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Anti-Stacking Provision Clear & Unambiguous Plaintiffs, Mark and Karen Kuhn (the Kuhns) sued seeking a declaratory judgment of the available liability insurance covering an accident between a semitruck owned by Jason Farrell and a school bus driven by Mark. In Mark Kuhn and Karen Kuhn v. Owners Insurance Company; et al, No. 4-22-0827, 2023 IL App (4th) 220827, Court of Appeals of Illinois, Fourth District (June 28, 2023) the semitruck was insured under a policy issued by Owners Insurance Company (Owners), and that policy also insured six other vehicles-two other semitrucks and four trailers- that were not involved in the accident. Each vehicle had a limit of $1 million per accident. The Kuhns sought a declaration that the coverage limits for all of the covered vehicles should be aggregated, or "stacked," resulting in a total of available liability insurance of $7 million for the accident. The trial court entered a written judgment in favor of the Kuhns, concluding that (1) the policy was ambiguous; (2) because the ambiguity should be construed against Owners, stacking of the policy's coverage limits was permitted; and (3) the aggregate limit of insurance for liability coverage under the policy was $7 million. Accordingly, the court granted the Kuhns' motion for summary judgment and entered judgment against Owners. Owners appealed BACKGROUND "Stacking” ordinarily involves combining or aggregating the policy limits applicable to more than one vehicle where the other vehicles are not involved in the accident. The rationale behind not allowing stacking of liability coverage-that liability policies insure particular cars-is contrary to plaintiff's position. Because the insurance attaches to a particular car. The Illinois Supreme Court recently declined to consider adopting a per se rule barring stacking of automobile liability coverage as a matter of law because the antistacking provision in that case was unambiguous and enforceable as written. [Hess v. Estate of Klamm, 2020 IL 124649, ¶ 30, 161 N.E.3d 183.' The Insurance Policy at Issue The policy provided "Combined Liability" coverage on each of the seven vehicles of up to "$1 Million each accident." The Kuhns argued that the wording of the policy and accompanying declarations were ambiguous pursuant to Illinois case law because the coverages and premiums set forth in the declarations were repeated for each insured vehicle. Owners argued that the policy declarations were consistent with each other and not ambiguous. Owners argued the policy contained an unambiguous antistacking provision that cleared up any arguable ambiguity in the declarations and should be enforced as written. In particular, subsection 5 explicitly stated that the limits for the same or similar coverage applying to other vehicles could not be added to determine the amount of coverage for an accident. ANALYSIS In general, antistacking provisions in insurance policies are not contrary to public policy. In Illlinois, an unambiguous antistacking clause will be given effect by a reviewing court. In this case, the "Limit of Insurance" provisions refer back to the declarations to define the policy limits and the declarations pages state seven separate times that the "combined liability" limit on each vehicle is $1 million for each accident. Reading the policy as a whole and interpreting its plain language, the court concluded that the declarations are consistent, not ambiguous, and the antistacking clause set forth in the policy clarifies any possible ambiguity. The coverages varied based on the vehicle insured; for example, the premiums for vehicle 1 and vehicle 2 (both semitrucks) were identical for liability, UIM/UM coverage, and medical payments, but only vehicle 1 had comprehensive and collision coverage. The Antistacking Clause Even if some ambiguity existed, the policy's antistacking clause cleared up any possible confusion. The explicit antistacking clause of the policy, is unambiguous and should be enforced as written. Instead of applying the Policy's clear anti-stacking provision, the trial court engaged in the very sort of tortured and strained reading of the Policy to find an ambiguity that this Court and the Illinois Supreme Court have repeatedly rejected. This was error, the trial court’s order was reversed and the case remanded with directions to enter summary judgment in favor of Owners. ZALMA OPINION It should be axiomatic that a trial court should never engage in tortured or strained reading of a policy to find an ambiguity that did not exist. A clear and unambiguous policy wording that refuses to allow stacking of coverages that apply to more than one vehicle insured when only one vehicle is involved in an accident, should be enforced as written. The Illinois Court of Appeals read the entire policy and found no ambiguity and insisted on enforcing the contract of insurance as written. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

No Coverage Under a False Name Cheryl Tisdale was injured in an automobile collision while she was driving her own vehicle containing passengers while logged into the Uber Technologies ("Uber") application as a paid driver. Tisdale served Farmers Insurance Exchange with the complaint, seeking underinsured motorist ("UM") coverage pursuant to an insurance policy Farmers issued to Raiser, LLC, a subsidiary of Uber. In Tisdale v. Farmers Insurance Exchange, No. A23A0616, Court of Appeals of Georgia (June 27, 2023) Farmers moved for summary judgment, arguing that Tisdale did not qualify as an insured under the Uber policy, or, in the alternative, that she was barred from seeking coverage because she intentionally concealed or misrepresented material facts and committed fraud by using a false identity in her Uber driver application and while using the app. The trial court granted summary judgment to Farmers. Tisdale appealed. FACTS Tisdale was an Uber driver from 2015 to 2017. According to her deposition, at some point Uber "stopped [her] from driving because they did a background check [,] and something popped up on there . . . they didn't agree with." In 2019, because she did not believe that Uber would hire her under real name, Tisdale applied to work for Uber using the name "Annie Mollie." Uber approved "Mollie's" application, and Tisdale began driving for Uber as Annie Mollie. In April 2020, Tisdale was involved in an automobile accident with Graves while driving her own car, which was registered under her legal name, and while logged into the driver version of the Uber app as Annie Mollie. Tisdale gave a recorded statement to Farmers as "Annie Mollie." In May 2020, Tisdale sued Graves for damages arising out of the accident, alleging that he rear-ended her, pushing her vehicle into the path of another vehicle, which struck her, and that she incurred in excess of $184,000 in medical expenses. At the time of the accident, Tisdale had not entered into a contract to use the Uber app in her own name/capacity, and Uber had not authorized her to drive as an Uber driver; instead, Tisdale operated her vehicle while logged into the Uber app using a false identity. Under these circumstances, Tisdale did not qualify as an insured under the policy Farmer's issued to Uber. ANALYSIS The hallmark of contract construction is to ascertain the intention of the parties, as set out in the language of the contract. As a result, when the language of an insurance policy defining the extent of an insurer's liability is unambiguous and capable of but one reasonable construction, the courts must enforce the contract as written and agreed to by the parties. Tisdale served her own UM carrier - State Farm Fire and Casualty Company - and Farmers with a copy of the complaint and discovery requests. Farmers, in response, alleged that coverage for Tisdale under Uber's UM policy was void. Farmers moved for summary judgment claiming Tisdale intentionally concealed or misrepresented material facts and committed fraud by using a false identity in her Uber application and while using the app, she did not qualify as an insured under the Uber policy, and she was barred from seeking coverage based on the fraud condition in the policy. The trial court granted summary judgment to Farmers. Tisdale concedes that she intentionally misrepresented her identity and presented Uber with a false driver's license and a false insurance registration card in order to become a driver. This misrepresentation and fraud provided her coverage under the Farmer's policy, which clearly bars the payment of damages to a driver who commits fraud or intentionally misrepresents or conceals a material fact relating to coverage. Therefore, the trial court properly granted summary judgment to Farmers. ZALMA OPINION It takes a great deal of chutzpah (unmitigated gall) to be fired by Uber for cause, rejoining Uber under a false name, and then claim a right to benefits from the Uber policy. Tisdale was punished by her lies and was not allowed to profit from her fraud. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

ZIFL - Volume 27, Issue 13 See the full video at and at https://youtu.be/yiSwfKAB7GM The Source For Insurance Fraud Professionals From https://zalma.com/blog, this, the Thirteenth 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: Fraud in Inception is Ground for Rescission No Restitution from Defrauded Insurer Esurance Property & Casualty Insurance Company (Esurance) appealed the trial court’s order granting summary disposition in favor of Nationwide Mutual Fire Insurance Company (Nationwide) and denying Esurance’s request for summary disposition. In Nationwide Mutual Fire Insurance Company v. Esurance Property & Casualty Insurance Company, and Derek Allen Gregory and Blair Gregory, No. 361298, Court of Appeals of Michigan (June 15, 2023) Esurance alleged its insured defrauded it when it acquired the policy, and it was entitled to rescind the policy regardless of the trial court’s balancing the equities. Read the full text of ZIFL in Adobe .pdf format at ZIFL-07-01-2023 More McClenny Moseley & Associates Issues This is ZIFL’s ninth 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 of the state of Louisiana. June 14, 2023 US Magistrate Judge Michael North held a hearing to advise insurers on how to handle thousands of Hurricane Ida claims affected by alleged fraud by Texas law firm McClenny Moseley & Associates. It’s standing room only, more than 200 lawyers in court. One fainted. Read the full text of ZIFL in Adobe .pdf format at ZIFL-07-01-2023 Ethics And the Public Insurance Adjuster An example of a public insurance adjuster and the lawyer who failed to follow the requirements set out by National Association of Public Insurance Adjusters (NAPIA). Both represented the same client, involved in a claim that resulted from the 1994 Northridge, California earthquake. The earthquake caused billions of dollars in damage across Southern California. It drew lawyers and public adjusters seeking large fees like vultures flying over a dead antelope. As a result of the disaster, investigation by insurers was limited because of the extent of losses caused by the earthquake and the need to rapidly serve their needs. Many unnecessary and spurious suits were filed. Insurance fraud was rampant, and insurers paid rather than fight because there were inadequate staff available to deal with fraud and governmental agencies threatened insurers with major fines if they did not pay quickly. Read the full text of ZIFL in Adobe .pdf format at ZIFL-07-01-2023 Good News From the Coalition Against Insurance Fraud When faced with a fraud conviction, this woman couldn’t stop herself from doing it again. Tanea Bouma, who had been court-ordered not to obtain employment or a volunteer role involving financial authority. Read the full text of ZIFL and many more reports of convictions in Adobe .pdf format at ZIFL-07-01-2023 Order Limiting Cross-Examination Fair and Appropriate In The People v. Renae Louise Witt, G061305, California Court of Appeals, Fourth District, Third Division (June 5, 2023) a jury had convicted Renae Louise Witt of committing seven counts of medical insurance fraud in violation of Penal Code section 550, subdivision (a)(6). The trial court suspended imposition of sentence and placed Witt on two years of formal probation and ordered her to serve 364 days in jail and yet, she appealed. Read the full text of ZIFL in Adobe .pdf format at ZIFL-07-01-2023 Health Insurance Fraud Convictions Gloucester County Man Admits Healthcare Fraud Christopher Gualtieri, 50, of Franklinville, New Jersey, pleaded guilty before U.S. District Judge Robert B. Kugler to one count of an indictment charging him with conspiracy to commit health care and mail fraud and one count charging him with obtaining oxycodone through fraud. Gualtieri, a Gloucester County, New Jersey, man on June 12, 2023 admitted defrauding his employer’s health insurance plan out of more than $4 million by submitting fraudulent claims for medically unnecessary compounded medications. Read the full text of ZIFL and dozens of convictions in Adobe .pdf format at ZIFL-07-01-2023 Other Insurance Fraud Convictions Clegg Gifford Shuns Over £7 Million Worth of Fraudulent Claims Insurance broker Clegg Gifford (CG) has successfully identified and avoided more than £7 million worth of fraudulent motor trade claims over a period of four years with the help of the counter-fraud team at law firm DAC Beachcroft (DACB). Read the full text of ZIFL and more convictions in Adobe .pdf format at ZIFL-07-01-2023 Barry Zalma 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 California 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; Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; I publish daily articles at https://zalma.substack.com, Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.

