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Claim of Disability Because of Stress of Arrest & Conviction Fails Jason Brand ("Brand") appealed from the judgment of the district court entered on September 30, 2021, challenging the court's dismissal of Brand's counterclaims for breach of contract and breach of the implied covenant of good faith and fair dealing. Brand's claimed Principal Life Insurance Company ("Principal Life") failed to pay him benefits under his disability insurance policy (the "Policy"). In Principal Life Insurance Company v. Jason P. Brand, Nos. 21-2716, 21-2908, United States Court of Appeals, Second Circuit (November 30, 2023) the Second Circuit resolved the dispute. DISCUSSION The words and phrases in a contract of insurance must be given their plain meaning and the contract must be construed to give full meaning and effect to all of its provisions. Straining a contract's language beyond its reasonable and ordinary meaning will not be understood to create an ambiguity. All provisions of a contract should be read together as a harmonious whole. The Criminal Activity Exclusion Applies and Justified Principal Life's Denial of Coverage Courts may enforce an exclusionary clause only when it has a definite and precise meaning, unattended by danger of misconception and concerning which there is no reasonable basis for a difference of opinion. Whenever an insurer wishes to exclude certain coverage from its policy obligations, it must do so in clear and unmistakable language. The Policy issued by Principal contains an exclusion for criminal activity (the "Criminal Activity Exclusion") that states: “This policy does not pay benefits for an injury or sickness which in whole or in part is caused by, contributed to by, or which results from: . . . Your commission of or Your attempt to commit a felony, or Your involvement in an illegal occupation[.]” Principal Life contended that the exclusion entitled it to deny Brand's 2014 claim for coverage. Application of the Criminal Activity Exclusion. As to the applicability of the Criminal Activity Exclusion, Brand premised his November 2014 claim for disability benefits on his assertion that he was "total[ly] disab[led]" by "extreme anxiety" that began in "July 2014, [after] a warrant was served" on him by officers of the New York State Attorney General's Office. The application cites no other cause or type of disability. On February 8, 2016-about fifteen months after filing the application-Brand entered into a plea agreement in which he admitted to committing, in connection with his businesses, and between January 1, 2009, and March 11, 2015, the felony crimes of enterprise corruption, insurance fraud in the first degree, and grand larceny in the second degree. Insured Admits Criminal Conduct Brand stated under oath that he committed enterprise corruption, insurance fraud, and grand larceny in the period before he submitted his disability claim for "extreme anxiety." Brand without merit contended that it was the criminal proceedings brought against him, not his commission of several felonies, that were the proximate cause of his disability. Even if the criminal proceedings triggered his most extreme anxiety, it was Brand's commission of the felonies that led to those criminal proceedings that in turn led to his disabling anxiety Brand's 2014 claim for benefits was barred by the Criminal Activity Exclusion and Principal Life was within its rights to reject the claim. The Court affirmed so much of the judgment as granted Principal Life's motion for summary judgment dismissing, based on the Criminal Activity Exclusion, Brand's counterclaims for breach of contract and breach of the implied covenant of good faith. However, the district court erred in dismissing the remaining claim asserted by Principal Life asking to reconsider Principal's request for rescission. ZALMA OPINION Misrepresenting material facts to an insurer when acquiring a policy allows the insurer to rescind the policy. Principal established that Mr. Brand was a criminal and denied his claim appropriately. It doesn't want him as an insured any more and sought rescission which the Second Circuit was unable to rule on so it returned the case to the trial court to decide whether rescission was appropriate because it appeared that he lied to obtain 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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

The Resource for the Insurance Claims and Insurance Fraud Professionals This, the 22nd issue of the 27th Year of ZIFL includes articles and reports relating to insurance fraud, including: Some Red Flags of Insurance Fraud Over the last two centuries insurers, insurance investigators, Special Investigative Unit Investigators, insurance lawyers, and insurance management have developed lists of indicators of potential insurance fraud. The indicators are known as the Red Flags of Fraud and are used to determine if it is necessary to begin a thorough investigation of an insurance claim to determine if a fraud is being attempted. To be able to work to deter or defeat attempts at insurance fraud the insurance claims person and the SIU investigators must be conversant in the red flags or indicators of insurance fraud. Read the full 21 pages of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/11/ZIFL-12-01-2023-1.pdf More McClenny Moseley & Associates Issues This is ZIFL’s nineteenth 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 21 pages of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/11/ZIFL-12-01-2023-1.pdf Litigation Financing Although this report from Texas lawyer Steven Badger deals with the litigation around the MMA debacles it is more important for fraud investigators to understand what is happening in litigation financing. Mr. Badger notes that “litigation financing and other interlopers [are] moving into the first-party claims world trying to line their pockets with insurance claim proceeds.” He concludes, and I agree: “This is a very dangerous trend.” Litigation from an entity called Equal Access Justice Fund, LP loaned to MMA $30,000,000 at 20% per year interest plus an additional 4% in advance, extension, and yearly service fees would require the law firm to pay the lenders more than $600,000.00 a year. Unlike the U.S. government law firms cannot print money. For a normal law firm working on hourly billing that interest rate plus service fees is a scary, if not impossible, obligation to meet. Most law firms will not produce enough net income to pay $600,000 a year interest and be able to even consider paying off the principal. In In Re: MMA a pleading filed in the Western District of Louisiana, by Intervenor Equal Access Justice Fund LP (“EAJF”) sought to recover the interest and principal from MMA and its partners as a result of its multiple hurricane suits that have bee removed from MMA’s control by the courts. Chutzpah! Guess Who's Back, Back Again? MMA's website is back up and running. The team is a bit smaller though. https://www.mma-pllc.com/our-team/ The new website for the MMA law firm states: “We believe that striking a balance between professionalism and self-empowerment is key to fostering a harmonious company culture—one where we are encouraged to build authentic relationships and welcome new opportunities.” Read the full 21 pages of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/11/ZIFL-12-01-2023-1.pdf ‘I Am Guilty.’ Murdaugh Pleads to 22 State Financial Crimes for 27 Year Sentence Alex Murdaugh pleaded guilty November 17, 2023, to stealing millions of dollars from vulnerable legal clients in schemes lasting over a decade under an agreement that all but ensures more prison time for the longtime lawyer who was convicted of killing his wife and younger son. Murdaugh agreed to plead guilty to 22 total counts, including money laundering, breach of trust and financial fraud, in exchange for a 27-year sentence. Judge Clifton Newman said he intends to officially accept the plea deal during a sentencing hearing set for Nov. 28 so that victims or their families may attend. “I agree that I wrongly took all of that money, your honor, and did all of those crimes,” Murdaugh told Newman. “I am guilty,” he added. Read the full 21 pages of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/11/ZIFL-12-01-2023-1.pdf Health Insurance Fraud Convictions Psychiatrist Convicted of Billing for Services Never Rendered Gustavo Kinrys, 52, of Wellesley, was convicted of seven counts of wire fraud, six counts of false statements relating to health care matters and one count of obstructing a criminal health care investigation. U.S. District Court Judge Denise J. Casper scheduled sentencing for Jan. 31, 2023. Kinrys was arrested and charged in December 2020. Read the full 21 pages of this issue and dozens more convictions at ZIFL at http://zalma.com/blog/wp-content/uploads/2023/11/ZIFL-12-01-2023-1.pdf Man Bites Dog Story Lawyer Sanction Upheld for Intimidating and Harassing an Insurer In Nguyen v. Aventus Ins. Co., 14-19-00607-CV (Tex. App. Sep 30, 2021) an April 2, 2018, sanctions order, that found that the lawsuit filed by Eric B. Dick, And Dick Law Firm, PLLC..." where the court found that the suit had no basis in fact, that it was brought in bad faith for the improper purpose of intimidating and harassing Aventus Insurance Company and that appellants hindered the litigation process and failed to make reasonable inquiries to ensure that the claims and pleadings were not groundless. Read the full 21 pages of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/11/ZIFL-12-01-2023-1.pdf Other Insurance Fraud Convictions Former Bail Agent And Torrance Police Officer Sentenced To 27 Years In Prison Rehan Nazir, 51, of Torrance, was sentenced November 29, 2023, to 27 years after an investigation by the Los Angeles County Sheriff Major Crimes Bureau and the California Department of Insurance found he had apprehended bail clients prior to their required court appearances and threatened to return them to jail if they did not pay him money or give him property. Read the full 21 pages of this issue of ZIFL and many more convictions at http://zalma.com/blog/wp-content/uploads/2023/11/ZIFL-12-01-2023-1.pdf It is Expensive to Lie to Your Insurer Fraud in Inception Allows Insurer to Rescind Lamin Fatty appealed the trial court’s order granting summary disposition to Farm Bureau on the basis of finding Fatty’s fraud was grounds for contract rescission and reimbursement of benefits paid. In Lamin Fatty v. Farm Bureau Insurance Company of Michigan, No. 363888, Court of Appeals of Michigan (November 21, 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 and read the full 21 pages of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/11/ZIFL-12-01-2023-1.pdf

Why an Amateur's Attempt at Fraud Failed See the full video at and at https://youtu.be/-AfnWKClZ-E This is a fictionalized true crime story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is presented to help a reader 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 insured was a poet. Before immigrating from Soviet Armenia, he was a member in good standing at the Armenian Poets Union. They paid him for his work five hundred rubles a month. He lived in the capital city of Yerevan in the shadow of Mount Ararat. He, like all Soviet citizens, before the fall of the Soviet Union, supplemented his income by buying and selling in the black market. He specialized in jewelry and diamonds. By 1977 he had amassed, off the pain and suffering of others, over 300 carats of diamonds and diamond jewelry. Most of the diamonds were old mine cut, popular in Russia in the 1890’s, but out of date. The wealth he had amassed frightened him. He knew that eventually the Soviet Police would catch him and send him to a Gulag. He was committing the most heinous of Soviet crimes: he was a successful entrepreneur. He went to the American Consulate and got a visa as a refugee. He had convinced the American Consulate the Soviet Government was censoring his poetry. He wanted freedom to write. Poetry is not an essential industry. The Soviet Government agreed to his immigration. He came directly to Los Angeles and settled in the Armenian community in the hills of Glendale, California. He brought with him all but twenty carats of the diamonds. He needed to use some of his 300 carats to bribe Soviet Customs Officials to get safely out of the country. For many years he and his family lived by selling the diamonds at auctions. He continued to write poetry but there was no market for Armenian poetry in the United States. The few Armenian language newspapers would publish his poems but could not pay him. Eventually his inventory of fine jewelry began to shrink. He had learned to enjoy living in the luxury the diamond sales had brought him. He didn’t know how to earn money to support himself in America. He did not want to return to Soviet Armenia to be a salaried poet. At a social gathering at the Armenian church after services he expressed his concerns to an acquaintance who ran an art gallery. The gallery owner had been in the United States longer than the poet. He knew how trusting Americans were. He knew that Americans believed what they were told until proved otherwise. He understood that Americans took seriously their belief that everyone was innocent until proven guilty. He explained to his poet friend how he could easily make enough money to support his family comfortably for the rest of his life. The gallery owner told the poet he would rent him a portion of his art gallery to open a jewelry store. The poet only needed to buy an insurance policy insuring against loss of an inventory of his jewelry. The insurer would not ask him before issuing a policy to prove he had any jewelry but would take his word. The poet was incredulous. “Won’t they want to see the jewelry?” “No. They insured my art gallery without ever sending anyone to look at the paintings. If they do send someone out just tell them the jewelry is in your safety deposit box. Tell them you feared bringing it out until you had insurance. You can put in showcases the jewelry you do have to make it look like a legitimate jewelry store.” The next day Poetry Jewelry was born. The poet immediately applied for insurance. He filled out the application form honestly stating that he had been in the jewelry business for ten years buying and selling jewelry from his home. This was his first attempt at a retail business. He had never had a loss. He had never had an insurance policy canceled. He had over a million dollars in inventory. The insurer took the risk without any questions. The security and safes were proper. The premium would be paid in full since the poet had obtained independent premium financing through his broker and only needed to pay 20% of the annual premium. The insurer issued a policy that requested an immediate inspection of the premises. The inspector visited the premises, saw immediately that it was not as represented and advised the company to cancel. They did. The insured went to a new broker. The new insurer did not require an inspection of the premises by anyone other than the broker. It issued a million dollar policy. Two weeks later, before the insurer could change its mind, the poet’s oldest son locked the poet and his mother, the poet’s wife, and the gallery owner in the small four by four foot bathroom. The son then took home all the inventory of Poetry Jewelers. The three people locked in the bathroom waited ten minutes to make sure the oldest son had driven away and then pushed the holdup button secreted in the bathroom because it is common for thieves to lock jewelry store owners in the bathroom. The three captives also pounded on the wall to gain the attention of the restaurant owner next door. The police were called and broke the door down to free the poet, his wife and the gallery owner. The loss exceeded a million dollars. The poet thanked God that they were insured. Their million dollar fraud would have been successful but for an unusual coincidence. The insurer hired as its adjuster the same firm that had inspected the store for the first insurer. The adjuster remembered the insured. He knew that the prior insurer had canceled. He knew when the poet told him that the policy was his first ever that he was lying. The adjuster knew when the insured told him that his inventory was a million dollars he was lying. The adjuster gathered the evidence together and presented it to the insurer. The insurer decided to rescind the policy and deny the claim. The insured and the gallery owner, his mentor, were shocked. They did not give up. They became more aggressive. They retained a lawyer. The lawyer immediately filed suit in U.S. District Court for breach of the covenant of