Zalma on Insurance

About Zalma on Insurance

Presentation of insurance issues relating to claims handling, insurance coverage, interpretation of insurance policy coverages, insurance fraud, and investigation.

Publisher

Barry Zalma

Category

business

Language

en

Explicit

No

First episode

21 Apr 2020

Latest episode

20 May 2024

Latest episodes

787 episodes in the feed.

1. 

   20 May 2024

   Zalma's Insurance Fraud Letter - May 15, 2024

   ZIFL-05-15-2024 (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf)Subscribe to ZIFL Here  (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL-01-01-2024.pdf) Post 4801 Read the full 23 page issue here in Adobe pdf format. (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) See the full video at  https://rumble.com/v4v566z-zalmas-insurance-fraud-letter-may-15-2024.html (https://rumble.com/v4v566z-zalmas-insurance-fraud-letter-may-15-2024.html)  and at https://youtu.be/r7TbELn-Si0 (https://youtu.be/r7TbELn-Si0) Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ (http://zalma.com/zalmas-insurance-fraud-letter-2/) This issue contains the following articles: The defendant, Vincent Chaney, appealed two orders from Superior Court denying his motions to suppress and for a new trial. In State of New Hampshire v. Vincent Chaney, No. 2022-0718, Supreme Court of New Hampshire (May 3, 2024) resolved the dispute over Chaney’s conviction. Read the full 23 page issue here in Adobe pdf format. (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) This is ZIFL’s twentyeigth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public. On April 23, 2023, MMA filed its Statement of Financial Affairs.  MMA Reported Gross Income as follows:  2024 - $803,956.63,  2023 - $12,247,362.23, 2022 - $22,596,895.00. Read the full 23 page issue here in Adobe pdf format. On January 2, 2024, in Kindle, paperback and hardback formats, The Compact Book of Adjusting Property Claims, Fourth Edition is now available for purchase here and here. The Fourth Edition contains updates and clarifications from the first three editions plus additional material for the working adjuster and the insurance coverage lawyer. Read the full 23 page issue here in Adobe pdf format. (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) Kimberli Orr obtained no-fault automobile insurance from defendant USA Underwriters and was involved in an automobile collision. Defendant denied plaintiff’s claim for benefits because it discovered that plaintiff made material misrepresentations on her application for insurance. Defendant argued that it was entitled to rescind and void plaintiff’s insurance policy, and the trial court granted defendant summary disposition. In Kimberli Orr v. USA Underwriters, No. 363452, Court of Appeals of Michigan (April 25, 2024) the Court of Appeals resolved the dispute. Read the full 23 page issue here in Adobe pdf format. (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) Ashley Bunton-Dodson, 36, of Las Vegas, and Remedy Wellness and Resource Center, LLC (“Remedy Wellness”), were sentenced May 7, 2024 in a Medicaid fraud case involving billing for services that were not provided to Medicaid recipients. http://Read the full 23 page issue here in Adobe pdf format. (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) LDI and St. Tammany Parish Sheriff’s Office to Help Consumers Avoid Storm-Related Insurance Fraud I usually write everything in ZIFL, but this notice is useful wherever you work or live and as you read just change “Louisiana” to your state’s name. Read the full 23 page issue here in Adobe pdf format. (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition provides detailed guidance and practical information on the four primary areas of any investigation of suspicious claims. The book also examines recent developments in areas such as arson investigation procedures, bad faith, extracontractual damages, The fake burglary, and Lawyers Deceiving Insurers, Courts & Their Clients During, Catastrophes—A New Type Of Fraud and the appendices includes the NAIC Insurance Information and Privacy Protection Model Act and usable forms for everyone involved in claims and will provide necessary information to the claims adjuster, SIU fraud investigator, claims manager, or coverage lawyer so he or she can be capable of excellence. The newest book joins other insurance, insurance claims, insurance fraud, and insurance law books by Barry Zalma all available at the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) Shannon Egeland's insurance scheme and concocted shooting, which led to the amputation of his left leg, "an unthinkable kind of situation,'' and tacked on three years and 10 months to his 10-year sentence for mortgage fraud. He was sentenced in U.S. District Court in Portland. Read the full 23 page issue here in Adobe pdf format. (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) Read the full article at https://www.linkedin.com/pulse/new-book-from-barry-zalma-tort-bad-faith-barry-zalma-esq-cfe and at https://zalma.com/blog plus more than 4300 posts. A Book Needed by Every Insurance Claims Professional Read the full 23 page issue here in Adobe pdf format. (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in   for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com Over the last 55 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals. Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455 Read the full 23 page issue here in Adobe pdf format (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) The Source for the Insurance Fraud Professional (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf)Incompetent Insurance Fraud Claim Results in ConvictionFraudster Pawns Jewelry & Then Claims it Stolen (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf)More McClenny Moseley & Associates IssuesNow Available New Book (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf)The Compact Book of Adjusting Property Claims – Fourth EditionHelp, My House Is Falling Into The SeaNormally Honest People Will Try Insurance Fraud"I present blogs and videos so you can learn how insurance fraud is perpetrated and what is necessary to deter or defeat insurance fraud. This Video Blog of True Crime Stories of Insurance Fraud, with the names and places changed to protect the guilty, are all based upon investigations conducted by me and fictionalized to create a learning environment for claims personnel, SIU investigators, insurers, police, and lawyers to better understand insurance fraud and weapons that can be used to deter or defeat a fraudulent insurance claim."The Honest Real Estate Lawyer Tempted to Commit FraudLies on Insurance Application ExpensiveFalse Statement on Application Requires RescissionHealth Insurance Fraud ConvictionsNBA STAR 'BIG BABY' IS GOING TO JAIL FOR INSURANCE FRAUDEx-Boston Celtics player Glen 'Big Baby' Davis has been sentenced to 40 months in prison for defrauding the NBA healthcare plan. Davis, alongside several others, participated in a scheme that involved submitting false or inflated claims for medical and dental services that were never provided. Davis personally submitted $132,000 in fraudulent claims, which were uncovered through geolocation data and travel records. Overall, the group defrauded the plan of over $5 million. Davis will also be on supervised release for 3 years and must pay $80,000 in restitution. Nevada AttorneyGeneral Ford Announces Conviction Of Health Care Company And Its OwnerHow to Avoid Insurance Fraud from the Louisiana Department of InsuranceNew Book Now Available from Barry ZalmaProperty Investigation Checklists: Uncovering Insurance Fraud, 14th EditionOther Insurance Fraud ConvictionsFormer Desert Sun VP Sentenced For Ordering His Son To Shoot Him In Legs To Delay PrisonThe Tort of Bad FaithWhat Every Insurance Professional, Every Insurance Coverage Lawyer, Every Plaintiffs Bad Faith Lawyer, and Every Insurance Claims Person Must know About the Tort of Bad FaithBarry Zalma (http://zalma.com/blog/wp-content/uploads/2024/05/ZIFL2-05-15-2024.pdf) --- Support this podcast: https://podcasters.spotify.com/pod/show/barry-zalma/support (https://podcasters.spotify.com/pod/show/barry-zalma/support)

2. 

   20 May 2024

   Overcharge of Force Placed Insurance Defense to Foreclosure

   Force Placed Insurance Charges Allow Special Defense to Foreclosure Post 4802 In an action to foreclose a mortgage the trial court granted in part the plaintiff's motion to strike the defendant's special defenses and counterclaim; subsequently, the court, Cirello, J., granted the plaintiff's motion for summary judgment as to liability only; thereafter, the court, Spader, J., rendered judgment of foreclosure by sale, and the defendant appealed. In M&T Bank v. Robert R. Lewis, No. SC 20817, Supreme Court of Connecticut (April 30, 2024) the appeal of a foreclosure judgment presented one question important to insurance professionals: Whether allegations of impropriety in a mortgagee's force placement of property insurance arise from the making, validity or enforcement of the mortgage for purposes of a special defense to a foreclosure action. Robert R. Lewis claimed that the trial court improperly granted the plaintiff's motion to strike two of the defendant's special defenses arising from the plaintiff's conduct in its force placement of flood insurance on the property at issue, alleging that the plaintiff had unclean hands and breached the implied covenant of good faith and fair dealing on the ground that those defenses do not arise from the making, validity or enforcement of the mortgage. After the defendant failed to make his monthly payment on August 1, 2017, the plaintiff notified him in writing of his default. The plaintiff subsequently elected to accelerate the note and foreclose on the mortgage. The parties participated in the state's court-supervised foreclosure mediation program but were unable to reach an agreement to modify the loan. The trial court granted the plaintiff's motion for summary judgment as to liability only. Defendant's claim that the trial court improperly granted in part the plaintiff's motion to strike the defendant's special defenses of unclean hands and breach of the implied covenant of good faith and fair dealing predicated on the plaintiff's improprieties in the force placement of the flood insurance, do not ''arise from the making, validity or enforcement'' of the mortgage. In the present case, the trial court struck the special defenses of unclean hands and breach of the implied covenant of good faith and fair dealing on the ground that the defendant's allegations did not relate to ''the specific mortgage at issue in this case.'' (Emphasis added.) The question remains whether those allegations are sufficiently related to the making, validity or enforcement of the mortgage. The Supreme Court concluded that they are. The defendant alleges, the plaintiff charged the defendant an amount greater than the ''cost'' of the insurance, in violation of section 5 of the mortgage agreement, concealed a ''kickback'' agreement that it had with ASIC. All of this alleged conduct is directly related to the plaintiff's reliance on and enforcement of section 5 of the mortgage agreement. The Supreme Court noted that the alleged effect of the plaintiff's conduct in enforcing section 5 of the mortgage agreement-that it wrongfully increased the defendant's overall debt-provides a sufficient nexus to the foreclosure action. Defendant's allegations in support of the special defenses are sufficiently connected to the enforcement of the mortgage. Since an action to foreclose a mortgage is an equitable proceeding it is a fundamental principle of equity jurisprudence that for a plaintiff to show that he is entitled to the benefit of equity he must establish that he comes into court with clean hands. The clean hands doctrine is applied not for the protection of the parties but for the protection of the court. It is applied not by way of punishment but on the basis of considerations that make for the advancement of right and justice.  A mortgagor who has defaulted on a mortgage is not precluded from asserting the special defense of unclean hands. Therefore, the Supreme Court took the Defendants allegations as true it concluded that the defendant alleged willful conduct that is not equitable, fair or honest. The defendant sufficiently pleaded that the plaintiff's alleged misrepresentations interfered with his right to receive the benefits of the agreement. This Defendant did by alleging that the plaintiff's kickback scheme wrongfully resulted in the defendant's payment of more than he was obligated to pay and more than the plaintiff was entitled to charge him, pursuant to the mortgage agreement. By alleging that Plaintiff's conduct with force placed insurance increased his overall debt the trial court improperly struck the special defenses. Insurance is important to every mortgagee needing it to protect the security for the loan. Mortgages require insureds to obtain insurance and allow, if they fail, to obtain force placed insurance that only protects the mortgagee at the expense of the insured. However, the mortgagee should never charge the insured more than it pays since that would be fraudulent and, as in this case, a defense to the foreclosure. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe (https://barryzalma.substack.com/subscribe) Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; (https://www.newsbreak.com/@c/1653419?s=01) Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; (https://rumble.com/c/c-262921;) Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg (https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg;). Go to the Insurance Claims Library – https://lnkd.in/gwEYk (https://lnkd.in/gwEYkxD). --- Support this podcast: https://podcasters.spotify.com/pod/show/barry-zalma/support (https://podcasters.spotify.com/pod/show/barry-zalma/support)

3. 

