Zalma on Insurance

Insurer that Pays Limit of Policy After Appraisal Did not Breach The Covenant of Good Faith & Fair Dealing Washington Street, LLC ("Washington Street") appealed a District Court order granting summary judgment to Nationwide Property and Casualty Insurance Company ("Nationwide"), which ended Washington Street's claims that Nationwide proceeded in bad faith in delaying cl...

Attorneys May Not Be Sued for the Tort of Bad Faith

No Indemnity for City's Sole Negligence The City of Kansas City sought contractual indemnity against Occupational Health Centers of the Southwest, P.C. doing business as Concentra Medical Centers in the Circuit Court of Jackson County only to be refused by the trial court. In City Of Kansas City, Missouri v. Occupational Health Centers Of The Southwest, P.C., d/b/a Concentra Medical Centers, N...

ZIFL Volume 27, Number 18 https://zalma.com/blog

Arson for Profit Scheme Defeated by RescissionPosted on September 14, 2023 by Barry Zalma Rescission of Insurance for Innocent Misrepresentation of Material Facts See the full video at https://rumble.com/v3hdpj2-arson-for-profit-scheme-defeated-by-rescission.html  and at https://youtu.be/CAarrB84t6E Back in 2001 I examined James E. Mitchell under oath on behalf of his insurer, United National Insu...

Clear & Unambiguous Exclusion https://zalma.com/blog

Ambiguous Policy Language Forces Insurer to Pay Losses It Did not Intend to Cover INSURER HOIST ON ITS OWN PETARD Insurers often complain that their insureds do not read the insurance policy and compel them to fulfill all policy terms or receive nothing. In my experience almost no one reads an insurance policy until there is a dispute over a claim. In Michigan an insurer did not read the policy it...

If Insurer Agrees to Defend Insured May Not Expect it to Pay Independent Counsel https://zalma.com/blog

Insurance Fraud Charges Against Defense Counsel Does Not Result in Reversal for Ineffective Counsel While Jesse Steven Castro's case was pending, his attorney was charged with two insurance fraud felony offenses. Castro's case proceeded to trial, and a jury convicted him of continuous sexual abuse of a child. Castro filed a motion for new trial claiming that he received ineffective assista...

A Fictionalized True Crime Story This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The Ben-Cohain brothers, quite by accident, came upon an imaginative fraud. The Los Angeles County District Attorney, after a lengthy investigation, charged them with violation of Penal Code § 550, in...

ANTI-SLAP MOTION FAILS BECAUSE PLAINTIFF NOT A PUBLIC FIGURE Tien Dung Tran, the owner of two YouTube channels, appealed from an order denying his special motion to strike plaintiffs Manh Van Truong (Mike) and Meiji Truong's complaint pursuant to the anti-SLAPP statute. He contends plaintiffs' claims, which include defamation and intentional and negligent infliction of emotional distress,...

ZIFL - 9/1/2023 - Volume 27, Issue 17 This, the seventeenth issue of the 27th year of publication Zalma’s Insurance Fraud Letter provides multiple articles on how to deal with insurance fraud in the United States. The issue begins with: Subscribe to Zalma's Insurance Fraud Letter The Source for Insurance Fraud Professional Allstate’s Qui Tam Actions Work to Take the Profit Out of Fraud Man Bit...

“Runner” Must Pay Restitution to Insurers The Eighth Circuit was called upon to decide the amount of restitution owed by a participant in a recruitment-and-kickback scheme aimed at defrauding automobile-insurance companies. The district court ordered restitution for every chiropractic patient that Abdisalan Hussein recruited from 2013 onward. In United States of America Plaintiff v. Abdisalan Abdu...

Appraisal Required to Establish Amount of Loss The plaintiff, Shelter Mutual Insurance Company (Shelter), appealed the circuit court of Coles County's March 28, 2023, oral pronouncement denying its motion for judgment on the pleadings and ordering the parties to proceed forward with the appraisal process as outlined in the at-issue insurance policy, and the circuit court's written March 30...

Premature Denial for Failure to Appear at EUO Fails It is not Reasonable to Deny a Claim for Failure to Appear for EUO Before the Date the EUO was Scheduled to Occur In March 2021, an arsonist destroyed a building on the Brockton Fair fairgrounds known as the "State Building," owned by BAS Holding Corporation ("BAS") and, according to BAS, insured against loss by Philadelphia I...

Agent for Insurer Only an Order Taker https://zalma.com/blog

Every Exclusion Must be Read as a Part of an Entire Policy https://zalma.com/blog

Bad Men Must Serve the Time for Crimes from Insurance Fraud to Murder After a multiple-count indictment against dozens of members of the Gangster Disciples five of them, Alonzo Walton, Kevin Clayton, Donald Glass, Antarious Caldwell, and Vancito Gumbs, appealed their convictions and sentences following a joint trial. Each raised several grounds for reversal contending they were overcharged and ove...

False Medical History Defeats No Fault Claim This case arose out of an accident that occurred in 2019. Plaintiff was hit by a car at around 8:15 p.m. while riding a bicycle in Flint, Michigan. Plaintiff sustained serious injuries, including multiple broken bones and lacerations, blunt force trauma to the chest and abdomen, and a traumatic brain injury. However he submitted a claim with false repre...

Insurers, Agents and Brokers Sophisticated Relationships Expensive Three sophisticated commercial parties in the insurance industry entered into what appears, in hindsight, to be a somewhat unsophisticated business arrangement. That arrangement led to complex litigation, which generally isn't a good thing for a business arrangement to lead to. In American Builders Insurance Company v. Keystone...

Man Bites Dog Story = Allstate May Sue on Behalf of State for Insurance Fraud Qui Tam Actions May Proceed to Trial https://zalma.com/blog

Waiver of Sovereign Immunity Does Not Apply to Federal Statutory Claims The doctrine of sovereign immunity is an "ancient" concept. It is the long-established view that a sovereign, such as a state, is "infallible," and, thus, immune from suit "absent the State's consent." The General Assembly provided such consent in the Maryland Tort Claims Act which waives the...

INTENTIONAL MISCONDUCT EXPOSED INSURER TO PUNITIVE DAMAGES https://zalma.com/blog https://zalma.com/blog

No Right to Change After Agreeing to a Settlement INSURER'S INSTIGATION OF SETTLEMENT IS EVIDENCE OF GOOD FAITH After parties to a suit resolved the suit by settlement one or more of the parties tried to renege on the agreement and appealed the trial court's order to enforce the parties' settlement agreement. The parties' settlement agreement required them to dismiss all claims, co...

Issue 27 Number 16: ZIFL-08-15-2023 See the full video at  and at https://youtu.be/x0EJFKVdjwQ Lawyer Paying for Clients Guilty Experienced Lawyer Claiming Ignorance of Law Is No Defense Robert Irving Slater was a practicing worker’s compensation attorney when he entered into an agreement that cost him his freedom. Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads...