Zalma on Insurance

Some of the Most Important Cases Creating the Tort of Bad Faith   https://zalma.com/blog In Comunale v. Traders & Gen. Ins. Co., 50 Cal. 2d 654 (1958), the  insurance company wrongfully refused to defend its insured who had been  sued in the underlying action for damages arising out of an automobile  accident. It also refused to conclude the suit after receiving an offer &n...

A Video Explaining Uberrimae Fidei  https://zalma.com/blog Ethics is a process of systematically applying, using, defending and  recommending concepts of right and wrong behavior.   Ethical behavior is required of both parties to a contract of insurance  for the system to work. If any party to the insurance contract acts  unethically the ability of insurance to work effect...

Explaining how to Deal With a Demand for Insurance Appraisal    https://zalma.com/blog Almost all property insurance policies contain an “appraisal” clause  similar to that in the Standard Fire Insurance Policy.  This appraisal provision is, in many states, considered an arbitration  proceeding.  In California, an appraisal complies with the requirements  of Cali...

A Video Explaining Why This Isn't Fraud I Just Need to Save Money  https://zalma.com/blog Insurance fraud is not limited to fake claims. Most people don’t present  claims. The basic principle upon which insurance is based require the  many to pay small amounts so that the few can collect. If the risk is  not spread fairly among the many, all suffer.  Most businessmen would...

Explaining the Application of the Private Limitation of Action Provision The phrase, “inception of the loss” in the standard fire insurance  policy has been interpreted to mean “the occurrence of the casualty or  event insured against.” [ See e.g. , Zuckerman v. Transamerica Ins. Co., 133 Ariz. 139, 650 P. 2d 441 (1982) (Arizona law); Closser v. Penn Mut. Fire Ins. Co ., 457 A. 2d 1081 (...

ZIFL 8/15/2021 -- Volume 25, Issue 16   https://zalma.com/blog and https://zalma.com/zalmas-insurance-fraud-letter-2/ Claim For Damage to Property That Existed Before Issuance of Policy Is  Fraud It Is a Crime to Claim Preexisting Damage as New Damage After accepting a Plea Agreement and having a judgment entered the  Defendant had no right to expunge his criminal record Vsevolod Se...

Explaining the Application of Other Insurance Clauses   https://zalma.com/blog Every third-party liability policy contains an “other insurance” clause  that attempts to control disputes when there are two or more policies  insuring the same risk. The term “other insurance” is used in a special  sense in insurance contracts. It describes the situation where two or  more pol...

The Trigger of Coverage/Property Damage    The term "trigger of coverage" means "what event must occur for  potential coverage to commence under the terms of the insurance policy"  and "what must take place within the policy's effective dates for the  potential of coverage to be 'triggered.'" [In Re Feature Realty Litig.,  468 F. Supp.2d 1287, 1295, n.2 (E.D. Wash. 20...

Explaining "Trigger" of Property Damage Coverage    https://zalma.com/blog  The term "trigger of coverage" means "what event must occur for  potential coverage to commence under the terms of the insurance policy"  and "what must take place within the policy's effective dates for the  potential of coverage to be 'triggered.'" [In Re Feature Realty Litig.,  468 F....

A Video Explaining Wear and Tear and Inherent Vice   https://zalma.com/blog  Wear and Tear   It is inevitable that objects deteriorate over time and wear out. Even  the pyramids in Egypt show wear and tear after more than 4000 years  being abused by sand and wind storms.  Recent decisions of the courts of appeal have gone through such changes  that even an inhere...

Insurers are large organizations with varying levels of authority for  the payment of claims.  HTTPS://zalma.com/blog  The adjuster is the representative at the loss  scene. He or she must report, in writing, to superiors with the  authority to pay the indemnity required unless the claim falls within  the authority provided to the adjuster who will only then write a s...

The Statute of Limitations as a Defense to Bad Faith   https://zalma.com/blog A one-year statute of limitations applies to a statutory bad faith  claim. Claims involving unfair settlement practices that arise under the  Unfair Trade Practices Act, West Virginia Code § 33-11-1 to -10 (1996  & Supp. 1997), are governed by the one-year statute of limitations  set forth in...