Arbitration May be used to Resolve Fraud This case is about the relationship between New Jersey healthcare providers and the insurance companies that pay those providers for treating patients for injuries arising from automobile accidents. In GEICO In v. Caring Pain Management PC a/k/A Careon Pain Management, Jinghui Xie, M.D., First Care Chiropractice Center, L.L.C., and Konstantine Fotiou, D.C., No. 2:22-cv-05017(BRM)(JSA), United States District Court, D. New Jersey (May 31, 2023) the insurer attempted to defeat fraudulent claims under the New Jersey no-fault law. BACKGROUND Multiple GEICO insurers (the "Plaintiffs) alleged a series of fraudulent schemes, including unlawful compensation in exchange for patient referrals, misrepresentation of the nature, extent, and results of patient examinations, and false representation regarding compliance with pertinent healthcare laws. MOTION TO DISMISS In deciding a motion to dismiss pursuant to Federal Rule of Civil Procedure 12(b)(6), a district court is required to accept as true all factual allegations in the complaint and draw all inferences from the facts alleged in the light most favorable to the non-moving party. DECISION The Insurance Fraud Prevention Act (“IFPA”), which was enacted roughly a decade after the No-Fault Law, provides that an “insurance company damaged as the result of a violation of any provision of this act may sue therefor in any court of competent jurisdiction.” In part, the New Jersey Legislature enacted the IFPA to address rising insurance rates resulting from widespread fraud with the clear objective to confront aggressively the problem of insurance fraud in New Jersey by facilitating the detection of insurance fraud and eliminating the occurrence of such fraud through the development of fraud prevention programs. A person or practitioner violates the IFPA by presenting or preparing false or misleading statements in connection with an insurance claim, or by failing to disclose the occurrence of an event that affects an individual's entitlement to insurance benefits or the amount of benefits THE COMMON LAW FRAUD, UNJUST ENRICHMENT, AND RICO CLAIMS The No-Fault Law's language, legislative intent and application cover Plaintiffs' claims for common law fraud, unjust enrichment and RICO. The plain language of the No-Fault statute provides that “[a]ny dispute regarding the recovery of . . . benefits provided under personal injury protection coverage . . . arising out of the operation, ownership, maintenance or use of an automobile may be submitted to dispute resolution on the initiative of any party to the dispute.” (emphasis added) Plaintiffs' claims involve: a dispute by [Plaintiffs] involving Defendants' recovery of PIP Benefits that one party wishes to send to arbitration. Consequently, Plaintiffs' common law fraud, unjust enrichment, and RICO claims fall within the statute's arbitration provision. Having reviewed the No-Fault Law's language, legislative intent, application, and arbitrable claims with Plaintiffs' claims for common law fraud, RICO and unjust enrichment, the USDC found there was nothing preventing an arbitrator from hearing the claims. New Jersey IFPA Claim The plain meaning of the New Jersey Insurance Fraud Prevention Act (IFPA) requires insurers' claims for damages under the IFPA be judicially resolved. Although the statute states that insurers “may sue in any court of competent jurisdiction,” arbitration does not constitute a court of competent jurisdiction. To the extent the IFPA may seem to contradict the No-Fault Law, state legislatures are presumed aware of prior enactments, including the pre-existing No-Fault Law. The state legislature could have provided a carve out for PIP Benefits disputes in the IFPA but did not. The USDC concluded that to avoid duplicative findings, the Court, in its discretion, declined to separately entertain the IFPA claim under the Declaratory Judgment Act. To the extent Plaintiffs seek a declaration that Defendants violated RICO, committed common law fraud, or are liable for unjust enrichment, an arbitrator shall decide that issue. ZALMA OPINION Clearly, the health care providers who were accused by GEICO of fraud felt that they had a better chance of success with an arbitrator rather than a federal judge. The judge found the statutes allowed for arbitration and sent the fraud to an arbitrator. I would like to be that arbitrator and hope the parties get an arbitrator who dislikes insurance fraud as much as I do, and find they would have done better with a federal judge. GEICO should be honored for working to defeat fraud by attempting to take the profit out of the fraud. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Suing All State Farm Insurers Unconscionable State Farm Mutual Automobile Insurance Company (“State Farm Auto”) and Defendant State Farm General Insurance Company (“State Farm General”) moved the court to dismiss all Plaintiff's claims against the entities. The motion was regarded as unopposed. In Bridget Butler v. State Farm Fire And Casualty Company, State Farm General Insurance Company, And State Farm Mutual Automobile Insurance Company, No. 3:22-Cv-03433, United States District Court, W.D. Louisiana, Lake Charles Division (June 23, 2023) a Bridget Butler whose home was damaged by two hurricanes sued three State Farm Insurance companies when only one insured her against the risk of loss of her property. INTRODUCTION Hurricane Laura made landfall near Lake Charles, Louisiana then Hurricane Delta made landfall near Lake Charles, Louisiana. During the relevant time period, Plaintiff Bridget Butler owned property in Monroe, Louisiana. An entity of State Farm provided a policy of insurance to Plaintiff. Plaintiff alleged that Defendant failed to timely and adequately compensate Plaintiff for her substantial losses pursuant to the Policy. In turn, Plaintiff filed suit against State Farm Auto, State Farm General, and State Farm Fire and Casualty Company (“State Farm Fire and Casualty”) claiming liability for damages for breach of contract plus general damages and for statutory violations and penalties under Louisiana Revised Statutes. State Farm General and State Farm Auto moved for dismissal of the claims against them. Plaintiff filed no response to the motion. RULE 12(b)(6) STANDARD Rule 12(b)(6) allows for dismissal when a plaintiff “fail[s] to state a claim upon which relief can be granted.” LAW AND ANALYSIS The Complaint alleges that the “Defendant” issued and maintained a Policy insuring Plaintiff's Property. The Complaint does not provide a specific policy number, and the Complaint asserts a policy number was unable to be identified because “Defendant” did not comply with Plaintiff's request for production of the policy number. Attached to their Motion to Dismiss State Farm General and State Farm Auto put forth an insurance policy with the policy number 99-CC-X642-7, and both companies assert that the attached policy is the Policy referenced in the Complaint. The attached policy is from State Farm Fire and Casualty and names Plaintiff as insured and the Property as the location of premises insured with a policy period of twelve months beginning August 25, 2020. State Farm General and State Farm Auto are not listed as parties in the attached policy. Additionally, both State Farm General and State Farm Auto maintain that neither entity has issued a policy to Plaintiff. Under Louisiana law, no action for breach of contract may lie in the absence of privity of contract between the parties. State Farm General and State Farm Auto are not parties to the attached policy, and each assert it did not provide Plaintiff with any insurance coverage. Therefore, neither State Farm General nor State Farm Auto are in privity of contract with the Plaintiff. According to the attached policy, Plaintiff is only in privity of contract with State Farm Fire and Casualty. CONCLUSION Defendants State Farm General Insurance Company and State Farm Automobile Insurance Company's Motion to Dismiss was granted. Plaintiff maintains claims against State Farm Fire and Casualty Insurance Company. ZALMA OPINION There should be no excuse for a plaintiff to require the State Farm entities that did not insure Ms. Butler to move the court for dismissal. A telephone call from defense counsel to plaintiff's counsel informing Ms. Butler of the proper defendant and voluntarily dismiss the wrong State Farm entities. The decision of the court was easy but Judge Cain has more important things to do than deal with an unnecessary motion. Sanctions against Plaintiff's attorney could have been warranted. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Settlement Based on Mutual Mistake Must be Rescinded People with a claim against an estate entered into a settlement agreement to resolve a claim against the estate regarding life insurance coverage that the decedent was required under a divorce decree to maintain for the benefit of the children of the broken marriage. Subsequently, the parties jointly petitioned the county court for Douglas County, Nebraska, for a declaration of their rights and obligations under the agreement. The county court reformed the agreement to be fair to all. The ex-wife appealed. In In re Estate of Jordon R. Wiggins, deceased et a., No. S-22-543, 314 Neb. 565, Supreme Court of Nebraska (June 23, 2023) the Supreme Court of Nebraska resolved the dispute in a Solomon-like fashion. BACKGROUND Jordon R. Wiggins died on August 28, 2019. Prior to his death, Jordon executed a will, which established the Jordon R. Wiggins Family Trust (the Trust) for his children's benefit. Jordon's father, Robert Wiggins, was appointed personal representative of Jordon's estate on October 17, 2019. Jordon was previously married to Allison Hardy, and two minor children, Elizabeth Wiggins and Leah Wiggins, were born to them during the marriage. The divorce decree required Jordon and Allison each to "maintain a life insurance policy" of at least $250,000 "to provide for the minor children" if Jordon or Allison died. On December 20, 2019, Allison brought a claim for $250,000 plus interest against the estate on the children's behalf, alleging that the personal representative had not yet identified any life insurance policy maintained by Jordon for the children's benefit. However, after the claim was brought, Jordon's former employer informed Jordon's brother, Jason Wiggins, that Jason was the sole beneficiary of Jordon's two employer-provided life insurance policies, valued at $360,000 total. The Settlement Subsequently, Jason, as an interested party; Allison, on behalf of the minor children; and Robert, as personal representative, agreed to settle Allison's claim against the estate. The settlement agreement began by acknowledging that "to the best of the [p]arties' knowledge," Jordon had not designated the children as beneficiaries of a life insurance policy of at least $250,000. The agreement then called for Jason to "gift" $250,000 of the insurance proceeds that he received to the Trust, whereupon Allison would withdraw the claim. However, after they entered the settlement agreement, the parties learned that Jordon's daughter Elizabeth was actually the beneficiary of one of Jordon's life insurance policies, while Jason was the beneficiary of the other policy. Thereafter, the insurer paid $120,000 "directly" to Elizabeth; this money was not placed in the Trust. The insurer also paid $240,000 to Jason, who then paid $130,000 into the Trust and retained $110,000. Allison took issue with Jason's action, arguing that he was required under the divorce decree, the settlement agreement, and Nebraska law to pay the entire $240,000 into the Trust for the children. The Validity of the Settlement At the hearing on the motion for declaratory judgment, Jason argued that the settlement agreement should be rescinded on various grounds, including the parties' mutual mistake as to Jordon's life insurance coverage. Alternatively, Jason argued that the agreement should be reformed due to this mutual mistake. Allison countered that there was no basis for reformation or rescission because the agreement in its written form correctly expressed the parties' intent at the time they entered the agreement and Jason assumed the risk of mistake. The county court ruled in Jason's favor. The county court ordered that the $130,000 that Jason paid into the Trust satisfied his obligation under the settlement agreement, because he was entitled to a credit of $120,000 for the life insurance proceeds that Elizabeth received. Believing that this $120,000 had been placed in the Trust, the county court also ordered that the $250,000 received into the Trust for the children's benefit satisfied the claim against the estate. It ordered that the settlement agreement be reformed accordingly. ANALYSIS Allison argued that the settlement agreement should be enforced against Jason because the agreement as written accurately reflects the parties' intent at the time they signed the agreement. A settlement agreement is subject to the general principles of contract law. Rescission, in contrast to reformation, may be granted where the parties have apparently entered into a contract evidenced by a writing, but owing to a mistake, their minds did not meet as to all the essential elements of the transaction, so that no real contract was made by them. Generally, grounds for cancellation or rescission of a contract include fraud, duress, unilateral or mutual mistake, and inadequacy of consideration. When used in reference to rescission, however, the term "mutual mistake" is not limited to a mistake in drafting the instrument. Specifically, for purposes of rescission, a mutual mistake of fact must relate to either a present or past fact or facts that are material to the contract, and not to an opinion as to future conditions as the result of present known facts. The situation is different as to rescission. Here, the evidence clearly and convincingly showed that the parties were mutually mistaken as to a fact which was a material inducement for the contract. Specifically, their mutual mistake of fact was their belief that Jordon failed to maintain any life insurance for the benefit of the children and instead named Jason as the sole beneficiary. On its face, the settlement agreement calls for Jason to pay money that he did not receive from the life insurance proceeds. It does not seem just and fair to require Jason to pay an additional $110,000-which would result in a total of $360,000 in life insurance proceeds' being available to the children-where the divorce decree contemplated a minimum of $250,000 in life insurance proceeds, Elizabeth received $120,000 of life insurance proceeds directly from the insurer, and Jason has already paid $130,000 into the Trust, which is available to both Elizabeth and Leah. The purpose of rescission is to place the parties in a status quo, that is, return the parties to their position which existed before the rescinded contract. A mutual mistake as to the existence of a fact that was a material inducement to the contract is not ground for reformation, although it may be ground for rescission. Accordingly, the Supreme Court reversed the judgment of the county court and remand the cause with directions for the county court to rescind the settlement agreement and conduct further proceedings not inconsistent with this opinion. ZALMA OPINION The most difficult problem raised by the need for life insurance after a divorce is what to do when the spouse required to carry life insurance for the benefit of the children of the broken marriage is enforcement. It would be simple to buy the insurance, name the children as beneficiaries and provide copies of the policy to the divorced spouse and/or the children. In this case, communications failed and the parties tried to be fair with to little information. Rescission was the appropriate resolution because the settlement was reached based on false information resulting in an unfair result. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Guilty Pleas Support to Crimes Against Family & Friends Deserves Consecutive Sentences Jon Settlemire ("Settlemire"), appealed the judgment of sentence imposing consecutive sentences only to find an appeals court with no mercy. When the Marion County Grand Jury returned a 45-count indictment charging Settlemire with a variety of felony-level crimes Settlemire entered a plea of not guilty to the indictment. After pre-trial proceedings Settlemire entered a negotiated plea of guilty to five crimes. In State Of Ohio v. Jon M. Settlemire, 2023-Ohio-1852, No. 9-22-33, Court of Appeals of Ohio (June 5, 2023) Settlemire pled guilty to a charge of Theft in violation, a fourth-degree felony; a charge of Forgery, a fifth-degree felony; a charge of Forgery in violation of, a fifth-degree felony; a charge of Theft, a fourth-degree felony; and amended to a charge of Forgery a third-degree felony. In exchange for the guilty plea the prosecution dismissed the remaining counts of the indictment. On April 28, 2022, a sentencing hearing was held. At that time, the trial court imposed a sentence and that all counts be served consecutively, for an aggregate sentence of 86 months in prison. THE CLAIMED ERROR In the sole assignment of error, Settlemire argueD that the trial court erred in ordering that the sentences in this case be served consecutively. Specifically, Settlemire assertd that the aggregate sentence here is disproportionate and overly severe when compared to the criminal conduct of which he was convicted. If multiple prison terms are imposed on an offender for convictions of multiple offenses, the court may require the offender to serve the prison terms consecutively if the court finds that the consecutive service is necessary to protect the public from future crime or to punish the offender and that consecutive sentences are not disproportionate to the seriousness of the offender's conduct and to the danger the offender poses to the public. In State v. Gwynne,___ Ohio St.3d ___, 2022-Ohio-4607, the Supreme Court of Ohio noted that defendants may appeal consecutive sentences, and that a statute states that an appellate court may increase, reduce, or otherwise modify a sentence or that it may vacate the sentence and remand the case for resentencing when it clearly and convincingly finds that the record does not support the sentencing courts decision. The appellate court’s review of Settlemire's sentences reflects that the trial court made the requisite consecutive-sentence findings pursuant to the statute at the sentencing hearing and incorporated those findings into the judgment entry of sentencing. The trial court noted when imposing sentence, and as confirmed by the record, Settlemire's multiple crimes of Theft and Forgery resulted in a loss of nearly $50,000.00 to the various victims, and the multiple victims in this case suffered serious economic harm. Settlemire's relationship with the victims facilitated the offenses, with one of those victims being Settlemire's elderly mother. Finally, as the trial court noted, Settlemire was initially charged with 45 felony counts in this case, and a sentencing court may consider charges that have been dismissed or reduced pursuant to a plea agreement. The number of consecutive sentences and the aggregate sentence here were not disproportionate or overly severe when compared to the criminal conduct of which Settlemire was found guilty. Having found no error prejudicial to the defendant-appellant in the particulars assigned and argued, the judgment of the Marion County Court of Common Pleas s affirmed. ZALMA OPINION Bad people who are convicted of multiple crimes deserve punishment. No fraud perpetrator is more deserving of punishment than a man who defrauds his elderly mother and relatives. The Ohio court properly sentenced Settlemire to spend the next 86 months in an Ohio State prison. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Even Clear Language in Policy Can be Ambiguous AI Collection of Facial Recognition Images Violates Illinois Statute After Wynndalco Enterprises, LLC was sued in two putative class actions for violating the Illinois Biometric Information Privacy Act ("BIPA") its business liability insurer, Citizens Insurance Company of America sued seeking a declaration that it has no obligation under the terms of the insurance contract to indemnify Wynndalco for the BIPA violations or to supply Wynndalco with a defense. The district court entered judgment on the pleadings for Wynndalco, finding that the language of the catch-all exclusion is ambiguous on its face and that, construing that ambiguity in favor of the insured, Citizens consequently had a duty to defend Wynndalco. In Citizens Insurance Company of America v. Wynndalco Enterprises, LLC, et al., No. 22-2313, United States Court of Appeals, Seventh Circuit (June 15, 2023) the litigation arose from a massive database of facial-image scans assembled by Clearview AI, an artificial intelligence firm that specializes in facial recognition software. Clearview AI allegedly extracted in excess of three billion photographs of individuals from online social media; converted those images into biometric facial recognition identifiers using proprietary algorithms; collected the original images and their biometric counterparts into its database; and paired those images with information as to where those images were found on the Internet. Clearview AI has also created a facial recognition application or "app" that allows a user to identify an individual by uploading a photograph of that person to the app. The app then allows the user to see other photographs of that same person on the media platforms or websites where they appear, along with the identifying information (including their name, address, and other personal information) associated with that individual. Both suits allege that Wynndalco's role in this transaction ran afoul of BIPA. Illinois became the first state in the nation to enact biometric data privacy legislation when it promulgated BIPA. Broadly speaking, BIPA codifies an individual's right of privacy in and control over his or her biometric identifiers and biometric information. At the time of the sale of the Clearview AI app to the Chicago Police Department, Wynndalco had business owner's insurance coverage through a policy issued to it by Citizens. Section II of the policy sets forth the liability coverage for the business. Citizens contends that coverage of the class action claims is barred by a catch-all provision in a policy exclusion barring coverage for injuries arising out of certain statutory violations. The catch-all exclusion provided: “Any other laws, statutes, ordinances, or regulations, that address, prohibit or limit the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information.” Illinois regards the proper interpretation of an insurance policy as a question of law. Policy terms that purport to limit the insurance company's liability are construed in favor of coverage, but only when the terms are ambiguous or susceptible to more than one reasonable interpretation. In some instances, the language of a policy exclusion may appear clear in isolation, but when compared with a separate policy provision granting coverage for the same type of action or injury that the exclusion ostensibly reaches, an ambiguity arises, in that the exclusion appears to take away with one hand coverage that the policy purports to give with the other. Because the aim of policy interpretation is to give effect to all provisions of the policy and avoid whenever possible construing one provision in a way that tends to nullify another provision, a court when confronted with such an ambiguity must consider whether the reach of the "swallowing" exclusion can be deemed narrower than its plain terms taken in isolation would otherwise suggest. There was no dispute that a literal, plain-text reading of the catch-all provision would include BIPA violations. The text does not seem particularly ambiguous. Quite the opposite, it seems clear as a bell- and the clear message is that the provision sweeps broadly. The text is undoubtedly broad. The Seventh Circuit agreed with Wynndalco that the catch-all provision of the exclusion is ambiguous. A plain-text reading of that provision would swallow a substantial portion of the coverage that the policy otherwise explicitly purports to provide in defining a covered "personal or advertising injury," and arguably all of the coverage for certain categories of wrongs-copyright infringement, to take one example- that are entirely statutory in nature. On a plain text reading, the catch-all provision has an extremely broad sweep-so broad, in fact, that the exclusion on its face would eliminate coverage for a number of statutory injuries expressly included in the definition of "personal and advertising injur[ies]" that the policy purports to cover. This clash between competing provisions of the policy gives rise to the Seventh Circuit concluding there is an ambiguity in the insurance contract language and that catch-all provision is "intractably ambiguous." Applying yet another well-established canon the ambiguity must be construed against Citizens and in favor of the insured. As the catch-all provision says nothing about injuries arising from statutes regulating privacy interests, and "[o]ral or written publication, in any manner, of material that violates a person's right of privacy" is covered the Seventh Circuit concluded that the injuries alleged complaints at least potentially fall within the coverage of the Citizens policy. The Seventh Circuit concluded that Citizens thus owes its insured, Wynndalco, a duty to defend it against those complaints. ZALMA OPINION Exclusions in policies exist to limit the coverages provided by the insuring agreement and cause it to provide less coverage than an unlimited insuring agreement. Since people are entitled to enter into any contract that the insurer is willing to offer and the insured is willing to accept, the court will usually not rewrite the contract. There was no question that the "catch-all" exclusion was clear and unambiguous but the District Court and the Seventh Circuit created an ambiguity because the exclusion limited the effect of the insuring agreements. In this case the Seventh Circuit rewrote the policy and provided the insured more coverage than was provided by the policy. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

No Restitution from Defrauded Insurer Esurance Property & Casualty Insurance Company (Esurance) appealed the trial court's order granting summary disposition in favor of Nationwide Mutual Fire Insurance Company (Nationwide), and denying Esurance's request for summary disposition. In Nationwide Mutual Fire Insurance Company v. Esurance Property & Casualty Insurance Company, and Derek Allen Gregory and Blair Gregory, No. 361298, Court of Appeals of Michigan (June 15, 2023) Esurance alleged its insured defrauded it when it acquired the policy and it was entitled to rescind the policy regardless of the trial court's balancing the equities. PERTINENT FACTS In 2015, Derek Gregory (Derek) was driving a truck insured by Esurance and co-owned with his wife, Blair Gregory (Blair). The truck collided with Daniel Moore (Moore), who was riding a bicycle. Moore was injured in the accident. Moore was uninsured, and his claim for personal protection insurance ("PIP") benefits was assigned to Nationwide via the Michigan Automobile Insurance Placement Facility (MAIPF). Nationwide paid a total of $454,871.09 in medical expenses on behalf of Moore. Nationwide subsequently filed this lawsuit against Moore and Esurance seeking to recover the PIP benefits it paid on Moore's behalf. Nationwide alleged that Esurance, as the insurer of the truck was in a higher priority position and was required to reimburse Nationwide. The Bases for Rescission Esurance subsequently filed a third-party complaint against Nationwide and the Gregorys, alleging that Blair had failed to disclose several material facts in her application for the insurance policy, including that she was married, that Derek occasionally drove the truck, that Derek had been in prior accidents involving alcohol, that Blair had been involved in prior accidents, and that Blair had filed prior claims with other insurance providers. Esurance argued that Blair's misrepresentations in her insurance application constituted fraud, warranted rescission of the policy, and prohibited Nationwide from recovering from Esurance as a higher-priority insurer. After a hearing on Nationwide's motion, the trial court issued a written opinion granting summary disposition in favor of Nationwide. The trial court noted that rescission is not automatically applicable in the face of fraud. The trial court held that Esurance had failed to show that rescission was warranted, and that Nationwide could stand in Moore's shoes and recover from Esurance on the basis of equitable subrogation RESCISSION Esurance argued that the trial court erred by granting summary disposition in Nationwide's favor. Specifically, Esurance contended that the trial court abused its discretion in concluding that the balance of the equities weighed against rescission. Equitable subrogation is a flexible, elastic doctrine of equity that is decided on a case-by-case basis. Equitable subrogation is the mode which equity adopts to compel the ultimate payment of a debt by one who in justice, equity, and good conscience ought to pay it. The Michigan Supreme Court has held that the plain language of the no-fault act does not preclude or otherwise limit an insurer's ability to rescind a policy on the basis of fraud. Although PIP benefits are mandated by statute, the no-fault act neither prohibits an insurer from invoking the common-law defense of fraud nor limits or narrows the remedy of rescission. However, the presence of fraud by the insured does not automatically entitle an insured to rescission. When innocent parties are affected, rescission is left to the trial court's discretion. Rescission should not be granted in cases where the result thus obtained would be unjust or inequitable or in cases where the circumstances of the challenged transaction make rescission infeasible. There is no dispute that Esurance is an innocent insurer, and that Moore is an innocent third party. Caselaw clearly demonstrates that the equities must be balanced between the injured person and the party seeking rescission. The Michigan Supreme Court already rejected Esurance's arguments and held that such insurers may be reimbursed via equitable subrogation for PIP benefits paid on behalf of an uninsured person. There was no evidence presented demonstrating that Esurance knew about this fraud before Moore was injured, and there was no showing of how Esurance could have been more diligent in reviewing the insurance application or in detecting the fraud. A determination of whether policy enforcement only serves to relieve the fraudulent insured of what would otherwise be the fraudulent insured's personal liability to the innocent third party. In totality, the court of appeal concluded that the trial court abused its discretion by holding that Esurance had failed to show that rescission was warranted. The ultimate issue in innocent-third-party cases is which innocent party should bear the ultimate burden of the insured's fraud. In this case, Moore has already recovered benefits from an alternate source, and rescission will have no effect on that coverage. In other words, if the policy is rescinded, neither Esurance nor Moore would, in practical terms, bear the burden of Blair's fraud. Under these circumstances, the trial court's decision to deny rescission fell outside the range of principled outcomes. The trial court was ordered to enter an order granting summary disposition in favor of Esurance. ZALMA OPINION No one should profit from fraud. Not even an innocent insurer that paid benefits under a no-fault insurance scheme since it would have had to pay even if there was no insurance on the other side. Esurance was entitled to rescind because it would never have insured the Gregorys but for the fraud in the inception. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Notice-Prejudice Rule Does not Apply to Claims Made and Reported Policy The Kentucky Supreme Court was asked to determine if the claims-made-and-reported management liability policy ("Policy") Allied World Specialty Insurance Company ("Allied World"), issued to Kentucky State University ("KSU") provided coverage because KSU did not comply with the Policy's notice provisions. The trial court applied the notice prejudice rule and the Court of Appeal reversed and the case was brought to the Kentucky Supreme Court in Kentucky State University v. Darwin National Assurance Company N/K/A Allied World Specialty Insurance Company, No. 2021-SC-0130-DG, Supreme Court of Kentucky (June 15, 2023) FACTS The Policy KSU purchased from Allied World was for the period from July 1, 2014 to July 1, 2015. The Policy allows claims made against KSU within the policy period to be reported to Allied World up to ninety days after the end of the policy period. The Policy expired July 1, 2015, and the 90-day extended reporting period ended September 29, 2015. During the policy period two professors submitted Notices of Charges of Discrimination to the United States Equal Employment Opportunity Commission ("EEOC") and Kentucky Commission on Human Rights (collectively, "EEOC Charges") related to their employment at KSU. KSU received written notice of the EEOC Charges on June 23, 2015. On September 2, 2015, the professors brought employment-related claims against KSU in Franklin Circuit Court, the substance of which would be covered under the Policy. On October 2, 2015, three days after the extended reporting period expired, KSU notified Allied World who denied coverage. KSU eventually sued Allied World and both moved for summary judgment. The circuit court granted summary judgment in favor of KSU. The circuit court concluded that the notice-prejudice doctrine applied. The Court of Appeals disagreed and held that the terms of the Policy are clear about the extended reporting period. The Court of Appeals determined that the notice-prejudice rule does not apply to the Policy in this case. ANALYSIS The primary issue before the Supreme Court was whether the circuit court properly interpreted the notice provisions within the claims-made-and-reported insurance policy issued by Allied World to KSU and then, based upon that interpretation, correctly assessed the role, if any, that the notice-prejudice rule plays in this case. Construction and Interpretation of Contracts. In the absence of ambiguity, a written instrument will be enforced strictly according to its terms, and a court will interpret the contract's terms by assigning language its ordinary meaning and without resort to extrinsic evidence THE POLICY. The Policy provisions which explain the insurer's coverage obligations in relation to the insured's reporting obligations and which present the notice requirements are found in three clauses all of which require notice no later than ninety days after the end of the policy period. Furthermore, with regard to reporting beyond the policy period, the Policy also provided KSU the right to purchase a Discovery Period after the expiration of the Policy. KSU did not purchase Discovery Period coverage. THE NOTICE-PREJUDICE RULE. The Policy expressly informed KSU that a condition of coverage - a condition precedent - was giving written notice of a claim as soon as practicable, but in no event was such notice of any claim to be provided to Allied World later than ninety days after the end of the Policy period. Since KSU did not purchase Discovery Period coverage, so the reporting period did not extend beyond the 90-day reporting period, the Policy clearly defined when notice was due and the consequences if notice is late. The Policy unambiguously informed KSU that if the notice provisions were not met, Allied World had no obligation to KSU under the Policy. Unlike the circuit court, the Supreme Court concluded that the Policy provisions at issue are unambiguous. Given the plain terms of the contract, their full force and effect does not equate to creating a windfall for the insurer. In the absence of circumstances justifying relief, courts do not make contracts different from those that the parties make for themselves, even when forfeiture provisions are harsh. Application of the Notice-Prejudice Rule to Claims-Made-and-Reported Policies. The Supreme Court concluded: "A claims-made-and-reported policy provides coverage only for claims made against the insured and reported to the insurer during the life of the policy regardless of when the underlying incident occurred. Timely notice of a claim is the event that not only triggers coverage, but also defines its scope." An occurrence-based policy is different. The Supreme Court concluded that Allied World was entitled to deny coverage to KSU when KSU did not comply with the notice requirements. ZALMA OPINION The claims made and reported liability insurance policy was designed to avoid long-term liability exposure faced by an "occurrence" policy and to avoid the insured's ability to extend reporting requirements by use of the notice-prejudice rule that allowed a late report as long as the insurer was not prejudiced by the delay. In this case a three day delay would not cause prejudice to the insurer but breached the clear and unambiguous condition precedent to coverage. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Appeal Back to District Court on Coverage Claim by Injured Jacob E. Godlove, Sr., and Kayla Kelley, on behalf of themselves and the Estate of Jacob Godlove, Jr., (collectively, Appellants), appealed to the District Court's order denying their motion to intervene in an insurance-coverage dispute. In County Hall Insurance Company, Inc. v. Mountain View Transportation, LLC; John R. Humes, Jacob E. Godlove; Kayla Kelley; Estate Of Jacob Godlove, Jr., No. 22-2397, United States Court of Appeals, Third Circuit (June 16, 2023) the Third Circuit deal with changed circumstances. FACTS Godlove and Kelley, who was pregnant at the time with Godlove, Jr., were in a motor-vehicle accident with a tractor-trailer owned by Mountain View Transportation, LLC and driven by John R. Humes. Godlove and Kelley, on behalf of themselves and the Estate, sued Mountain View and Humes in state court for the resulting injuries, including the death of Godlove, Jr., which occurred two months after the accident. Mountain View's insurer, County Hall Insurance Company, Inc., claimed its insurance policy did not cover the accident because Humes was not listed on the relevant schedule of drivers. The letter also informed Mountain View that County Hall would defend the state-court tort action under a reservation of rights. County Hall filed a federal court case against Mountain View and Humes, seeking a declaration that the policy did not cover the accident. After Mountain View and Humes failed to respond, the Clerk of Court entered a default against them at County Hall's request. After Appellants filed the state-court declaratory judgment action, County Hall moved the District Court for a default judgment in this federal action. The same day, Appellants moved to intervene in this action and to strike the entry of default. The District Court denied the motion to intervene and the motion to strike. During the pendency of the appeal, Appellants settled the underlying state-court tort suit against Mountain View and Humes, who were represented by counsel under County Hall's reservation of rights. Appellants obtained a $1,000,000 judgment against Mountain View and Humes and an assignment of rights under any insurance policies. Soon after, Appellants again sought a declaration in state court that the insurance policy covered the accident-this time standing in the shoes of Mountain View and Humes. That action remains pending. When the District Court entered its order denying the motion to intervene, Appellants were only "plaintiffs who ha[d] asserted tort claims against the insured." In the District Court's words, they were "strangers to [the] insurance contract." That is no longer so. ANALYSIS First, Appellants now have a judgment against Mountain View and Humes. Second, they have a purported assignment of rights under Mountain View's insurance policy and have sued County Hall in state court on that basis. The Third Circuit concluded that since the District Court might reach a different conclusion on the motion to intervene in view of the changed circumstances; or the purported assignment of rights might require or permit party substitution of the Federal Rules of Civil Procedure; and because no declaratory judgment has been entered it might be appropriate for the District Court to stay this action pending resolution of the state-court declaratory judgment action. The Third Circuit, therefore exercised judicial restraint and refused to express any view on the propriety of the stated possibilities. For that reason the Third Circuit decided to avoid making a decision and allow the District Court to evaluate the changed circumstances in the first instance. Consistent with that principle, the Third Circuit vacated the District Court's order and remanded the case back to the District Court for further proceedings. ZALMA OPINION When facts change after a ruling by a district court on an insurance coverage issue it is inappropriate for an appellate court to stomp on the jurisdiction of a trial court. Noting that the changed facts could have resulted in multiple different resolutions the Third Circuit exercised required judicial restraint and required to trial court to decide the issues by taking into consideration the changed facts exercising the wisdom accorded to King Solomon. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library

For Want of $78 a Wife's Injuries Go Uncompensated Plaintiff Eric Levy sought a declaration that defendant New York Central Mutual Fire Insurance Company (New York Central) is obligated to provide plaintiff with coverage, defense, and indemnification for an August 29, 2021 car accident where he negligently injured his wife. New York Central moved for an order granting summary judgment dismissing plaintiff's complaint and for a declaratory judgment declaring that it is not obligated to provide plaintiff with a defense or indemnification for the motor vehicle accident that is alleged to have occurred onAugust 29, 2021, as no Supplemental Spousal Liability coverage exists for this claim. In Eric Levy v. New York Central Mutual Fire Insurance Company, Index No. 66227/2021, 2023 NY Slip Op 23183, the New York Court found in favor of the insurer. FACTUAL AND RELEVANT PROCEDURAL BACKGROUND On August 29, 2021, while driving his car, plaintiff accidentally struck his wife Lisa Grauer (Grauer), and Grauer allegedly suffered serious including a fracture. At the time of the accident, plaintiff had an active motor-vehicle insurance policy through New York Central with bodily-injury liability limits of $250,000.00 per person injured. Grauer filed a claim against plaintiff to New York Central, alleging that she was injured as a result of plaintiff's negligence. Plaintiff alleged that New York Central is liable for breach of contract in the amount of $250,000.00 for failing to provide plaintiff with coverage, a defense and indemnification. Plaintiff moved for summary judgment on his amended complaint and is requesting a declaratory judgment, as set forth in the first cause of action. Plaintiff submitted an affidavit, describing the events that transpired and alleges that he was not provided with proper notice of SSL coverage. New York Central avered that no SLL coverage exists for plaintiff's policy, that it did comply with all notification requirements, and that plaintiff declined to purchase SLL coverage. New York Central issued a revised renewal policy adding an additional vehicle and included an SSL endorsement. The additional premium for the SSL coverage was $78.00 and plaintiff declined to purchase it. Supplemental spousal liability insurance provides bodily injury liability coverage under a motor vehicle insurance policy to cover the liability of an insured spouse because of the death of or injury to his or her spouse, even where the injured spouse must prove the culpable conduct of the insured spouse. DISCUSSION Insurance Law § 3420 (g) was amended by Chapter 584 of the Laws of 2002, to require insurance carriers to offer their insureds supplemental spousal liability (SSL) insurance for an additional premium. This SSL coverage provides drivers with the option to be insured in cases where their negligence causes death or injury to their spouse. Both parties present the insurance policy in support of their summary judgment motions and do not dispute the contents. The Court found that New York Central has made prima facie showing it is not obligated to provide plaintiff with indemnification or a defense for the motor vehicle accident occurring on August 29, 2021, because no SSL liability existed for this claim. Since Plaintiff declined to purchase the SLL an insurer is not required to provide insurance coverage for injuries sustained by an insured's spouse. It was undisputed that plaintiff did receive notification of the availability of the supplementary spousal liability insurance, and he refused to pay the extra $78 premium. Accordingly, it was ordered that plaintiff Eric Levy's motion was denied it its entirety. New York Central Mutual Fire Insurance Company's cross motion for an order granting summary judgment dismissing plaintiff's complaint and for a declaratory judgment, is granted; and it was further ordered that defendant New York Central, because, as no Supplemental Spousal Liability coverage existed; and it was further ordered that the case was dismissed, and the Clerk was directed to enter judgment accordingly. ZALMA OPINION Insurers do not like, because of the potential for fraud, to insure against injury to a family member of the insured. New York passed a law requiring insurers to provide coverage for injury caused to a spouse as long as the insured pays an additional premium. Mr. Levy refused to pay the extra $78 and, by so doing, refused the coverage that only after the accident he wanted. No luck since he got the offer and the charge and refused it. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Failure of Proposed Insured Stay Alive Until Policy Delivered Costs Fiance Almost $5 Million On January 27, 2021, Dr. Travis Richardson completed an application for an individual life insurance policy with Pacific Life seeking $4,816,949.00 in coverage. Blevins was Dr. Richardson's fiancé and was listed as the primary beneficiary of the policy. Lamar Breshears was the insurance agent for Pacific Life. Champion Agency (“Champion”) handled details. Dr. Richardson died unexpectedly before the policy was delivered and the insurer refused to pay. In Pacific Life Insurance Company v. Katie Blevins, No. 3:21-CV-00143 JM, United States District Court, E.D. Arkansas, Northern Division (June 15, 2023} the USDC resolved the claim of the beneficiary. FACTS On February 1, 2021, Champion transmitted Dr. Richardson's application to Pacific Life with the instructions to process the application and to mail the policy to Champion at its office in Albuquerque, New Mexico. Pacific Life received Dr. Richardson's application on February 2, 2021. On March 11, 2021, Pacific Life's underwriting department approved Dr. Richardson for Policy and the initial monthly premium of $16,668.68 was paid. The same day that the policy was approved, Pacific Life uploaded an electronic copy of the policy to its Planned Performance Tracking portal (the “PPT portal”). On March 12, 2021, Dr. Richardson emailed Breshears and asked him when the policy was active. Breshears responded the same day, stating, “Today. If you were to die today, the policy would pay out a death benefit.” Breshears was wrong because Dr. Richardson died unexpectedly on March 14, 2021. The physical policy was received by Champion March 15, 2021. Pacific Life refunded the initial premium payment on March 25, 2021, taking the position that the policy was not “in force” at the time of Dr. Richardson's death because it had not been “delivered” as required by the application and policy. ANALYSIS It was undisputed that delivery of the policy was a valid condition precedent to Blevins being entitled to receive payment under the policy. The application states that: “[c]overage will take effect when the Policy is delivered and the entire first premium is paid only if at that time each Proposed Insured is alive, and all answers in this Application are still true and complete.” (emphasis added.). The policy, which incorporates the application, states that a Policy is in effect and provides a Death Benefit on the Insured on the date the Policy and associated riders become effective. The Policy Date for this policy was March 11, 2021 a date before Dr. Richardson died. Pacific Life claimed that delivery of the policy required Dr. Richardson to have received and accepted a physical copy of the policy. It is undisputed that this did not happen, and Pacific Life sought summary judgment. The Court found that there were no material facts in dispute and agreed that the policy was not delivered. The fact that the challenged terms are not defined does not make them vague and ambiguous. Importantly, the USDC noted that the policy must be read as a whole, and effect given to all provisions. Construction that neutralizes any provision of a contract should never be adopted if the contract can be construed to give effect to all provisions. The policy in question unambiguously state that it is in force (defined as meaning in effect and paying death benefits), “subject to your acceptance of the delivered policy and payment of the initial premium.” (emphasis added). While the term “policy date” clearly was confusing even to Breshears, it did not neutralize the delivery and acceptance requirements. In addition to the delivery requirement, the application stated that coverage under the policy would take effect when it was delivered “only if at that time” the proposed insured was alive and “all answers in this Application are still true and complete." Under Arkansas law, “if the policy was mailed [to the agent] unconditionally for the sole purpose of delivery to the assured,” the mailing of the policy from the insurance company to the agent would constitute constructive delivery. The burden of proof to show that the policy was unconditionally delivered to the agent for delivery to the insured is on the plaintiff. Breshears testified that he understood delivery of the policy to mean “physically sending the policy to the client,” and that a “hundred percent of his policies have been delivered by paper.” Pacific Life has established that it physically mailed the policy to Champion pursuant to the instructions it received with the transmittal of Dr. Richardson's application. Included with the mailed policy were a delivery receipt and an amendment to the application to correct minor inaccuracies. Blevins did not establish that there is a genuine issue of material fact on the issue of constructive delivery of the policy. Since at that time the outstanding delivery requirements had not been communicated to Breshears or Champion at that time, she argues that those delivery requirements were waived. However, that does not support her claim that the precondition of delivery itself was waived. The Court has no doubt that Dr. Richardson, Breshears, and Blevins believed that Dr. Richardson was covered under the policy as of March 11, 2021. However, Pacific Life's motion for summary judgment was granted. ZALMA OPINION People buy life insurance because they recognize that life is a disease from which all humans suffer. We all, eventually, die. Dr. Richardson wanted to protect his fiance and applied for a life insurance policy that he expected to have for many years only to die before the policy was delivered to him. Insurance policies must be read as a whole. In this case, the policy never came into effect because he was not alive when the policy was delivered. A sad result but on its face a correct decision. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Fictionalized True Insurance Fraud A Story of Life Insurance Fraud This is a fictionalized True Crime Story of Insurance Fraud to explain why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is intended to help you to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the ­­­Perpetrators than any Other Crime. The Hungarian owned and operated a board and care facility for the aging in Carson City, Nevada. He brought his younger brother over from Hungary in 1975 to help him in the business. It was only a twenty-bed facility and with little help, the two could manage the entire business. The oldest brother was the thinker. He got an honorary Ph.D. from the New World Society of Abundant Consciousness that ran a school in the desert just north of Pahrump. After receiving his honorary degree for a donation of $15,000, he insisted on the title doctor. The doctor had no training in any field. He had a high school diploma and had operated several restaurants before buying the board and care facility. He believed that the title conferred on him the right to prescribe medicine, to give psychological advice, and to do anything he pleased. He would get drugs for his patients from other than legitimate sources. He would bill their insurers as if they were prescription drugs prescribed by a staff physician. His younger brother maintained the facility, cooked the meals for the residents, doubled as a nurse and ran the business. The doctor acted like royalty. Since the small business required both to work if it was to make a profit, the business began to deteriorate. Cash flow was minimal. Patient services became almost nonexistent. The doctor skimmed as much money into his pocket as he could and keep the patients alive. Neither he nor his brother drew anything much more than subsistence monies from the business. The dedicated younger brother made the business work. He began to cut personal corners. First, he decided to drop a $100,000 life insurance policy. With the reduced earnings of the business, he could not afford to pay the premium. The doctor, who used the same insurance agent, was told of the intent of the brother to cancel. The doctor asked the agent to keep the policy in effect without his brother’s knowledge. The doctor would pay the premium as a business expense of the board and care facility. The agent, not wishing to lose his commission, agreed and kept the policy in force, accepting premium payments from the doctor. The younger brother suffered from severe hypertension. His controlled the disease by diet and medications. He trusted his older brother. He thought his older brother was wise and knowledgeable. He thought his older brother had, at least, the same level of expertise as any physician and trusted his brother more than a physician. After the doctor had paid the first monthly premium on the life insurance policy, he explained to his brother that the hypertension drugs prescribed for him were dangerous. He told his younger brother that he had in the inventory of the board and care facility drugs that were more effective. Since they were in the stock of the facility the doctor could give them to his brother at no cost. The brother stopped taking his prescribed medicine and started taking the drugs given him by his brother. The doctor did not tell his brother that the drugs contained digitalis. Digitalis is a drug that, although useful in reducing chest pains in people with heart conditions, is poisonous in the amounts the doctor told his brother to take. It is even more poisonous to a person with hypertension. Within two weeks of taking his brother’s drugs, the younger brother was found by his wife apparently dead, on his kitchen floor. Paramedics arrived and immediately began CPR. Because she did not know what to do after calling the paramedics, the wife called her brother-in-law. He arrived at the scene about the same time as the paramedics. He was hysterical and interfered with the paramedics. They had to forcibly remove him from his brother so they could perform CPR. They put the brother in an ambulance and began racing toward the emergency hospital with red lights and siren. The doctor followed and almost sideswiped the ambulance twice. They called for police help on their radio. A Carson City police officer pulled the doctor off to the side of the road and restrained him for sufficient time to allow the ambulance to arrive at the hospital. They could not revive the younger brother. They pronounced him dead one hour after arrival at the hospital. The doctor convinced the wife there should be no autopsy. His brother, her husband, had a severe heart condition that was well documented. He explained that there should be no reason to cut his body to satisfy a local ordinance. The doctor convinced the brother’s family physician to sign the death certificate showing the cause of death as a heart attack. The family physician did so without evidence of such a heart attack. The family physician had not even seen the deceased within six months of his death. The family physician clearly violated the law. He thought the death certificate would help the family who appeared adamantly against the invasive procedures of an autopsy. The widow was not an intelligent woman. She had limited education in her country of birth, Hungary. She could barely read or write the English language and spoke it with a thick accent. She relied totally on her brother-in-law. He handled the disposition of her husband’s estate. She signed whatever papers he put before her. One paper he put in front of her was a claim form making claim on the life insurance policy. The claim form did not use the sister-in-law’s address but, rather, a P.O. box held in secret by the doctor. The insurance company, presented with an appropriate claim form signed by the widow and what appeared to be a proper death certificate, immediately issued its check for $100,000 plus interest, made payable to the widow, the sole beneficiary named in the policy. The doctor received the check. He signed the widow’s name to it and deposited the money in his account. He used the money to pay the debts of the board and care facility and to buy a new home for himself on five acres of desert property outside Carson City. The widow was left with nothing but debts. She sold the home she and her husband lived in since arriving in the U.S. After paying a commission to the realtor and the funeral expenses she had only $1,000 left. Her brother-in-law loaned her $10,000 which she used to buy some secondhand furniture and move into a small apartment. She met a blackjack dealer at a casino and married him so she would have some means of support. The doctor lived in luxury for a year off the proceeds and then began planning his next insurance fraud. He has no other brothers to kill, so he decided to obtain life insurance on the residents of the board and care facility none of whom had a long life expediency. (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

ZIFL - 6-15-2023 - Volume 27, Issue 12 The Source For Insurance Fraud Professionals This, the Twelfth 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: Restitution Order Can’t Be Discharged in Bankruptcy After Frayba Tipton and William Tipton pled guilty to committing insurance fraud, they were ordered to pay victim restitution to Nationwide Insurance Company of America (Nationwide). Nationwide obtained a civil judgment and an award of over $1,200,000 in civil litigation against the Tipton’s only to have the judgment discharged in bankruptcy. Nationwide then petitioned the trial court to convert the criminal restitution orders to civil judgments against both defendants. The trial court granted Nationwide’s petition and entered civil judgments against the defendants. In Nationwide Insurance Company Of America v. Frayba Tipton et al., C095606, California Court of Appeals, Third District, San Joaquin (May 26, 2023) the court agreed that the restitution order could be made collectible as a civil judgment and not subject to discharge in bankruptcy. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf More McClenny Moseley & Associates Issues This is ZIFL’s eighth 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 of the state of Louisiana. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Another Insurer Bites the Dust Nevada Insurance Commissioner Petitions to Place Friday Health in Receivership Friday Health Plans of Nevada has fallen afoul of Nevada Insurance Commissioner Scott Kipper who filed legal action with the Nevada District Court to place it under regulatory supervision. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Bad News from The Public A new survey shows it’s, like, totally cool to exaggerate damages on an insurance claim or, like, totally awesome to say you hurt yourself at work when you didn’t. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Health Insurance Fraud Convictions Fifteen Year Sentence in $134 Million COVID-19 Health Care Fraud and Money Laundering Scheme Billy Joe Taylor, age 44, pleaded guilty to conspiracy to commit health care fraud and money laundering on October 27, 2022. According to court documents, Taylor and his co-conspirators submitted more than $134 million in false and fraudulent claims to Medicare in connection with diagnostic laboratory testing, including urine drug testing and tests for respiratory illnesses during the COVID-19 pandemic, that were medically unnecessary, not ordered by medical providers, and not provided as represented. Taylor and his co-conspirators obtained medical information and private personal information for Medicare beneficiaries, and then misused that confidential information to repeatedly submit claims to Medicare for diagnostic tests. According to court documents, Taylor and his co-conspirators received more than $38 million from Medicare on those fraudulent claims. See the full issue and dozens more convictions at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Florida Judge Slams SFR Contractor for Misrepresentation, Fraud in Tower Hill Case SFR Services, a Florida restoration firm made famous by its volume of claims litigation and its charges that United Property & Casualty Insurance Co. had instructed desk adjusters to alter their estimates, now finds itself in some legal trouble of its own. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Other Insurance Fraud Convictions Man Sentenced to Prison for Staged Arson and Insurance Fraud Denis Vladmirovich Molla falsely reported to the Brooklyn Center Police Department that his camper had been intentionally set on fire the 30-year-old Minnesota resident has been handed a 30-month prison sentence, followed by one year of supervised release, for filing fraudulent insurance claims related to a staged arson incident. See the full issue and more convictions at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf The Baseball Card Scam This is a Fictionalized True Crime Story of Insurance Fraud from my experience as an Insurance Fraud Expert and is provided to explain why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is true, only the names and places were changed to protect the guilty. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Qui Tam and Insurance Fraud The qui tam portion of the California Insurance Frauds Prevention Act, like that in many other states, has a qui tam provision. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf It’s Time to Subscribe to Locals or Substack For Subscribers Only I Have Published Special Insurance Videos See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Umbrella Policy Always Excess Over Primary Policy Two insurance companies argued who must indemnify an insured for a settlement involving their mutual insured. Great American Insurance Company paid subject to a reservation and sued the primary insurer, Allied World Assurance Company, alleging that because it was the umbrella insurer it only owed after Allied World as the primary insurer, paid its limits. The district court agreed, granting summary judgment in Great American's favor. In Great American Insurance Company v. Allied World Assurance Company, Inc., No. 22-12496, United States Court of Appeals, Eleventh Circuit (May 31, 2023) determined who was on first to the obligation to indemnify the insured, Tribridge Residential. After two women were shot and killed at an apartment complex that Tribridge managed an ensuing lawsuit alleged Tribridge negligently failed to implement security. Tribridge settled that suit with plaintiffs. Three different insurance companies insured Tribridge. AmTrust International Underwriters DAC, an insurance company that issued Tribridge a primary commercial general liability policy, paid out its policy limit toward the settlement. Then, Allied World and Great American disagreed about which policy was the priority coverage for the rest of the settlement. ALLIED WORLD POLICY Allied World issued Tribridge a commercial general liability policy. Allied World issued a "primary policy," it contains an excess clause purporting to render its coverage excess of other insurance when liability arises from Tribridge's property management activities. GREAT AMERICAN POLICY Great American issued a "Commercial Umbrella Coverage" policy which includes Tribridge as an additional insured. The policy covers "those sums in excess of the 'Retained Limit' that the 'insured' becomes legally obligated to pay imposed by law or . . . because of 'bodily injury.'" Great American paid the rest of the settlement against Tribridge and sued Allied World, seeking equitable contribution and a declaratory judgment that its coverage obligation is not triggered until Allied World's policy limit is exhausted. ANALYSIS Georgia law delineates between a "primary" insurance policy "written to provide primary coverage"- and an "umbrella" policy- operating as true excess over and above any type of primary insurance. All primary coverage must be exhausted before umbrella policy coverage is triggered. Primary policies precede umbrella policies even when the primary policy includes an applicable "excess clause." Umbrella policies, almost without dispute, are regarded as true excess over and above any type of primary coverage, excess provisions arising in regular policies in any manner, or escape clauses. Primary policies take priority to umbrella policies, even when the primary policy includes an applicable excess clause. Great American's commercial umbrella coverage policy only covers those sums in excess of listed underlying insurance. The Allied World policy is written to provide primary coverage and the Great American policy is the true excess policy. Accordingly, Allied World's primary policy must be exhausted before the Great American umbrella policy applies. In sum, Allied World is first in the pecking order as the "primary insurer." Summary judgment was affirmed for Great American but the court reversed the award of attorney's fees. ZALMA OPINION The great comedians Abbot & Costello created the "Who's on First Routine" that brought laughter to the question of who is in control. In this case a primary insurer, even with an "excess" and/or "escape" clause the primary is always on first and the umbrella only owes after the primary - the insurer on first - pays its limit and then the umbrella, on second base pays whatever is needed after the primary pays its limit. Allied World tried to avoid its obligation, failed, and is required to reimburse Great American. If you found this post to be useful please inform your friends and colleagues so that they can subscribe at https://zalma.com/blog. (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Kona Coffee Must be From the Big Island of Hawaii L &K Coffee claimed its various insurance companies erroneously denied coverage to defend it against a Lanham Act false-advertising lawsuit brought by Hawaiian coffee growers. The district court concluded the applicable insurance policies did not obligate a defense and entered summary judgment in the insurance companies' favor. In L&K Coffee LLC, dba Magnum Roastery; Kevin Kihnke v. LM Insurance Corporation; Liberty Insurance Corporation; Selective Way Insurance Company; Valley Forge Insurance Company; Continental Casualty Company, No. 22-1727, United States Court of Appeals, Sixth Circuit (June 1, 2023) the Sixth Circuit resolved the coverage dispute. FACTS L&K Coffee, LLC, a Michigan-based company, roasts and sells coffee products throughout the United States. Defendants are insurance companies from whom L&K purchased general commercial liability and umbrella insurance policies. Coffee growers from the Kona region of the Island of Hawai'i sued L&K and other coffee companies for "false designation of origin, false advertising, and unfair competition" in violation of the Lanham Act, 15 U.S.C. § 1125(a), in the Western District of Washington. These "Kona Plaintiffs" alleged that the defendants falsely designated the origin of the coffee they branded and distributed as "Kona" coffee "when most of the coffee beans contained in the coffee products were sourced from other regions of the world." The Kona Plaintiffs' operative complaint summarized their contentions as to L&K as follows: "L&K falsely designates the geographic origin of its "Kona" coffee products with the prominent placement of KONA on the front of the packaging." The deceptive marketing was alleged to be designed to mislead consumers into believing that L&K's Magnum Exotics "Kona" products contain coffee from the Kona District, when the coffee products actually do not contain a significant amount of Kona coffee, if any. The plaintiffs also alleged that L&K deliberately misled the consumer into believing that L&K's Magnum Exotics coffee products contain significant amounts of premium Kona coffee beans in order to justify the high price L&K charges for what is actually ordinary commodity coffee. L&K asked the insurance companies to defend and indemnify them in that matter under the policies' "personal and advertising injury" coverage. Personal and advertising injury, in pertinent part, is defined as an "injury . . . arising out of" (1) a publication that "disparages a person's or organization's goods, products or services," or (2) "[i]nfringing upon another's . . . slogan in your advertisement." Based on this language and the Kona Plaintiffs' allegations, the insurance companies denied coverage because, as one insurer put it, "none of the offenses in the definition of 'personal and advertising injury' include false advertising, and none of the allegations in the complaint fall within any of the offenses in the definition." ANALYSIS The duty of an insurance company to provide a defense depends upon the allegations in the complaint and extends to allegations which even arguably come within the policy coverage. An insurer's duty to defend does not depend solely upon the terminology used in a plaintiff's pleadings. Rather, it is necessary to focus on the basis for the injury and not the nomenclature of the underlying claim in order to determine whether coverage exists. The term "disparage" means an untrue statement directed towards another's property. A disparagement claim requires a company to make false, derogatory, or disparaging communications about a competitor's product." (emphasis in the opinion) The Kona Plaintiffs alleged L&K violated the Lanham Act's prohibition on false designation of one's own product. See 15 U.S.C. § 1125(a)(1). The Sixth Circuit concluded that this is not "disparagement." Upon review of the Kona Plaintiffs' complaint, the Sixth Circuit Court agreed with the district court that the complaint does not set forth an arguable theory of recovery. In the Kona Plaintiffs' own words, "only coffee grown on farms located within the Kona District of the Big Island of Hawaii . . . can be truthfully marketed, labeled, and sold as Kona coffee." L&K violated the false designation of its product and that was not a covered cause of loss. ZALMA OPINION It never pays to lie to your customers. When doing so harms someone else you are subject to damages from those your lie harms. By falsely designating its product of "Kona" coffee when L&K claimed its cheap, generic coffee was "Kona" Coffee it was involved in a tort that was not covered by the policies of insurance. (c) 2023 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 and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

