Zalma on Insurance

Insurers Must Demand & Prove Restitution Required to Make Them Whole Defendants Alfredo Ayala and Juan Luis Ayala owned farm labor contracting businesses and shared business offices and office staff. Defendants were charged with insurance and tax fraud by underreporting their payroll amounts. Alfredo and Juan pleaded no contest to workers' compensation insurance fraud and tax fraud, agreed...

Obesity, Diabetes, and Covid Not Basis for Compassionate Release The US Congress, feeling sorry for federal prisoners amended the law to create The First Step Act to allow a District Court to shorten a sentence when there exists extraordinary and compelling reasons to release the Prisoner.  In United States Of America v. Earl Lee Planck, Jr., Criminal No. 5:20-CR-24-KKC-MAS-1, United States Distri...

After Rescission an Insurer May be Required Only to Pay an Innocent Injured Person On rare occasions bus accidents create a temptation to passengers to claim injuries as soon as it looks like insurance may apply. When the passengers on a bus insured by West Bend Mutual Insurance Company (West Bend), their injuries appeared like magic. As a result of its attempted investigation of a bus accident, W...

ZIFL Volume 27, Issue 7 The Source For Insurance Fraud professionals https://zalma.com/blog

No Contract Compelling Arbitration Between Insurer and Insured No Arbitration In Alex Weingarten v. Certain Underwriters At Lloyd's, London Subscribing To Policy Number IML-0114N0-190029, B321148, California Court of Appeals, Second District, Fourth Division (March 23, 2023) Certain Underwriters at Lloyd's, London (Lloyd's Underwriters) appealed from the trial court's order denying...

Intoxicated Driving Not in the Course and Scope of Employment https://zalma.com/blog

Satisfaction of Mortgage Eliminates Right of Mortgagee to Recover from Homeowners Policy In Thomas P. Williams, Sr. v. Nationwide Insurance a/k/a Nationwide Mutual Insurance Company, Civil Action No. 22-1090, United States District Court, E.D. Pennsylvania (March 24, 2023) Nationwide denied the claim of its insured because they failed to comply with the Policy's post-loss duties by failing to...

Forum Non Conveniens Dismissal Is Not A Judgment On The Merits The Fifth Circuit Court of Appeals resolved insurance issues concerning cable-damage in the Arabian Gulf by recognizing the difference between a broker and an agent, the place where - and to whom - a policy was delivered, and how to deal with the issue personal jurisdiction the court has over the parties and that a forum non conveniens...

Occupancy Provision Prevents Coverage for Insured Injured as a Pedestrian George Mims was injured when he was struck by an automobile while walking toward his own vehicle. At the time of the accident Mims had no contact with his vehicle, either before or after the accident, and there was no causal connection between his vehicle and the injuries he suffered. In George Mims; Cecilia Mims v. USAA Cas...

Forum Non Conveniens Dismissal Is Not A Judgment On The Merits The Fifth Circuit Court of Appeals resolved insurance issues concerning cable-damage in the Arabian Gulf by recognizing the difference between a broker and an agent, the place where - and to whom - a policy was delivered, and how to deal with the issue personal jurisdiction the court has over the parties and that a forum non conveniens...

Claims Made Policy May Not Respond to Claims Made After Expiration of the Policy Twin City Fire Insurance Company sold a malpractice insurance policy to John S. Xydakis, an attorney and one of the Defendants. Xydakis made claims under the policy based on lawsuits and motions filed against him in Illinois state court. Twin City sought a declaratory judgment that it owes no insurance coverage to Def...

California Insurance Code § 533 Prohibits Insurance for Wilful Acts of the Insured Aspen Specialty Insurance Company appealed from the district court order dismissing its complaint against Miller Barondess, LLP, and several of its partners (collectively "MB"). Aspen appealed to the Ninth Circuit in Aspen Specialty Insurance Company v. Miller Barondess, LLP Louis R. Miller; James Goldman;...

MCS-90 Is a Surety Agreement Different from the Insurance Policy https://zalma.com/blog

No Coverage if Person Fails to Qualify as an Insured  Plaintiff CSAA Fire & Casualty Insurance Company (CSAA) sued Roman  Ramirez and eventually filed a Motion for Summary Judgment. In CSAA Fire  & Casualty Insurance Company v. Roman Ramirez, No. 2:22-cv-00318-RFB-EJY,  United States District Court, D. Nevada (March 10, 2023) the USDC  resolved the coverage issue....

Investigation of Suspected Fraud   See the full article at 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:  ...

No Compelling Reason to Release Convicted Arsonist and Murderer Read the full blog at https://zalma.com/blog

"Caused by" is Synonymous with "Arises From" Read the full blog post at https://zalma.com/blog

In Martinique Properties, LLC v. Certain Underwriters at Lloyd's of  London, Subscribing to Policy Number W1551E160301; Beazley Lloyd's  Syndicate 2623; Beazley Lloyd's Syndicate 623, No. 21-3561, United  States Court of Appeals, Eighth Circuit (March 1, 2023) the Eighth  Circuit interpreted the Federal Arbitration Act as applied to an  insurance appraisal.  Read the...

Failure to Fulfill Protective Safeguards Endorsement Defeats Fire Claim   See the full blog post at https://zalma.com/blog In Frankenmuth Mutual Insurance Company v. Fun F/X II, Inc. and Cao  Enterprises II, LLC, No. 22-1933, United States Court of Appeals,  Seventh Circuit (February 28, 2023) the insurer rejected a fire claim  because the named insured knew, and didn't tell, F...

Being a good neighbor is hard work.  Read the full article at https://zalma.com/blog Sometimes it’s impossible. Marsha  was not a good neighbor. She would “borrow” things from her neighbors  and never return them. Most of her small kitchen appliances arrived  because of such loans. Marsha had an extensive collection of CDs and  long-playing records, none of which she purch...

Suing an Insurer & its Chairman as Racist for Denial of Claim is not Viable https://zalma.com/blog

ERISA Plan Must be Enforced as Written   When Anthony Hayes' employment ended, so did his employer-provided life  insurance. Hayes then missed the deadline to convert his coverage to an  individual policy. After Hayes died, his surviving spouse filed suit  seeking relief under a provision of the Employee Retirement Income  Security Act allowing "a participant or beneficiar...

Insurance Agent Who Kept Premium Money Loses License

ZIFL Volume 27, Issue Number 5   Read the full text of ZIFL at http://zalma.com/blog/wp-content/uplo... .   McClenny Moseley & Associates & Insurance Fraud  The McClenny Moseley & Associates (MMA) series of lawsuits, court hearings and insurance department actions have brought about some very serious problems for MMA, including court orders, lawsuit dismissals, administr...

ERISA Plan Must be Enforced as Written   When Anthony Hayes' employment ended, so did his employer-provided life insurance. Hayes then missed the deadline to convert his coverage to an individual policy. After Hayes died, his surviving spouse filed suit seeking relief under a provision of the Employee Retirement Income Security Act allowing "a participant or beneficiary" of an employee b...