Zalma on Insurance

ZIFL - 06-15-2021  https://zalma.com/blog Quote of the Issue - “Learn from yesterday, live for today, hope for  tomorrow.” - Albert Einstein What Is Insurance Fraud?  When an insurer is asked to pay a fraudulent insurance claim it is the  victim of a tort, a civil wrong and in most states, a crime.  Black’s Law Dictionary, 6th Edition, defines fraud as: "An intentional &nb...

Describing Grounds for the Tort of Bad Faith Unexplained Delays in Communication   https://zalma.com/blog When an insured asks a question of his or her insurer an answer is  expected. An insurer should respond to all inquiries promptly, and in no  event later than 15 days. If an insured submits a proof of loss to  which the insurer has agreed and asks “when can I expect to be p...

A Video Explaining Various Defenses to 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, serv...

A Video Explaining Intentional Torts   https://zalma.com/blog Negligence, strict liability, absolute liability, and products liability  all are “accidental” by definition: the persons being held liable for  injury to the plaintiff had no intent to harm the plaintiff. Intentional  torts are harmful or offensive contact, intentionally done. If I  attempt to hit you but hit s...

A Video Explaining Defenses to Tort Claims    https://zalma.com/blog Contributory and Comparative Negligence  At one time, a plaintiff who contributed in any amount to his or her own  injury recovered nothing. The California Supreme Court thought the  result was harsh. A person 99% responsible for another’s injury would  have an absolute defense. The California Suprem...

Catastrophes and Anti-Concurrent Cause Policy Language  https://zalma.com/blog The United States Court of Appeal, Fifth Circuit entered an important  decision with regard to water damage and insurance policy coverage for  claims resulting from water damage and catastrophe losses. In Leonard v.  Nationwide, 499 F.3d 419, 37 A.L.R. 6th 785 (2007) the first of the  Katrina ca...

Explaining The Need to Prove an Occurrence   https://zalma.com/blog An “occurrence” is usually defined as accidental loss or damage which  results, during the policy period, in bodily injury or property damage.  In Green v. State Farm Fire & Casualty Co. 127 P.3d 1279, 2005 UT  App 564 (Utah App. 12/30/2005) a homeowner sued the insured developer  after he sustained pr...

A Proposal to Create a Staff of Claims Professionals    https://zalma.com/blog To avoid claims of breach of contract, bad faith, punitive damages,  unresolved losses, and to make a profit, insurers must maintain a claims  staff dedicated to excellence in claims handling. That means they  recognize that they are obligated to assist the policyholder and the  insurer to...

Recognizing a Moral Hazard in the Underwriting of Insurance    https://zalma.com/blog The moral hazard is the increase in uncertainty caused by personal acts  of individuals. These acts may contribute to the probability or severity  of loss. The individual creating the problem may be the policyholder or  another person. In either case the chance of loss is increased. A mor...

Do Insurers Get Their Money’s Worth from Fighting Fraud?    https://zalma.com/blog The Law of Unintended Consequences Strikes Again to Help Set Up a Bad  Faith Case   How a Statute to Protect Against Bad Faith Offers Created an Opposite  Result  In White v. Cheek, A21A0212, Court of Appeals of Georgia (May 21, 2021) a  personal injury action arising from an...

Explaining Insurance Fraud and How to Defeat It  https://zalma.com/blog To prove civil fraud it is the obligation of an insurer to present admissible evidence that establishes the requirements of the common law that generally identifies nine elements needed to establish fraud: 1. a representation of fact; 2. its falsity; 3. its materiality; 4. the representer’s knowledge of its falsity or ign...

Explaining Personal Indemnity and Insurable Interest    https://zalma.com/blog First party property insurance is a contract of personal indemnity. The  insurer promises to indemnify the first party, the insured, in the event  the insured incurs a loss as a result of one of the perils insured  against by the wording of the policy. Insurance does not follow title to  th...

A Video Explaining Casualty Insurance   https://zalma.com/blog  "Casualty insurance” is defined as an “agreement to indemnify against  loss resulting from a broad group of causes such as legal liability,  theft, accident, property damage, and workers' compensation.” Black's  Law Dictionary 871 (9th ed. 2009).  Liability insurance is part of the casualty line of insura...