"Reside" is not Ambiguous NO COVERAGE FOR INSURED WHO DOES NOT RESIDE IN DWELLING The plaintiffs appealed the dismissal of their suit against Farmers Automobile Insurance Association (Farmers). The plaintiffs were insured by Farmers for a St. Joseph residence that the plaintiff Judy had inherited from her deceased brother. The plaintiffs filed a claim with the company following a fire that destroyed the residence. Farmers denied the claim as the plaintiffs were not occupying the property at the time of the fire and were therefore not covered under the terms of the policy. In Judy Dardar and Ivan Dardar v. Farmers Automobile Insurance Association and Jason Sticklen, Farmers Automobile Insurance Association, No. 5-22-0357, 2023 IL App (5th) 220357-U, Court of Appeals of Illinois, Fifth District (June 2, 2023) the claim of the Dardar's was resolved. BACKGROUND Before he died David Jones, Judy's brother, purchased an insurance policy from Farmers through Sticklen for property and liability insurance coverage for his residence in Champaign County. After David's death Judy was appointed the legal independent representative of his estate. Farmers issued a homeowner's policy amending declarations, which added the decedent's estate and Judy as additional insureds as well as a non-occupancy permit endorsement. Once the estate was closed, and the house was transferred to Judy, she began making renovations to the residence. The plaintiffs were undecided as to whether they were going to live in the house after the renovations were complete or sell it. Then, on July 4, 2018, firework embers from an unidentified source caught the house on fire, and it was destroyed. The plaintiffs never lived in or occupied the home. Judy had no knowledge that the policy was issued without the non-occupancy permit endorsement. Farmers denied the claim on the basis that the policy covered their "residence premises," which was defined as: the one-family dwelling where you reside; the two, three, or four-family dwelling where you reside in at least one of the units; or that part of any other building in which you reside. Farmers determined that the plaintiffs did not reside at the St. Joseph property and therefore were not covered under the policy terms. Judy claimed Sticklen failed to properly inform Farmers of her condition, and Farmers issued a new policy without the non-occupancy permit endorsement. The court found that, based on the facts alleged, there was not a sufficient basis for a breach of contract claim against Farmers and granted Farmers' motion to dismiss. Based on the relevant facts, the plaintiffs could never plead that they ever resided on the St. Joseph property. ANALYSIS The issue on appeal was whether the trial court erred in granting Farmers' motion to dismiss the breach of contract count. A court must construe a policy of insurance as a whole and take into account the type of insurance purchased, the nature of the risks involved, and the overall purpose of the contract. “Reside" is not ambiguous as it is used in the policy contract language between Farmers and the plaintiffs. The record established that the plaintiffs never lived on the property, were not occupying it in any way, and had not decided whether they would move into the home once the renovations were done. The mere fact that because "reside" has more than one definition does not make it ambiguous when, as here, there is no definition of the word that would apply to the plaintiffs. The Court of Appeal, like the trial court, concluded that the term "reside" as used in Farmers' policy s not ambiguous. ZALMA OPINION There is nothing secret or difficult to understand about a policy definition that provides "one-family dwelling where you reside." Since the insured did not reside in the dwelling and never resided in the premises, the unambiguous requirement of coverage was not met. They could easily have acquired a fire insurance policy that insured the plaintiffs, as a non resident, against the risk of loss of the house by fire. Instead they acquired a homeowners policy that required that they reside in the house. They did not and they recovered nothing. (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Losing a Lawsuit is not Evidence of Discrimination David Webb, proceeding pro se, appealed an order dismissing his complaint. Webb was involved in a car accident. He sued a law firm, firm employees, insurance companies, and other entities related to his legal representation, insurance coverage, and the sale of his vehicle after the accident. The District Court dismissed the complaint on the grounds that Webb's claimed lossses were either frivolous or he failed to state a claim upon which relief may be granted. David Q. Webb v. Attorney James P. Hall, et. al., No. 22-3267, United States Court of Appeals, Third Circuit (June 2, 2023) the Third Circuit resolved the dispute. Webb claimed in Counts I and II of his complaint that Phillips, McLaughlin &Hall, P.A. and other defendants discriminated against him based on his race. Webb is black, and he alleges that the defendants refused to provide him the same legal representation, insurance coverage, or access to his vehicle that is afforded to white citizens. However, Webb alleged no supporting facts. He also asserted that the defendants violated his rights under the Fourth and Fourteenth Amendments in connection with the seizure and sale of his vehicle and that he was denied his right to equal protection in the handling of his insurance claims. The District Court dismissed these claims on the ground that the defendants are not state actors, as required for a claim under § 1983. The Third Circuit concluded that Webb has not shown that the District Court erred in dismissing these claims. The District Court also dismissed Webb's state law claim for legal malpractice against James Hall (Count VI). Webb alleges that Hall did not convey a settlement offer by National General Insurance Company to him. To the extent the District Court required Webb to aver that an underlying suit against the insurer would have been successful but for Hall's negligence the loss of a judgment is not the only way to show resulting loss. Webb also claimed intentional infliction of emotional distress by Hall, who allegedly refused to confirm that he had conveyed Webb's settlement demand to certain insurers and lied about not receiving an offer from National General Insurance Company. Webb also claimed that defendant Copart, Incorporated intentionally inflicted emotional distress by unlawfully seizing and selling his vehicle after the accident. Webb failed to allege conduct by either defendant that exceeds the bounds of decency and is regarded as intolerable in a civilized community. The judgment of the District Court was affirmed. ZALMA OPINION To sue an insurance company, lawyers, and individuals because a law suit resulting from an auto accident did not go as you wished still requires allegations of viable torts and evidence supporting the claim. Just because the plaintiff was black and thought he was being discriminated against still needed evidence. Plaintiff's suit failed because he had no evidence to support his claims. (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Breach of Contract is not an Occurrence In American Home Assurance Company v. Superior Well Services, Inc., No. 22-1498, United States Court of Appeals, Third Circuit (May 31, 2023) American Home Assurance Co. ("American Home") appealed the District Court's order grant of summary judgment for policy holder Superior Well Services, Inc. ("Superior"). BACKGROUND The Underlying State Law Claim U.S. Energy contracted with Superior for hydraulic fracking services to extract natural gas from wells owned by U.S. Energy. In November 2007, Superior notified its insurance provider, American Home, about the potential claim for damage to wells. In February 2008, American Home agreed to provide Superior with defense counsel, but it also sent Superior a letter reserving its right to contest insurance coverage. U.S. Energy sued Superior in New York state court, alleging that Superior had damaged 97 of its wells. After trial the jury found that Superior breached the contract by failing to perform services with reasonable care, skill and diligence. The jury found Superior had damaged 53 of the 97 wells and specified that Superior "fail[ed] to perform its contract with U.S. Energy in a workman like manner" and that this "failure" was "a substantial factor in causing damage to the U.S. Energy wells[.]" Accordingly, it awarded U.S. Energy $6.16 million, a figure that was increased to approximately $13.18 million after the state court tabulated interest. THE DISPUTE BETWEEN SUPERIOR AND AMERICAN HOME Superior's policy provided coverage for "property damage" arising out of an "occurrence." The policy defined "property damage" as both "[p]hysical injury to tangible property, including all resulting loss of use of that property." Superior also purchased an "underground resources and equipment coverage" ("UREC") endorsement that amended the CGL policy to provide additional coverage "against risks associated with well-servicing operations[.]" Specifically, the endorsement "added" coverage "with respect to 'property damage' included within the 'underground resources and equipment hazard' arising out of the operations performed by [Superior] or on [Superior's] behalf[.]" American Home sued seeking a declaratory judgment that Superior's policy does not indemnify Superior for any damages that might be awarded to U.S. Energy and which were caused by Superior's breach of contract. THE DISTRICT COURT'S OPINION The District Court granted summary judgment for Superior and, by extension, for U.S. Energy, and it ordered American Home to indemnify Superior for the state court judgment. The Court concluded that each of the 53 damaged wells gave rise to a separate occurrence, triggering an independent coverage limit for each respective well. DISCUSSION The definition of "accident" required to establish an "occurrence" under the policies cannot be satisfied by claims based upon faulty workmanship. Such claims simply do not present the degree of fortuity contemplated by the ordinary definition of "accident" or its common judicial construction in this context. To hold otherwise would be to convert an insurance policy into a performance bond. The Court was unwilling to do so, especially since such protections are already readily available for the protection of contractors. The UREC endorsement reinstates coverage by providing that the exclusion "does not apply to any 'property damage' included within the 'underground resources and equipment hazard[.]'" Notably, to trigger coverage, the endorsement expressly requires "property damage," which, under the underlying policy, is covered only if it "is caused by an 'occurrence.'" The endorsement incorporates the "occurrence" requirement by way of the "property damage" requirement. No provision in the endorsement implicitly, let alone expressly, repudiates the "occurrence" requirement. The Third Circuit Court of Appeal concluded that the endorsement does not displace the underlying policy's occurrence requirement and reversed the District Court's summary judgment order and remanded the case to the District Court with instructions to enter judgment for American Home. ZALMA OPINION The key to every liability insurance policy is that for coverage to apply the loss must be fortuitous, that is neither expected nor intended by the insured, and must fit within the generally understood meaning of the term "accident." Under no definition of fortuity is faulty workmanship by the insured. Since the jury found the insured responsible for its breach of contract by means of faulty workmanship there was no occurrence and no coverage (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Insurance Fraudster and Killer Wastes the Court's Time With Frivolous Action Pro Se Party Has a Fool for a Client In State Of Delaware v. Ryan Shover, ID No. 1511001640, Superior Court of Delaware (May 15, 2023) the appellate court dealt with proceedings by convicted murderer and insurance fraudster, Ryan Shover who acted as his own attorney. F ACTS Ryan Shover was found guilty of two counts of Murder First Degree, two counts of Possession of a Deadly Weapon During the Commission of a Felony, First Degree Conspiracy, and Insurance Fraud. The Supreme Court of Delaware issued its Mandate affirming the judgment of the Superior Court. Defendant then filed a pro se Motion for Post-conviction Relief and Motion for Appointment of Counsel and the Superior Court granted the Motion for Appointment of Counsel. The appointed Counsel filed a Motion to Withdraw and informed the Court that, after a thorough review of the record, Defendant's claims lacked merit and there were no additional meritorious claims that he could ethically present. Defendant then filed pro se a Motion for Reconsideration of his Post-conviction Motion and a second pro se Motion to Compel. The Court denied Defendant's second Motion to Compel as moot on the same basis that it denied his first Motion to Compel. ANALYSIS Appointed Counsel advised the court that he concluded that Defendant's claims lacked sufficient merit to the point that he could not ethically advocate Defendant's position. In the Motion to Withdraw, appointed Counsel engaged in a detailed analysis of Defendant's claims before concluding that they were devoid of merit. With respect to Defendant's Motion for Post-conviction Relief, Superior Court Criminal Rule 61(a) states such motions must be based on a sufficient factual or legal basis. Superior Court Criminal Rule 61(b)(2) requires that post-conviction motions "specify all grounds for relief which are available to the movant . . . and shall set forth in summary form the facts supporting each of the grounds thus specified." After a review of the Motion for Post-conviction Relief and Motion to Withdraw, in addition to the applicable legal authorities, it was evident to the appellate court that Defendant's grounds for relief had no merit. In addition, the court concluded that Defendant's constitutional right to confront witnesses was not violated by a witness refreshing his recollection with the FBI agent's typewritten notes of that witness' prior out of court statement because the State was permitted to refresh a witness' recollection in this manner pursuant to Delaware Rule of Evidence 612. It was the witness' in court testimony, not the typewritten notes of that witness' prior statement, that constituted the evidence that went to the jury. Therefore, appointed Counsel's Motion to Withdraw was granted and Defendant's Pro Se Motion for Post-conviction Relief was summarily dismissed. ZALMA OPINION Courts tend to protect the rights of a pro se party, even