   20 May 2024

   Officer Immune from Suit

   Insurance for State of Delaware Waives Sovereign Immunity On February 15, 2023, Kimberly Letke ("Plaintiff") filed a pro se Complaint against Defendant Matthew Sprinkle ("Sprenkle") for defamation and malicious prosecution.  On October 3, 2023, Plaintiff filed another Complaint added Defendants Cpl. Tyler Beulter of the DNREC police ("Beulter") and the Attorney General of Delaware, Kathleen Jennings ("Jennings"), in which she added three additional claims: false arrest and violations of public trust, unlawful detention, and violations of her rights under the Fourth Amendment to the United States Constitution. In Kimberly Letke v. Matthew Sprenkle, CPL. Tyler Beulter, and Attorney General Kathleen Jennings, C.A. Nos. S23C-10-019 CAK, S23C-10-002 CAK, Superior Court of Delaware (May 6, 2024) the court was faced with a Motion to Dismiss based upon sovereign immunity. Sprenkle hunted and harvested a deer in Cape Henlopen State Park, allegedly trespassing on Plaintiff's neighbor's property to reach the Park. Plaintiff shouted at Sprenkle and called the police. The police spoke with Sprenkle and ultimately arrested Plaintiff for a violation of the Delaware statute prohibiting impeding lawful hunting. The charge was ultimately dropped. Plaintiff's claims, including those for defamation and malicious prosecution spring from that incident and the statements that Sprenkle allegedly made to Beulter about Plaintiff. The doctrine of sovereign immunity provides that the State of Delaware, including its agencies, can only be sued by consent, or by an express act of the General Assembly. When the State has not waived sovereign immunity, the Court does not have to consider whether the State Tort Claims Act is applicable. The Court has dismissed in the past claims against Delaware state agency defendants where the state agency defendants submitted an affidavit from the Insurance Coverage Administrator of the State of Delaware affirming that the State had not purchased any insurance coverage for such claims. Without a waiver of sovereign immunity, the Court held that plaintiffs' claims were barred, and therefore, the Court was not required to consider whether the State Tort Claims Act was applicable. Assuming arguendo that there is not absolute sovereign immunity for Beulter, or that the State has waived sovereign immunity with respect to him or his agency, the doctrine of qualified immunity bars Plaintiff's claims against Beulter. When properly applied, qualified immunity protects all but the plainly incompetent or those who knowingly violate the law. Plaintiff's claims against Beulter are founded upon an alleged act or omission arising out of the performance of his official duty, and, therefore, is barred by the qualified immunity statute. First, all actions surrounding Plaintiff's arrest were in the performance of an official duty. Second, there is nothing in the Complaint, other than what may be fairly read as mere accusations, that indicates Beulter was not acting in good faith. Third, there is nothing in the Complaint that indicates that Beulter acted with gross or wanton negligence. For the reasons discussed above, Defendant Beulter's Motion to Dismiss was GRANTED. No one likes being arrested. Regardless you cannot sue a police officer or a prosecutor for defamation if everything they did was part of their official duties. The state of Delaware allows the state to waive sovereign immunity only if the state has bought insurance to protect it against such claims. Since there was no insurance protecting the officer he was immune from the suit. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe (https://barryzalma.substack.com/subscribe) Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; (https://www.newsbreak.com/@c/1653419?s=01) Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; (https://rumble.com/c/c-262921;) Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg (https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg;). Go to the Insurance Claims Library – https://lnkd.in/gwEYk (https://lnkd.in/gwEYkxD). FACTSAbsolute ImmunityQualified ImmunityANALYSISZALMA OPINION --- Support this podcast: https://podcasters.spotify.com/pod/show/barry-zalma/support (https://podcasters.spotify.com/pod/show/barry-zalma/support)

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