A Video Explaining Ethics and the Covenant of Good Faith & Fair  Dealing    https://zalma.com/blog On rare occasions, an insured will act unethically in his, her or its  relations with an insurer. When they do, if discovered by the insurer or  its claims person, the right to indemnity may be lost. As you read  about the decision from the United States Supreme Cour...

A Video Explaining Appraisal in a Homeowners Claim   https://zalma.com/blog Almost all homeowners policies contain an “appraisal” clause similar to  that in the Standard Fire Insurance Policy.  Appraisal should be used as a last resort when all efforts to reach an  agreed amount of loss with the insured have failed. The appraisal  provision is optional, and neither the ins...

A Video About the Effect of the Tort of Bad Faith    https://zalma.com/blog It is indisputable that in the 1950’s, 1960's and 1970’s the insurance  industry abused some insureds to avoid paying legitimate claims. Without  a factual basis, insureds were accused of arson or other variations on  insurance fraud. Indemnity payments were refused on the flimsiest of  excuse...

Intentional Torts Should Never Be Insurable    https://zalma.com/blog Insurance against the liability that comes from an intentional tort is  said to be against “public policy.” Insurance companies are generally  forbidden to write liability insurance promising protection against the  consequences of an intentional tort since such activity would encourage  intentional...

Exclusions for Wear & Tear, Depletion, Deterioration, Rust,  Corrosion and Erosion, and Water Damage    https://zalma.com/blog  The wear and tear exclusion, perhaps because it is so obvious, has  seldom been the subject of appellate review. The exclusion for wear and  tear is not, however, as argued by the insured, limited to ‘abnormal  wear and tear,’ but ra...

Mysterious Disappearance, Loss or Shortage Disclosed on Inventory,  Intentional Acts & Inherent Vice   https://zalma.com/blog  An exclusion is a provision of an insurance policy referring to hazards,  perils, circumstances, or property not covered by the policy.  Exclusions are usually contained in the coverage form or causes of loss  form used to construct the in...

Mysterious Disappearance, Loss or Shortage Disclosed on Inventory, Intentional Acts & Inherent Vice https://zalma.com/blog An exclusion is a provision of an insurance policy referring to hazards, perils, circumstances, or property not covered by the policy. Exclusions are usually contained in the coverage form or causes of loss form used to construct the insurance policy.” [ IRMI Online Glossa...

ZIFL – May 15, 2021    https://zalma.com/blog The May 15, 2021 issue of Zalma’s Insurance Fraud Letter Includes  articles on the following subjects:   EUO Is A Condition Precedent  People who commit insurance fraud tend to run from serious insurers who  deny claims for fraud, misrepresentation, concealment or failure to  fulfill conditions precedent. State F...

A Podcast About Commercial Property Claims Require Experienced and  Qualified Adjusters    The adjustment of a commercial loss is performed in the same manner as  any other property loss. The difference is one of tone, extent of loss  and professionalism of the insured, rather than substance.  Adjusters who usually deal with a business entity, and its officers or &nbs...

Types of First Party Property Fraud    https://zalma.com/blog Every first-party property adjuster will face in his or her career  attempts to defraud the insurer for whom the adjuster works. It is  necessary that the adjuster is aware of each type of property insurance  fraud he or she may encounter. Some, but surely not all, fraud types  follow:  Arson for Profi...

Rescission is an Important Remedy to Avoid Fraud    Never Rescind a Policy Without a Thorough Investigation and Advice of  Counsel  https://zalma.com/blog Insurers must use the rescission remedy with care. Insurers should never  assume that the promise to pay indemnity to the insured under a policy  of insurance can, with impunity, be broken by advising the insured th...

Insurance Claims and Mold Reality  https://zalma.com/blog Get Rich Quick Thanks to Mold   Although there have been successful lawsuits, the days of multi-million  dollar verdicts in insurance mold claims are probably disappearing.  As for the get-rich-quick mold remediation companies, they are finding  that they must give real service or they will soon be visiting the &nbs...