a convicted murderer, but should reconsider that tendency. The Delaware court provided an attorney to deal with the defendant's motion for post-conviction relief only to have that lawyer move to be relieved because there was no basis in fact or law for the relief sought and it would be unethical for counsel to represent Ryan Shover. Bending over backwards the appellate court considered the spurious arguments, wrote a detailed opinion, and denied relief. Shoyer will serve his full sentence. (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Insured Must Reside at Dwelling for Homeowners Policy Coverage to Apply Plaintiff alleged that, on October 28, 2020, Hurricane Zeta caused significant damage to his property. Plaintiff alleged that Southern conducted an inspection which constituted “satisfactory proof of loss,” but that Southern failed to adjust the claim or provide compensation to Plaintiff following the inspection. Plaintiff alleged that he was forced to hire his own experts, and repair estimates. In Todd M. Korbel v. Republic Fire And Casualty Insurance Company And Southern Underwriters Insurance Company, No. 2:21-CV-2214, United States District Court, E.D. Louisiana (May 31, 2023) BACKGROUND Plaintiff sued seeking damages. Southern generally denied the allegations and asserted a number of affirmative defenses including that Plaintiff did not “reside” at the Property, and that he is therefore not entitled to coverage under the Policy. APPLICABLE LAW Residence under the Policy The plain, ordinary and generally prevailing meaning of the word “reside” requires more than purchasing a home or intending to move into it. Plaintiff argued that he received mail, including correspondence from Southern, at the Property, that he paid water and electric bills for the Property in his name, that he was at the Property every day performing work or checking on the Property, that he had stored some belongings at the Property, and that he had a homestead exemption on the Property. As the Fifth Circuit has previously explained to Plaintiff himself in a previous lawsuit, this evidence is insufficient to create an issue of material fact as to whether Plaintiff resided in or at the Property. In an earlier case Plaintiff brought similar claims for damages and statutory bad faith penalties under Louisiana law after a house that he had purchased, but not moved into, was damaged during Hurricane Katrina. The insurer raised the same lack of coverage defense to Plaintiff's claims for certain damages, arguing that Plaintiff did not reside at the property as was required under the insurance coverage contract. Although Korbel clearly spent a great deal of time working on the house and intended it to be his residence in the future, this evidence was insufficient to establish residence. Given that Plaintiff kept only a minimal amount of furniture there and did not engage in leisure activities at the house, but rather went to the Property to work on or check on the house the facts establish he did not reside there. In fact, Plaintiff admitted in his deposition that he did not move into the Property but was still living at another location at the time the Property was impacted by Hurricane Zeta. Accordingly, Plaintiff did not ‘reside' at the Property, and is not entitled to coverage under the Policy. ZALMA OPINION Homeowners policies require that the insured reside at the premises that is the subject of the policy. Since the evidence established Korbel did not reside at the premises but only visited for purposes other than residence and it was in no condition to live in, he did not meet the requirement of residence as he did not in a previous case he brought to the Fifth Circuit Court of Appeals. He could have purchased a policy for a property in the course of construction but did not. Once he lost with the same argument it was unwise to make the same losing argument to the to the USDC that had failed on an appeal to the Fifth Circuit. (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

California’s Dumbest Criminals Must Pay Restitution After Frayba Tipton and William Tipton pled guilty to committing insurance fraud, they were ordered to pay victim restitution to Nationwide Insurance Company of America (Nationwide). Nationwide obtained a civil judgment an award of over $1,200,000 in civil litigation against the Tipton’s only to have the judgment discharged in bankruptcy. Nationwide then petitioned the trial court to convert the criminal restitution orders to civil judgments against both defendants. The trial court granted Nationwide’s petition and entered civil judgments against the defendants. In Nationwide Insurance Company Of America v. Frayba Tipton et al., C095606, California Court of Appeals, Third District, San Joaquin (May 26, 2023) the court agreed that the restitution order could be made collectible as a civil judgment and not subject to discharge in bankruptcy. BACKGROUND After a fire destroyed the defendants’ home, they filed an insurance claim in which they overstated losses related to the contents of their home. (People v. Tipton, supra, 3C083065.) Nationwide alleged in court filings that among the overstated losses was the claimed loss of an original Vincent van Gogh “Starry Night” painting which is still safely in a museum. Defendants pled guilty to a felony insurance fraud allegation and no contest to a felony perjury allegation, and the trial court placed them on five years of formal probation. After informing defendants of their right to have a judicial determination of the amount of restitution that would be owed to Nationwide and holding an evidentiary hearing to determine the amount, the trial court ordered defendants to pay $792,597.22 in victim restitution to Nationwide in 2016. Though defendants were later able to have the award against them discharged in federal bankruptcy proceedings, the order of discharge explained that “debts for most fines, penalties, . . . or criminal restitution obligations” were not discharged. In 2020, the probation department informed the parties that it would cease its efforts to collect restitution because probation had expired although they should have moved to incarcerate the Tiptons for failure to pay restitution. The trial court agreed with Nationwide after the hearing and the court entered civil judgments against each defendant in favor of Nationwide for over $1,000,000 (accounting for the outstanding unpaid restitution, plus 10 percent annual interest). DISCUSSION California law provides: “In every case in which a victim has suffered economic loss as a result of the defendant’s conduct, the court shall require that the defendant make restitution to the victim.” (§ 1202.4, subd. (f).) A trial court must order full restitution. A restitution order imposed pursuant to section 1202.4, subdivision (f) is enforceable “as if” it was a civil judgment and is enforceable in the same manner as is provided for the enforcement of any other money judgment. As made clear on the criminal order of restitution used in criminal cases Penal Code section 1214 provides that once a dollar amount of restitution has been ordered, the order is then enforceable as if it were, and in the same manner as, a civil judgment. The Victims’ Bill of Rights Act of 2008, known as “Marsy’s Law,” amended article I, section 28 of the California Constitution by expanding and constitutionalizing the protection of victims’ rights, including the right to restitution. (See People v. Gross (2015) 238 Cal.App.4th 1313, 1317.) A victim’s constitutional right to restitution cannot be bargained away or limited, nor can the prosecution waive it. Victims are first in line to receive any money collected from criminal defendants ordered to pay restitution. Because the California Constitution guarantees crime victims the right to restitution and that right is given a broad and liberal construction and statutes regarding the right should be construed in the context of the relevant statutory scheme. ANALYSIS The Court of Appeals concluded that the trial court did not err when it converted the restitution orders as it clearly had authority to deem them money judgments pursuant to section 1214, subdivision (b) and properly did so. While enforceable as if it were a civil judgment, a restitution order “is not a civil judgment” and the victim restitution statutes demonstrate legislative recognition of the distinct and separate right of a victim to pursue a civil remedy irrespective of the restitution order The plain language of section 1214 equates a restitution order to a civil judgment and articulates how such orders can be enforced within the criminal courts, but if a civil court is asked to convert such a restitution order into a civil judgment, as in the case here, it is not error for it to do so. The judgments are affirmed. ZALMA OPINION To claim that they lost the original Vincent van Gogh painting “Starry Night” was stupid enough since it is located in the Museum of Modern Art in New York and has been there for many years, should have made the fraud claim easy for Nationwide to prove and makes understandable the civil judgment and the restitution order. Even though they discharged the civil judgment in bankruptcy they could not discharge the restitution order. Nationwide can now collect over $1 million from any assets the Tipton’s have. They violated the terms of their probation by not paying restitution and should have been put in jail. The Tipton’s should consider their freedom from jail a lucky award. (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 A ClaimSchool™ Publication © 2023 Barry Zalma & ClaimSchool, Inc., Go to my blog & Videos at: Zalma on Insurance, at https://zalma.com/blog, Go to the Insurance Claims Library,Listen to the Podcast: Zalma on Insurance, Videos from Zalma on Insurance,Subscribe to Barry Zalma on Substack.com,Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01,Subscribe to the e-mail Version of ZIFL, it’s Free! Read the last two issues of ZIFL here,Go to the Barry Zalma, Inc. web site here,Videos from “Barry Zalma on YouTube,” videos at Rumble.com at https://rumble.com/zalma, @Zalma on Truth Social; Follow me on LinkedIn here.

Theft by Authorized Representative Excluded

ZIFL - Volume 27, Issue 11 The Source For Insurance Fraud Professionals This, the eleventh 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: Steal From the Government - Go to Jail New Statute Requires Sentencing Review In The People v. Howard Oliver, B317368, California Court of Appeals, Second District, Third Division (May 12, 2023) Howard Oliver appealed from the judgment entered after a jury convicted him of conspiracy to cheat and defraud Medi-Cal, Medi-Cal fraud; grand theft, false and fraudulent claims, insurance fraud, and four counts of tax evasion for 2012 through 2015. Oliver was sentenced to an aggregate sentence of seven years eight months in prison and ordered to pay over $2.85 million in restitution. Read the full article & full issue at ZIFL-06-01-2023 More McClenny Moseley & Associates Issues This is ZIFL’s seventh 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 of the state of Louisiana. Read the full article & full issue at ZIFL-06-01-2023 Dealing with Questionable Documents Bogus receipts and the need for confirmation of purchase are closely connected, guidelines applicable to both are suggested to avoid fraudulent claims. The following guidelines are in a certain order, and it is suggested that a “by the numbers” approach be followed so that the investigation can be most effective and successful. This order is suggested because the claims person will be establishing and preserving certain evidence that will be difficult for the insured to dispute as the handling and investigation evolves. Read the full article & full issue at ZIFL-06-01-2023 Good News from the Coalition Against Insurance Fraud After initially pleading not guilty last year, Connie Jo Clampitt has been found guilty of over $7M in medical insurance fraud. Clampitt has since pleaded guilty, and both she and her partner, Terrance Barnard, were indicted for healthcare fraud. Read about many more convictions and Read the full article & full issue at ZIFL-06-01-2023 Health Insurance Fraud Convictions Boston Man Sentenced to Two Years in Prison for Benefit Fraud Fernando Mateo Valenzuela, 69 a Hyde Park, Massachusetts man was sentenced May 24, 2023 in federal court in Boston for using a stolen identity to fraudulently obtain government assistance benefits. Valenzuela was sentenced by U.S. District Court Judge Leo T. Sorokin to two years and one day in prison and three years of supervised release. Valenzuela was also ordered to pay restitution of $29,051 to the Department of Unemployment Assistance and $7,230 to the Department of Transitional Assistance. Read about dozens more convictions and Read the full article & full issue at ZIFL-06-01-2023 Other Insurance Fraud Convictions Yucaipa Driver And Wife Sentenced After YouTube Videos Of Intentional Collisions Christopher Phelps, 40, of Yucaipa, and his wife, Kimberly Phelps, 40, were sentenced after pleading no contest to felony counts of insurance fraud, child abuse and assault with a deadly weapon. This comes after a Department of Insurance investigation revealed the couple caused collisions in an attempt to collect undeserved insurance payouts. Read about many more convictions and Read the full article & full issue at ZIFL-06-01-2023 It’s Time to Subscribe to Locals or Substack For Subscribers Only I Have Published Special Insurance Videos I published on Locals.com more than 25 videos and two webinars of the Excellence in Claims Handling program. I also published on Substack.com videos and webinars of the Excellence in Claims Handling Program available only to Subscribers. The subscribers have access to all the videos and a webinar on “The Examination Under Oath A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud” among others. The videos start with the history of insurance and work their way through various types of insurance and how to obtain and deal with insurance claims; Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com; Subscribe to my publications at substack at substack.com/refer/barryzalma; Go to substack at substack.com/refer/barryzalma; Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support Read the full article & full issue at ZIFL-06-01-2023 (c) 2023 Barry Zalma & ClaimSchool, Inc. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 Barry Zalma, Esq., CFE, is available at http://www.zalma.com and zalma@zalma.com Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library