good faith and fair dealing and made claim for fifty million dollars over the one million dollar claim. The insurer was confident it was right. It would not allow an insurance fraud to go forward. It would fight the poet through trial. It was, unusually for American insurers, dedicated to its cause. The insurance company spared nothing. Its lawyers deposed every person who had any connection with the poet. The deposition of the poet lasted for three days. Each member of the family was deposed. Paralegals poured over every word of the transcripts and found conflicting testimony. The insurer obtained documentary evidence from every possible location except Yerevan, Soviet Armenia. The lawyers spent weeks preparing for trial. The poet was unprepared. His family was unprepared. They expected, regardless of the evidence they presented, that the jury would hate the insurance company and punish it. At trial, although well-rehearsed, the poet’s lies began to compound. The testimony of the inspector established the inventory was not there at the time of the inspection. The insured did not have a safety deposit box and therefore could not even prove the existence of a box to hold the jewelry he claimed he had. Under cross-examination the poet’s son’s testimony became confused. The judge took over the cross- examination and, unable to answer confidently, the poet’s son broke down and cried on the stand. Lies were admitted. After five days of trial with testimony from nine in the morning until six every night, the jury went off to deliberate. The jury returned with its verdict in forty-five minutes after spending thirty minutes to pick a foreman. The verdict was for the defense. The jury was convinced that the poet had presented a fraudulent claim and that the insurance company had properly rescinded the policy. The result was unusual. The cost was enormous. The investigation cost, court costs, expert witness fees and attorneys’ fees exceeded $500,000. The insurer defeated the claim for one million dollars in lost jewelry and fifty million dollars in punitive damages. The word went out. This insurance company fights. Do not insure with them. The insurer saved more than the payment of the poet’s claim. It saved all the other fraudulent claims that would have been presented had they not fought. The poet paid nothing to his lawyer who took the case on a contingency basis. He continued living off the jewelry he brought from Soviet Armenia. The poet’s attempt at insurance fraud failed. He learned a lesson about American jurisprudence. He would only make claims against insurance companies willing to insure him after he honestly reports his earlier attempts at fraud. He would not fake a fraudulent claim. He was lucky he was not referred to the U.S. Attorney by the trial judge. This blog was adapted from my book Insurance Fraud Costs Everyone Amazon.com. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Fraud in Inception Allows Insurer to Rescind Post 4678 Lamin Fatty appealed the trial court's order granting summary disposition to Farm Bureau on the basis of finding Fatty's fraud was grounds for contract rescission and reimbursement of benefits paid. In Lamin Fatty v. Farm Bureau Insurance Company Of Michigan, No. 363888, Court of Appeals of Michigan (November 21, 2023) the Court of Appeals resolved the dispute. FACTS After a motor vehicle accident where Fatty sustained bodily injuries the issue of rescission was raised when it was discovered that at the time of the accident, Fatty was insured by Farm Bureau under the no-fault act. Fatty obtained insurance with Farm Bureau on July 17, 2019. On the application for insurance, Fatty answered the following question in the negative: "Are any vehicles to be insured used to carry persons for a fee?" Fatty received treatment for his injuries at Columbia Clinic among other medical facilities, and indicated to providers that he was "rear-ended as an Uber driver." Uber records indicated that Fatty began working as an Uber driver in early May 2019 (before he applied for the insurance) and drove for Uber on the day of the accident. Fatty's drive log shows he picked up a rider at 6:05 p.m. and dropped them off at 6:30 p.m. Fatty picked up another rider at 6:38 p.m. and dropped them off at their destination at 6:50 p.m. Fatty continued picking up riders and completing trips that night until 8:17 p.m. After this discovery, Farm Bureau filed a counterclaim on the basis of fraud, requesting reimbursement of benefits paid to or on behalf of Fatty with regard to the accident. The trial court granted Farm Bureau's motion for summary disposition of the counterclaim, including its request for reimbursement of $104,730.82 for benefits paid, because the policy was rescinded under the doctrine of fraud in the procurement. The trial court also found Fatty's fraud entitled Farm Bureau to attorney fees under the no-fault act, and costs. Specifically, the trial court found the requested costs of $2,599.50 were reasonable and awarded $10,000 in attorney fees. Fatty appealed. SUMMARY DISPOSITION OF THE CLAIM The trial court properly rescinded the insurance policy because Fatty committed fraud in the procurement of the contract by explicitly denying using his vehicle to carry passengers for a fee. Because of this rescission, summary disposition of Fatty's claims was appropriate, without regard to whether Fatty was driving for Uber at the time of the accident. Fraud in the inducement to enter a contract renders the contract voidable at the option of the party deceived. An insurer has a reasonable right to expect honesty in the application for insurance. Rescission abrogates the contract and restores the parties to their relative positions had the contract never been made. A court must not hold an insurance company liable for a risk that it did not assume. Farm Bureau's evidence in the form of the litigation representative's affidavit that he told the truth the policy would have been refused was unrefuted and it establishes the materiality of the misrepresentation. Fatty's denial of carrying passengers for a fee was determined to be a material representation. SUMMARY DISPOSITION OF THE COUNTERCLAIM Reimbursement of the PIP benefits paid to Fatty was an appropriate remedy following rescission. Because the claim was fraudulent and Farm Bureau was the prevailing party, the award of attorney fees and costs was also proper. The trial court properly awarded attorney fees to Farm Bureau. Farm Bureau was forced to defend against a claim pursued under a policy that was procured by fraud. Therefore, the award is within the range of reasonable and principled outcomes and was not an abuse of discretion. Accordingly, the award of attorney fees and costs to Farm Bureau was proper. The trial court properly rescinded the contract because Fatty committed fraud in the procurement by explicitly denying he used his vehicle to carry passengers for a fee. Because the claim was fraudulent and Farm Bureau was the prevailing party, the award of attorney fees and costs was also proper. ZALMA OPINION Rescission is an equitable remedy that allows a contract to be voided from its inception as a result of fraud in the inception. Farm Bureau was deceived by Fatty who lied about a material fact, that he was carrying passengers as an Uber driver. He received no fault benefits as a result of this fraud and the court properly ordered the policy rescinded, ordered Fatty to repay the benefits he received plus attorneys fees it took to defeat the claim. Fatty learned that fraud does not pay and that he should never lie to a prospective insurer. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Coverage Excluded Cannot be Changed to Coverage Provided An insurance coverage dispute that involved a commercial insurance policy ("the Policy") that plaintiff, Winfire Management, LLC ("Winfire") held with defendant, Massachusetts Bay Insurance Company ("Mass Bay"). The trial court concluded that the Policy covered Winfire's business-income losses that resulted from a sewer backup and entered judgment in Winfire's favor. Mass Bay appealed. In Winfire Management, LLC v. Massachusetts Bay Insurance Company, No. 362960, Court of Appeals of Michigan (November 21, 2023) the Court of Appeals read the policy as written and resolved the dispute. BACKGROUND Winfire's claim for lost rental income following a July 2020 sewer backup at one of Winfire's commercial properties was refused by Mass Bay. Winfire sued Mass. Bay for breach of contract for refusing to cover these business-income losses. Soon after, Mass. Bay moved for summary disposition arguing that the Policy did not provide business-interruption coverage for losses from a sewer backup. Mass Bay conceeded that the Policy covered physical damage from sewer backups it explained that taking together the policy provisions in the Business Income (And Extra Expense) Coverage Form ("the BI Form") and the Causes of Loss -Special Form ("the CL Form"), the Policy excluded coverage for lost business income from a sewer backup. In response, Winfire disputed Mass. Bay's interpretation of the Policy. Winfire argued that, because the Policy covered property damage from sewer backups under the Gold Property Broadening Endorsement ("the GP Endorsement"), a sewer backup was a covered loss triggering business-income loss coverage under the BI form. The trial court agreed with Winfire . Accordingly, the court held, as a matter of law, that the Policy covered Winfire's business-income losses from the July 2020 sewer backup. PRINCIPLES OF LAW The sole issue on appeal is whether the Policy covered Winfire's business-income losses resulting from the sewer backup. When an insurance company argues that a policy exclusion negates coverage, the insurance company has the burden to prove that one of the policy's exclusions applies. Consistent with the rules of interpretation, clear and specific exclusions will be enforced as written so that the insurance company is not held liable for a risk it did not assume. ANALYSIS Winfire's commercial property insurance policy with Mass. Bay provided blanket building coverage, blanket business-income coverage, and blanket personal property coverage. There is no dispute that evaluating Winfire's claim for business-income losses begins with the BI form. The BI form governs business-income coverage and states that a claimed business income loss "must be caused by or result from a Covered Cause of Loss." The BI policy provided that: Exclusions We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss. Water (3) Water that backs up or overflows or is otherwise discharged from a sewer, drain, sump, sump pump or related equipment .... The Policy explicitly excluded coverage for business-income losses from a sewer backup. The CL form controls what constitutes a Covered Cause of Loss to trigger business-income coverage under the Policy. Per the CL form, a Covered Cause of Loss under the BI form excludes losses caused directly or indirectly by water that backs up, overflows, or is discharged from a sewer. The amendment providing property coverage for sewer backup amendment was added to "Additional Coverages" in the "Building and Personal Property Coverage Form." It was not added to the BI form. That change explains why Mass. Bay covered the "direct physical loss or damage" to Winfire's property that resulted from the sewer backup. The GP Endorsement did not amend the sewer backup exclusion referenced in the CL form that precludes coverage for business-income losses. The Policy unambiguously excluded coverage for Winfire's business-income losses stemming from the sewer backup. The Court of Appeals noted that a court must enforce insurance policy exclusions that are clear and specific exclusions. Therefore, the trial court's judgment for Winfire was reversed and remanded for entry of an order granting summary disposition for Mass. Bay. ZALMA OPINION The insured tried to convince the Court of Appeals that when an insurer changes a policy to provide sewer backup coverage for property damage it must also provide similar coverage for BI losses. Although the imaginative and well presented argument convinced the trial court the Court of Appeal read the entire policy and noted that the amendment only applied to property damage and not to BI losses. Failure to read the full policy caused Winfire and the trial court to err and cause the trial court's order to be reversed. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Underwriting Against a Certain Loss and Claim is Appropriate

USDC Should Have Considered the Intentional Act Statute California State Grange ("Grange") brought this action as a judgment creditor of non-party Chico Community Guilds ("Guilds") seeking to recover from Guilds' insurer Carolina Casualty Insurance Company ("Carolina Casualty") damages awarded by the state court. The underlying judgment followed a lawsuit quieting title to real and personal property wrongfully converted by Guilds. Grange appealed the district court's grant of Carolina Casualty's motion to dismiss without leave to amend based on its conclusion that the underlying claims were not covered under the policy. In California State Grange v. Carolina Casualty Insurance Company, No. 22-16169, United States Court of Appeals, Ninth Circuit (November 13, 2023) the Ninth Circuit Agreed to the District Court's ruling in part and sent the case back to the court to another part of the case. FACTS Grange sued Guilds in Butte County Superior Court over the assets of Chico Grange No. 486 in which Grange brought several causes of action including cancellation of deed and quiet title, slander of title, and conversion. On February 25, 2021, the state court entered a ruling granting summary judgment to Grange on all claims. The judgment awarded in relevant part: the cancellation of the unauthorized deed recorded by Guilds in 2017; $23,167.50 in attorney's fees related to the slander of title claim; "damages for conversion" of bank accounts in the amount of $80,697.68 plus $9,307.87 in prejudgment interest; and $1,945.49 in costs. Grange sued Carolina Casualty in the USDC seeking a declaration that Carolina Casualty has a duty to indemnify Guilds under the policy to collect on the judgment for all monies awarded. The district court dismissed Grange's suit without leave to amend. ANALYSIS The district court did not err in dismissing Grange's claim for indemnification as to the conversion damages and prejudgment interest awarded by the Butte County Superior Court as restitution not covered under the policy. In the state court's ruling on summary judgment, the Butte County Superior Court noted that Grange was not seeking title to the other personal property items identified in the complaint, but rather, only sought the converted funds totaling at least $80,697.69 in Guilds' bank accounts, which, in turn was the exact amount awarded. The relevant insurance policy explicitly excepts disgorgement or restitution from the definition of damages covered under the policy. Because the conversion damages and prejudgment interest awarded by the Butte County Superior Court was restitution not covered under the policy, the district court's dismissal as to that claim was affirmed. The USDC failed to consider whether the attorney's fees awarded pursuant to the slander of title claim may have been covered under the policy where a wrongful act is defined as including any "error, misstatement, [or] misleading statement." Slander of title involves the publication of a false statement that could be negligent. The district court also failed to consider whether such coverage would implicate California Insurance Code § 533. Carolina Casualty argued that under such an interpretation – if slander of title is a wrongful act because it includes a misleading statement – coverage is barred under California Insurance Code § 533 because such an action would be purposeful. Despite Carolina Casualty's contention to the contrary, a willful act does not include negligent misrepresentations within the meaning of section 533. Bearnaise Butte County Superior Court made no finding as to whether Guilds' actions were done with the requisite "willfulness" the applicability of section 533 is thus not readily apparent on the face of the record before the Ninth Circuit. Because the district court failed to consider the available, alternative basis for coverage under the policy that may be vulnerable to the argument that coverage was barred by section 533, the district court should reconsider the interpretive question. The district court's dismissal of Grange's claim for attorney's fees was vacated and remanded for reconsideration consistent with the opinion. Because the issue for which the case is now being remanded was not considered by the district court because it would be futile, the district court did not err by denying California State Grange leave to amend. ZALMA OPINION The Ninth Circuit, trying to help a plaintiff to recover from an insurer when coverage is questionable, sent the case back to the District Court to determine if the acts of the Guilds were sufficiently intentional to bring into effect California Insurance Code Section 533 or not. If the USDC finds it willful then Carolina Casualty will owe nothing and if not it will owe a few dollars more. In so doing the Ninth Circuit makes the litigation a punishment of the insurer who was required to deal with a suit and an appeal on a policy that probably owed nothing but it will cost more to succeed than to pay off the plaintiff. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Most Insurers Have Rules Prohibiting their Employees to Get Gifts See the full video at and at https://youtu.be/7qPdaA01t3A When I was a young lawyer I tried to give gifts to the claims personnel who referred cases to me and my law firm. I tried to provide them with gifts that they would enjoy only to be told I was violating the company rules. I talked with management and was allowed to make a gift to the claims offices and would send them a book for their library. It was acceptable and accepted by the claims people with good grace and didn't disappear as would a box of Mrs. Field's cookies. If you or your firm works with insurers and you wish to thank your clients consider sending a gift of a book or books for your clients that include: Everything Needed by the Insurance Claims Professional from Barry Zalma The library contains many books on the subject of insurance. The Books include: A Compact Book on How Judges Read, Understand, Interpret and Rule on Insurance Policy Issues The book is available at Amazon.com as a hardcover here; a paperback here; and as a Kindle Book here. The Compact Book on Ethics How Ethical Doctrines from the Beginning of the Written Word to the Present Resulted in the Incorporation of the Covenant of Good Faith The book is available as a Kindle book, a Paperback or a Hardcover “How to Acquire, Understand, and Make a Successful Claim on a Commercial Property Insurance Policy: Information Needed for Individuals and Insurance Pros to Deal With Commercial Property Insurance” The Book is now available as a Kindle book here, paperback here and as a hardcover here The Tort of Bad Faith Available as a Hardcover Available as a paperback Available as a Kindle Book The Equitable Remedy of Rescission of Insurance Available as: A Kindle book A Paperback or a hardcover . Insurance Fraudsters Deserve No Quarter Book That Explains How to Defeat or Deter Insurance Fraud Available as a paperback here. Available as a hardcover here.Available as a Kindle Book here. The Examination Under Oath to Resolve Insurance Claims Available as a Kindle book Available as a paperback. Available as a hardcover. Insurance Fraud – Volume I & Volume II Second Edition Available as a Kindle book; Available as a Hardcover; Available as a Paperback Available as a Kindle book; Available as a Hardcover; Available as a Paperback The Homeowners Insurance Policy Handbook How To Buy An Appropriate Homeowners Policy And Successfully Make A Claim To The Insurer Available as a Kindle Book here. Available as a paperback here. It’s Time to Abolish The Tort of Bad Faith A book examining the creation, history and effect of the Tort of Bad Faith. Insurance Fraud Costs Everyone Available as a Kindle Book and Available as a Paperback from Amazon.com. California SIU Regulations 2020 Available as a Kindle book here. Available as a paperback here. California Fair Claims Settlement Practices Regulations 2022 Minimum Standards for Adjusting Claims in CaliforniaEvery Claims Person in California Must Read, Understand, or be Trained About the California Fair Claims Settlement Practices Regulations by September 1 of Each Year Available as a Kindle Book. Available as a Paper Back “Zalma’s Mold & Fungi Handbook” Kindle Edition Paperback Edition “Getting the Whole Truth: Interviewing Techniques for the Lawyer” Learn techniques that can help you interact with others and effectively gather the facts you need. Zalma on Insurance Claims – Third Edition Ten Volumes Comprising A Comprehensive Group of Materials on Property & Casualty Insurance Claims Mold Claims The Compact Book of Adjusting Property Insurance Claims – Third Edition A Manual for the First Party Property Insurance Adjuster. Available as a Kindle book. Available as a paperback. The Compact Book on Adjusting Liability Claims, Third Edition A Handbook for the Liability Claims Adjuster available as a Kindle book Available as a paperback. The Little Book on Ethics for the American Lawyer The practice of law demands more than knowledge of statutory and case law. It Available as a Kindle book here. Available as a paperback here. Random Thoughts on Insurance Available as a paperback. Available as a Kindle book. Fictionalized True Insurance Crime Books Insurance Fraud Costs Everyone available as a Kindle Book and Available as a Paperback from Amazon.com. Candy and Abel: Murder for Insurance Money How a young lawyer and wise old investigator defeated an Available as a Kindle Book. Available as a paperback. Murder And Insurance Fraud Don’t Mix Available as a Kindle book. Available as a paperback Murder & Old Lace: Solving Murders Performed for Insurance Money Available as a Kindle book. Available as a paperback. Arson for Terrorism and Profit How an Insurance Investigator and Insurance Lawyer Defeated a Plot to use a Fire to Fund Terrorism Available as a Paperback and as a Kindle book M.O.M. & The Taipei Fraud How an Experienced Adjuster Defeated a $7 Million Fake Burglary Claim Available as a paperback. Available as a Kindle book. Arson-For-Profit Fire at the Cowboy Bar & Grill Available as a paperback. Available as a Kindle book. The Defeat of a Fake $10 Million Jewelry Robbery Insurance Claim Available as a Kindle Book here. Available as a paperback here. New Books from Full Court Press The Insurance Law Deskbook. Paperback, only $95.00 available at https://www.fastcase.com/store/fcp/insurance-law-deskbook-2/ California Insurance Law Deskbook Available at https://www.fastcase.com/store/fcp/california-insurance-law-deskbook/ a paperback for only $95.00. Zalma on Property and Casualty Insurance Insurance Law Deskbook Learn the insurance basics that are essential to every civil practitioner. Available at Fastcase.com bookstore. California Insurance Law Deskbook Fastcase.com bookstore. Insurance Bad Faith and Punitive Damages Deskbook All available at fastcase.com bookstore. From Thomson Reuters Property Investigation Checklists Uncovering Insurance Fraud, 13th Edition Available at https://store.legal.thomsonreuters.com/law-products/Forms/Property-Investigation-Checklists-Uncovering-Insurance-Fraud-13th/p/106702361 and as a THOMSON REUTERS PROVIEW eBOOK EDITION https://store.legal.thomsonreuters.com/law-products/Forms/Property-Investigation-Checklists-Uncovering-Insurance-Fraud-13th/p/106702363 From the American Bar Association The Insurance Fraud Deskbook This book is written for individuals who are focused on the effort to reduce expensive and pervasive occurrences of insurance fraud. Lawyers who represent insurers, claims personnel, prosecutors and their investigators can all benefit from this exhaustive resource Available at http://shop.americanbar.org/eBus/Default.aspx?TabID=251&productId=214624; ororders@americanbar.org, or 800-285-2221. Diminutionin Value Damages How to Determine the Proper Measure ofDamage to Real and Personal Property The Commercial Property Insurance Policy Deskbook How to Acquire a Commercial Property Policy and Present and Collect a First-Party Property Insurance Claim If you buy a book I will add all of your clients to my substack non-subscriber list and as free subscribers to Zalma's Insurance Fraud Letter. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Breach of Condition Precedent Defeats Policy Blog Post 4673 Plaintiff appealed the trial court's order granting summary disposition in favor of defendant. In 23771 Blackstone, LLC v. Conifer Insurance Company, No. 364333, Court of Appeals of Michigan (November 16, 2023) the Plaintiff sought to avoid the fact it breached the material condition requiring it to maintain a fire sprinkler system as a protective safeguard. FACTS A fire occurred at plaintiff's building in Warren, Michigan. The building housed a marijuana growing operation. Defendant insured the property against fire and other hazards under a commercial property insurance policy that defendant originally issued in 2017 and renewed annually thereafter. The parties did not dispute that defendant's policy included a Protective Safeguards Endorsement (PSE), which provided, in pertinent part that the policy required as a condition precedent that the insured was "required to maintain the protective devices or services listed in the Schedule. The protective safeguards to which the endorsement applied was an Automatic Extinguishing System. After the fire, plaintiff filed a claim under the policy, but defendant denied the claim because the property did not have an automatic extinguishing system (AES). Plaintiff sued alleging that defendant had repeatedly inspected the property and "was aware, or should have been aware, from the inspection and other sources, that the property did not have an automatic sprinkler system." The insurer moved for summary disposition arguing that the policy language was clear and unambiguous, and that because plaintiff did not have an AES on its property, it was precluded from recovering fire protection benefits under the terms of the policy. Plaintiff faced with an obvious failure of a condition responded that that defendant should be estopped from denying coverage for lack of an AES because the PSE was ambiguous since it did not actually define the system. The trial court ruled that the insurer was entitled to summary disposition because the policy unambiguously precluded coverage if the insured property did not have an AES, and it was undisputed that there was no AES on plaintiff's property. AMBIGUITY Initially, plaintiff argued that the language of the policy was ambiguous and that it should be construed against defendant and in favor of coverage because an AES is not defined in the PSE. Finding that the language of the PSE was not ambiguous the Court of Appeals noted that the PSE refers to a definition of an "automatic sprinkler system," stating that it means: “a. any automatic fire protective or extinguishing system, including connected: (1) Sprinklers and discharge nozzles; (2) Ducts, pipes, valves, and fittings; (3) Tanks, their component parts and supports; and (4) Pumps and private fire protection mains. b. When supplied from an automatic fire protective system; (1) Non-automatic fire protective systems; and hydrants, standpipes, and outlets." [Emphasis added.] Accordingly, the court concluded that the PSE is not ambiguous because it adequately explained the meaning of an AES. Plaintiff asserted that the AES requirement should not bar coverage for its fire loss because both it and defendant were fully aware that an AES did not exist at the property. Plaintiff was aware because it owned the property, and defendant was aware because multiple inspections revealed that there was no AES on the property. However, the mere fact that defendant and plaintiff may have been aware that the property did not have an AES does not establish that the parties mutually understood and agreed that an AES was not required as a condition of coverage. The policy unambiguously required that the property have an AES as a condition of coverage, and there was no evidence that defendant ever intended or agreed that an AES was not necessary. There was no evidence of a mutually shared factual mistake by the parties regarding the impact of not having an AES at the property on the availability of coverage. ZALMA OPINION Insurance policies are contracts. They agree to indemnify an insured against multiple risks of loss but never every potential risk faced by the insured. When an insurer requires protective safeguards like fire sprinklers or burglar alarms it reduces its premium because of the fact that the risk of loss is lessened by the protective safeguard. Failure to maintain a protective safeguard, a condition precedent, eliminates coverage because the risk of loss was not as promised. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

My Family and I are Thankful to Share This Thanksgiving with You See the full video at and at https://youtu.be/WZV5IWPH4lM My family and I have much to be thankful for this year, not the least of which are the care provided by my daughter, Stephanie, who cares 24/7 for my wife and her mother, Thea who continues to recover her memory. I am personally in good health, walking four to five miles a day, with the assistance of my new aortic heart valve that was inserted with a transcatheter heart valve (TVR). In my semi-retirement I continue working only six to eight hours a day doing what I love the most, writing about insurance, insurance claims, insurance law and acting as an insurance claims consultant and expert witness. I am thankful for you, my friends, clients and readers of “Zalma’s Insurance Fraud Letter,” my blog “Zalma on Insurance,” my Substack publications, my videos on Rumble.com and YouTube.com and my books and other writing including the new Third Edition of the ten volumes of my treatise, “Zalma on Insurance Claims.” As a first generation American I am honored to join with all Americans the ability to celebrate Thanksgiving that started when the United States was a dream and just a colony of Great Britain to give thanks for the good things in life at least once a year. It took Abraham Lincoln, our greatest President, to make it an official holiday. The Thanksgiving holiday gives me and my family the opportunity to consider the blessings we received and to thank all who have made it possible. Please allow me this opportunity to explain to you all the things I, and my family, can give thanks for: 1. I have loved my wife of 55 years since we first met when she was nine and I was twelve. 2. I am thankful that she still loves me and lets me make clear every day that I love her more now than I did when she ignored me when I was 12. 3. My three adult children who are successes in their own right. 4. That my three children, my almost seven-year-old granddaughter live nearby, put up with my wife and I, and are healthy, successful, and mostly happy in what they do. 5. That my grandson graduated from Puget Sound University in Washington state and is now working full time for a major business in Los Angeles. 6. My clients who, for the more than 55 years have allowed me to earn a living doing what I love: practicing law until I let my license go inactive, acting as a consultant, testifying as an expert witness, writing materials to help others provide excellence in claims services and creating videos to help every member of the insurance profession learn more about insurance and insurance claims handling. 7. My publishers the American Bar Association, Full Court Press, Fastcase.com, Thomson Reuters and Amazon.com. 8. My dearly departed parents and grandparents for having the good sense to leave the Ottoman Empire at the beginning of the 20th Century so we could avoid the Holocaust and I could be born American. 9. My country for giving me a place to live and work in peace and complain about it without fear. 10. The state of California, where I was born, and have lived for 81 years, for allowing me to have my home and grow my family, and the ability to pay the high taxes for the privilege. 11. Those of you who read what I write and gain something from it. 12. Eighty one years of mostly good health, but for a small heart attack, clogged arteries and a deteriorated aortic heart valve, that gave me the ability to continue to work – albeit at a reduced rate because of the skills of my cardiologists and the St. John’s hospital in Santa Monica. 13. Allowing me the health and ambition to avoid my cardiologist by walking every day and working on my garden and bonsai. 14. The hundreds of friends I have never met but with whom the Internet has allowed me to communicate in parts of the world I have never visited. 15. The wonder of the Internet that allows me to publish E-books, Zalma’s Insurance Fraud Letter (ZIFL) and my blog instantly on line. 16. That my family can get together to express our thanks for each other and our happiness this year again without a need for anything but enjoying each other’s company. 17. That most of you who I know only by my publications can also gather with your families to express your thanks. 