Zalma on Insurance

A Video Explaining the Remedies Available for Defects  https://zalma.com/blog Construction defect suits are now flooding the courts of North America  in greater numbers every year. Construction Defects & Insurance is  designed to help the property owner, builder, construction professional,  insurer, insurance professional, construction defect plaintiffs’  lawyer, const...

Explaining the Hazards of Failing to Reside in the Dwelling the Risk of  Loss of Which Was Insured    https://zalma.com/blog Insurance companies often see disputes relating to the terms “domicile”  and “residence” when dealing with a homeowners policy. It is important,  therefore, that everyone in the business of insurance must understand  the meaning, and application...

A Video Explaining the Interpretation of Actual Cash Value    https://zalma.com/blog Determining the actual cash value of an item of personal property is  often difficult and is subject to different interpretations across  multiple jurisdictions. When an insurer and insured cannot agree on the  amount of actual cash value loss they have the right to seek appraisal —  ...

HTTPS://zalma.com/blog This fraud technique involves a loss at a time when an individual has no  or inadequate insurance. Following the loss, the individual applies for  insurance or increases the limits of existing coverage. After a period  of time (usually several days or weeks), a fraudulent claim is submitted  for a loss reported to have happened after the new policy came i...

Explaining The Equitable Remedy and Insurance  https://zalma.com/blog Rescission is an equitable remedy as ancient as the common law of  Britain.  When the United States was conceived in 1776 the founders were concerned  with protecting their rights under British common law. They adopted it  as the law of the new United States of America modified only by the  limitati...

Independent insurance adjusters serve insurance companies who do not  have sufficient claims staff to handle insurance claims on behalf of  those various insurers without staff in every jurisdiction where there  is property the risk of loss of which was insured.   https://zalma.com/blog The professional insurance adjuster recognizes that the work of  adjusting insurance cl...

Every Profession has the Occasional Crook  https://zalma.com/blog  When a public insurance adjuster exceeds his or her authority and  attempts to defraud an insurer on behalf of the adjuster’s client, the  standard “Concealment or Fraud” provision precludes the insureds from  obtaining any recovery under their policies as the claims submitted by  Berson, their public...

Explaining the Investigation of Third Party Insurance Fraud   https://zalma.com/blog nsured Suspected  If the insured is suspected of involvement in a third party insurance  fraud, like a staged automobile accident, it will be necessary for the  insurer to retain two attorneys.  One attorney will be required to  defend the insured under the terms of the policy.  ...

The Special Investigative Unit   https://zalma.com/blog California, Washington, New Jersey, and Florida are among many states  that require each insurer to have an SIU in place.  SIUs help identify  and investigate suspicious claims, although some insurance companies  outsource this work to other insurers and investigative agencies. An SIU  may be a small team whose p...

A Video Explaining Why a Plaintiff Has no Right to Assert Fifth  Amendment Protection    https://zalma.com/blog The Fifth Amendment to the U.S. Constitution protects an individual from  being forced to testify in a manner that might incriminate him or her  and subject the witness to prosecution. It is a defense, however, not a  weapon that can be used against a defend...

A Video Explaining the Right of Insurers to Assist Prosecutors   https://zalma.com/blog  Insurance fraud is a major component of white-collar crime. It is slowly  becoming a more significant component of the law-enforcement agenda.  The insurance industry plays a leading role in assisting prosecutors in  the investigation and prosecution of insurance fraud. The industry ha...

A Video Explaining Professional Conspiracies   https://zalma.com/blog   The Doctor Lawyer Conspiracy  The doctor–lawyer conspiracy will often begin in one of two ways. An  attorney uses individuals, called “chasers,” “runners,” or “cappers,” to  recruit a clientele of auto accident victims, usually for a flat fee.  They look for victims of actual automobile accid...

ZIFL - Volume 25, Issue 13    https://zalma.com/blog Attorneys Should Never Be Involved in Fraud with Clients The Crime Fraud Exception to The Attorney Client Privilege  In United States of America v. Aron Chervin, Et Al, No. 10 CR 918  (S.D.N.Y. 09/21/2011) an indictment involving multiple health insurance  fraud perpetrators attempted to keep from their criminal trial wi...

Explaining How Citizens Can Act to Defeat Insurance 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 tam [ “Qui tam” is an abbreviation  of...

Explaining How Citizens Can Act to Defeat Insurance 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 tam [ “Qui tam” is an abbreviation  of...

A Video Explaining the Obligations of an Adjuster to the Underwriting of  Insurance   https://zalma.com/blog  Adjusters are the representatives of the insurers who fulfill the  promises made by the underwriter when the risk was taken and a policy  was issued. The adjuster (sometimes called a claims representative) must  determine that the decision to insure was based...

Explaining Health Insurance Fraud    https://zalma.com/blog The nation’s bill for health care fraud is enormous  as large as $300  billion or more every year. Fraud takes place at many points in the  health care system, in hospitals, nursing homes, and diagnostic  facilities, by doctors, attorneys, health care providers, durable  equipment providers, and patients. On...

A Video Explaining How to Discover and Defeat Insurance Fraud    https://zalma.com/blog Next to tax fraud, insurance fraud is the most practiced crime in the  world. It is perpetrated by members of every race, religion, sexual  orientation, and nationality. Insurance fraud is perpetrated by members  of every profession. The temptation to commit insurance fraud is great &nb...

 Explaining How to Retain Defense Counsel   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 How to Avoid Conflicts of Interest    https://zalma.com/blog It is imperative that the defense attorney and the adjuster both  recognize that where the interests of the insurer and the insured  conflict in a suit on a liability policy, the attorney’s duty is to the  insured. The attorney and the adjuster must be careful that the attorney  does not become th...

Trial Preparation   https://zalma.com/blog After completion of investigation, written discovery, oral depositions,  and retention of necessary expert witnesses, the trial preparation part  of the case begins.  The defense attorney’s response should include the settlement value, or  range of values, he or she places on the case.  After reviewing the report, the adjuste...

Explaining The Ethical Obligations of the Claims Person when Retaining  an IME    HTTPS://zalma.com/blog Medical examiners have established their own codes of ethics with regard  to an IME and are obligated by those codes to report their findings  fairly and accurately. The American Board of Independent Medical  Examiners has published a code of Ethics.  The adju...

Explaining the Use of Experts to Resolve Claims  https://zalma.com/blog When the investigation is complete the adjuster must determine if  assistance is needed from liability experts, medical experts, or legal  counsel, or if it is better to rely on the layperson’s understanding of  physics, medicine, or other special areas involved in the particular  case.  Because a...

About the Waiver of the Privilege   https://zalma.com/blog INTENTIONAL WAIVER  Insurers frequently turn to outside counsel, or internal claims  adjusters who are licensed lawyers, for legal advice regarding their  coverage determinations on claims. In later litigation over denials of  coverage or a carrier’s claims-handling conduct, a question that  frequently arises...

Explaining Why Insurance for Punitive Damages is Against Public Policy   https://zalma.com/blog in Most States   Insurers generally argue that they cannot indemnify or insure for  punitive damage awards. Insurance carriers typically rely, in  California, on “public policy” and point to California Insurance Code  Section 533. Section 533 states:  An insurer is not...