assurance Co. of Canada v. Wells...

Coinsurance is often misunderstood in first party property insurance. https://zalma.com/blog  It  is a clause that causes frequent dissatisfaction with insureds over  claim settlements.  Historically most losses are partial losses. It is rare that the entire  building or amount of covered property is destroyed. Knowing this,  individuals deciding to insure their busin...

A Video Explaining the Coinsurance Clause https://zalma.com/blog Coinsurance is often misunderstood in first party property insurance. It is a clause that causes frequent dissatisfaction with insureds over claim settlements. Historically most losses are partial losses. It is rare that the entire building or amount of covered property is destroyed. Knowing this, individuals deciding to insure their...

Every Claims Person in California Must Be Trained on the Fair Claims  Settlement Practices Regulations by September 1    https://zalma.com/blog The Reasons Why the California Department of Insurance Imposed the  California Fair Claims Settlement Practices Regulations on All Insurers  Doing Business in California   In 1993, after waiting five years after receiving dire...