Explaining the Contents Required of a Liability Claims File    https://zalma.com/blog The claim file is the basic foundation on which all claims are resolved.  It is used by defense counsel to properly defend a claim. It is the  source of all necessary information to make a reasoned decision with  regard to a claim. An incomplete claim file is a danger to the insurer &nbsp...

A Video Explaining Defenses to Various Intentional Torts   https://zalma.com/blog  Self-Defense and Defense of a Third Party  The California Civil Code states:  Any necessary force may be used to protect from wrongful injury the  person or property of oneself, or of a wife, husband, child, parent, or  other relative, or member of one’s family, or of a ward, servant, m...

Explaining "Fortuity" as an Unwritten Exclusion    https://zalma.com/blog Because the purpose of insurance is to protect insureds against unknown,  or fortuitous, risks, fortuity is an inherent requirement of all  insurance policies that take on the risk of loss accepted by the policy.  [Two Pesos, Inc. v. Gulf Ins. Co., 901 S.W. 2d 495, 502 (Tex. App.  Houston [14th...

Convicted Insurance Fraudster Appeals Finding She Breached Probation  https://zalma.com/blog Fraud Perpetrators Have Unmitigated Gall  Kristi Heffington appealed from the revocation of her probation. She  argued on appeal that the revocation court’s decision was error even  though it was proved that she had sent text messages to herself claiming  it came from her past empl...

Responsibility of the SIU Compliance Office   https://zalma.com/blog The primary responsibility of the Special Investigative Unit (SIU)  Compliance Review Office is to inspect insurance companies to ensure  regulatory compliance with regard to the establishment, staffing and  operation of the insurer's SIU.  The Office also is responsible for  updating, distributing,...

A Video Explaining How to Allocate Defense Costs When two or More  Insurers Insure the Same Risk    https://zalma.com/blog Since other insurance clauses usually do not prescribe how defense costs  should be apportioned among insurers, courts have developed general  allocation rules. When only one of two insurers is held to provide  coverage, that insurer must bear the...

Liability Insurance Is    https://zalma.com/blog Insurance, by definition, is a contract where the insurer, for  consideration (premium) agrees to indemnify another against a contingent  or unknown risk of loss. It is used as a method to spread losses among  many people who are insured with the same company. The insurer, by its  policy, promises, in exchange for a pre...

A Video Explaining the Need tor Training of the Fair Claims Settlement  Practices Regulations    https://zalma.com/blog In 1993, after waiting five years after receiving direction from the  California Supreme Court, the state of California determined that the  insurance industry needed to be regulated to stop insurers from treating  the people insured badly and withou...

A Video Explaining Foundation & Shear Wall Defects    https://zalma.com/blog Foundation Defects   A foundation is the base upon which a structure stands. If a foundation  is inadequately engineered it will not properly hold a structure up and  will pose a hazard to the structure, to adjoining structures, and to  occupants of the building.  A foundation is the...

Construction Defect Experts    https://zalma.com/blog In construction defect cases, the standard of care and its breach must  generally be shown through expert testimony. Lay testimony is sometimes  sufficient where the defects are of common knowledge.  In construction cases and other cases involving licensed professionals,  standard of care evidence in negligence mat...

Explaining Some More of the Construction of a Dwelling. https://zalma.com/blog Interior Floor Finishes    Concrete is poured in place from 3½ to 6 inches thick at various areas.  It is usually poured into a form built with lumber or uses already  placed foundation walls as forms for basement and first floor slabs. The  concrete floors are usually reinforced with #3, #4, an...

Explaining Some More of the Construction of a Dwelling  https://zalma.com/blog Roofing  Asphalt shingles account for close to 90 percent of all residential  roofs.  Sheet metal, cement tiles, wood shakes or shingles, and  traditional slate or ceramic tile are used across the country. For  low-slope roofs, polymer membranes compete with asphalt roll roofing,  coal...

Explaining Some of the Construction of a Dwelling  htttps://zalma.com/blog To understand the construction defect claim and the litigation  surrounding construction defects, it is necessary to first have a basic  understanding of construction, what is proper and prudent and what can  go wrong. Building codes prescribe basic standards. When these standards  are not followed,...