18. To those friends I meet almost every day as I walk along the Ballona Creek bike path. When I enlisted in the U.S. Army in 1967 to avoid the draft I volunteered to serve anywhere in the world other than Viet Nam and was sent, with the wisdom only the U.S. Army Intelligence Corps could understand, to Peoria, Illinois where I became a Special Agent in Charge of an office investigating people who sought security clearances. I was trained to be an investigator and enjoyed every minute of the job. Until the Army I had never seen a river without a concrete bottom only to see the mighty Mississippi as my first real river. I had never seen snow other than in the distance on mountains only to find myself shoveling the snow off the driveway in the small half-of-a-house I rented from an old couple who could not do it themselves. My investigative assignments required me to travel throughout Central Illinois from the Iowa to the Indiana borders. I stopped at court houses along the way, all of which had signs that Abraham Lincoln practiced law there. Those experiences with the courts, law enforcement officers, and court personnel probably gave me the incentive to become a lawyer. When I finished my three year enlistment I returned home, proposed marriage to the love of my life, convinced her to agree and her parents to accept me as a son-in-law. After we were married I began the study of law at night and found my first real job where I could use the skills I learned in the Army. I was hired as a claims trainee at the Fireman’s Fund Insurance Company who spent the time to train me to be a claims adjuster. The training I received was, unlike what is done at modern insurers. It was thorough. I was required to read a treatise on insurance and insurance claims handling. I was sent out with experienced adjusters in all types of insurance Fireman’s Fund wrote, and eventually allowed to deal with the public under close supervision. Contrary to what was done in the insurance industry at the time, the Fireman’s Fund allowed me to study at night while I worked as a full-time insurance adjuster. I was fortunate enough to work for a claims manager - Coleman T. Mobley - who did not require me to go out of state to adjust major storm claims if it interfered with my law school studies. Since I was in law school 50 weeks a year the only storm duty I was required to work was a fire storm that burned from the San Fernando Valley to the ocean at Malibu. Because of Mr. Mobley and the Fireman’s Fund I was able to complete my studies and pass the California Bar in 1971 and was admitted to the California Bar on January 2, 1972. I took a cut in pay to get my first job as an Associate Attorney with a law firm that was willing to teach me to be a lawyer handling every kind of problem a new lawyer could face from wills, tort claims, divorce, drunk driving, trials, depositions, and dozens of orders to show cause in multiple courts around the Inland Empire of California. By doing so, when I started practicing law in 1972, I became a lawyer who could deal with any issue brought to me. I was fortunate enough to move to an insurance law firm in Century City where I was assigned to a coverage lawyer who was trying to deal with over 500 active matters who, when I arrived, assigned me 250 of the matters and pointed me to the firm’s library to learn what to do. At the time new technology was an IBM Selectrict typewriter that could erase errors from the keyboard without the need to use white-out paint. I did legal research in the firm’s large library which, when it was inadequate for the task, I had to drive to the County Law Library in downtown Los Angeles. Research in a large library took days to find support for an issue. I needed three professional legal secretaries to keep up with my dictation. Now, using modern technology, I can do the same legal research in 30 minutes on Fastcase.com, need no secretary, and can operate my expert witness, consulting, writing, training and publishing businesses with no employees. In 1979 I decided it was time to be my own boss. I started a law firm called Barry Zalma, Inc. with a secretary who came from my last firm and brought an IBM Selectrict typewriter with her into a small windowless office. I had obtained a line of credit from a bank that I hoped would carry us until the practice started since the only case I was certain would move to my new firm was my sister’s rear-ender from which I could not take a fee. The office was furnished with a file cabinet from my father-in-law’s dental practice and a dining room table from my wife’s grandmother who had passed away. I received my first call at 8:10 a.m. on the first day, October 1, 1979, and my practice began. I had nothing to do on October 3, 1979 so I wrote an article for publication. After that I had no peace and the firm quickly grew to 9 lawyers and a staff to serve them all defending people who were insured and acting as coverage counsel for insurers who needed advice and defense of bad faith suits. I was more successful than I ever expected. I, whose experience was limited to Los Angeles County and Central Illinois, found a need to travel to Taipei, Taiwan and London, England on behalf of my clients. I worked, as I had learned from my father who survived the Depression, 16 hours a day six or seven days a week. When I became 75 years old my firm had been reduced to a sole practice and I decided it was time to stop practicing law and become a consultant and fulfill my childhood dream to be an author. I am a very lucky and happy man. I do work that I love. I fulfilled my childhood dreams. I Live in a home I have owned for more than 47 years that my wife and I adapted and increased as children were born to meet our needs. I have the love of my life with me and look forward to celebrating our 56th wedding anniversary next month. I am honored that my eldest daughter has come back to live with us and care for my wife and I who are not able to do everything we used to do. I have three wonderful children, two great grandchildren and all live close. My son shares my office building and has time to visit with me as allowed by his busy schedule. I hope, on this Thanksgiving weekend, that you can join my family and me remembering that it is more important to think about our blessings and those things that we have to be thankful for than to get in line for “Black Friday” to buy an inexpensive flat screen t.v. or tablet. Enjoy the holiday and your family as I will. (c) 2023 Barry Zalma

Speculation About Extraneous Facts Does Not Trigger Duty to Defend AutoDistributors, Inc. and Steven Schneider (collectively "AutoDistributors") appealed the district court's order granting judgment on the pleadings in favor of Scottsdale Insurance Company, Nationwide E&S Specialty, Scottsdale Indemnity Company, and National Casualty Company (collectively "Defendants"). In Autodistributors, Inc. et al v. Nationwide E&S Specialty; et al., No. 22-16445, United States Court of Appeals, Ninth Circuit (November 17, 2023) the Ninth Circuit interpreted the insurance policy. FACTS This case arose from an underlying dispute between Sixt Franchise USA, LLC, Sixt Rent a Car, LLC (collectively "Sixt"), and AutoDistributors. Sixt Franchise and AutoDistributors entered into a Franchise Agreement that allowed AutoDistributors to operate a Sixt rental car franchise and use Sixt's trademarks in connection with that franchise. Sixt sued AutoDistributors claiming it violated the Franchise Agreement by operating a used-car-sales business at the franchise location and using Sixt's trademarks in connection with that business. AutoDistributors tendered the suit to its insurer Scottsdale Insurance Company ("Scottsdale"), and Scottsdale refused to defend or indemnify. AutoDistributors sued the Defendants for breach of contract and breach of the implied covenant of good faith and fair dealing. The district court ruled for Defendants, holding that Scottsdale had no duty to defend AutoDistributors. DUTY TO DEFEND An insurer must defend a suit which potentially seeks damages within the coverage of the policy. To determine whether there is a duty to defend, the insurer compares the terms of the policy with the allegations of the complaint and any other facts that are reasonably inferable or otherwise known. If the allegations suggest a possibility of coverage, the duty to defend is triggered-even if the precise causes of action pled by the third-party complaint fall outside policy coverage. AutoDistributors' insurance policy covers "personal and advertising injury," defined to mean injury "arising out of" a specified list of offenses. The policy excludes "'personal and advertising injury' arising out of the infringement of copyright, patent, trademark, trade secret or other intellectual property rights" (the "IP Exclusion"). Some Of Sixt's Allegations Clearly Fell Outside The Policy's Coverage. Sixt alleged that AutoDistributors breached the Franchise Agreement by "operating the unauthorized Used Car Sales Business at the Store" and "using the Store to facilitate a start-up incubator business." That alleged conduct did not implicate any of the offenses in the definition of "personal and advertising injury," so it did not trigger the duty to defend. Sixt also alleged that AutoDistributors infringed Sixt's trademarks by using the trademarks in connection with the used car business. Based on these allegations, Sixt alleged claims of trademark infringement and false designation of origin under the Lanham Act, common law trademark infringement, and common law unfair competition. This theory was also part of Sixt's breach of contract claim because Sixt argued that the Franchise Agreement restricted the use of the trademarks. Even assuming that trademark infringement would constitute a "personal and advertising injury," there was no coverage for these claims because of the policy's IP Exclusion. That exclusion provides that the policy does not cover "personal and advertising injury" arising out of the infringement of "trademark." Although the Sixt Complaint used the word "slogan" once, that single word did not trigger the duty to defend when read in context. AutoDistributors points to no allegation in Sixt's Complaint describing AutoDistributors' use of items associated with Sixt's slogans, as opposed to Sixt's trademarks. An insured may not trigger the duty to defend by speculating about extraneous “facts” regarding potential liability or ways in which the third party claimant might amend its complaint at some future date. The extrinsic facts which may create a duty to defend must be known by the insurer at the inception of the third party lawsuit. ZALMA OPINION Personal Injury liability coverage is a very broad coverage providing defense and indemnity for multiple types of offenses. The Scottsdale policy in this case provided a Personal Injury coverage but limited it with an IP exclusion that defeated the claim of AutoDistributors because it was clear and unambiguous. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

After Paying the Insured More than $637,000 he Sues for More Vahagun Safarian appealed from the judgment entered after the trial court granted the summary judgment motion filed by Fire Insurance Exchange (Fire). Safarian sued Fire for breach of contract and related claims after Fire denied in part Safarian's claim for coverage under his homeowner's insurance policy for damage to the foundation of his home resulting from a burst pipe that flooded the soil around the home. In Vahagun Safarian v. Fire Insurance Exchange, B323862, California Court of Appeals, Second District, Seventh Division (November 14, 2023) Safarian asked the Court of Appeals to provide coverage for damages over the almost $700,000 received for damages due to a water line break and water damages. FACTUAL BACKGROUND Fire issued Safarian homeowner's insurance policy effective from June 13, 2017 through June 13, 2018 (Policy). The insured property was Safarian's three-level hillside home on Sunset Drive in Los Angeles (Property). Paragraph 12, states, "We do not insure loss or damage consisting of, composed of or which is the movement, settling, cracking, bulging, shrinking, heaving, or expanding of any part of covered property, whether natural or otherwise .... [¶] [This] includes by way of example but not limited to foundations, foundation fill material, foundation piers, foundation beams, slabs, pads, patios, walls, floors." The policy also provided that "This water exclusion applies even if water combines or contributes in any way with any other excluded cause of loss or damage hereunder to cause loss or damage..." And the policy at paragraph (f) specifically excludes foundation damage. PROPERTY DAMAGE, CLAIM, AND LAWSUIT Water flooded the exterior of the Property as well. Safarian submitted a claim to Fire for water damage to the Property. Fire ultimately paid Safarian $637,999 in policy benefits, including $313,371 for damage to the Property, with the remainder for damage to personal property and loss of use. Safarian hired William Musakhanyan, a licensed public adjuster, to handle his claim. Musakhanyan notified Hodson that the Property may have sustained foundation damage as a result of the plumbing breach. On March 12, 2018 a structural engineer retained by Safarian reported, "The water leak also appears to have caused fill soils in the crawl [space] . . . to settle," which in turn caused interior floor tiles to separate and an exterior foundation wall to develop cracks. Musakhanyan transmitted the engineer's report to Hodson, who on April 10 responded by email, "Per our conversation-as you know, Earth movement is not covered." Fire denied Safarian's claim for foundation damage. Safarian sued . FIRE'S MOTION FOR SUMMARY JUDGMENT Fire argued it paid all covered damages and therefore did not breach the Policy. The trial court found the language of the Policy was undisputed and the trial court found that Safarian failed to meet his burden to prove Fire intentionally relinquished its right to invoke the paragraph (f) foundation damage exclusion, and he could not meet this burden based only on Fire's denial of coverage in light of Fire's reservation of rights in the denial letter. Finally, the court found that because there was no breach of contract, Fire was entitled to summary judgment as to the entire action. DISCUSSION In general, interpretation of an insurance policy is a question of law that is decided under settled rules of contract interpretation. The insured has the burden of establishing that a claim, unless specifically excluded, is within basic coverage, while the insurer has the burden of establishing that a specific exclusion applies. On appeal, Safarian contended the water coverage extension provided coverage for any damage to the Property resulting from a plumbing breach, regardless of whether the damage was an uninsured loss under the Policy's general terms. The Court of Appeal agreed with the trial court that foundation damage is not a covered loss under the Policy, regardless of the cause, and Fire was entitled to judgment as a matter of law. The dispositive issue here was not, as argued by Safarian, the convergence of a covered peril (flooding from the burst pipe) and an excluded peril (earth movement, water, soil conditions, and settling) because the purported covered peril is not covered at all. The water damage extension for a burst pipe itself has an exclusion in paragraph (f) for foundation damage. Thus, neither peril provides coverage. Safarian contended that Fire waived its right to enforce the paragraph (f) foundation damage exclusion by failing to assert it during the adjustment of his claim. Waiver is not established merely by evidence that the insurer failed to specify the exclusion in a letter reserving rights. Safarian did not present evidence that Fire intentionally relinquished its right to assert the paragraph (f) foundation damage exclusion. Fire was free to develop one defense without impliedly waiving another. ZALMA OPINION No insurance policy covers every possible risk of loss. Fire found coverage for the damage done by the burst pipe and paid the insured what he agreed to concerning damage to the structure and his contents for more than $670,000. He then sought payment for damages due to settlement of the structure and its foundation that was clearly and unambiguously excluded by trying to create coverage without a basis in the policy or in the facts of the claims handling. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

RTFP - Court Reads the Full Policy Mark Scafella appealed the order granting Erie Insurance Company ("Erie") and Stanley Geho summary judgment in the underlying declaratory judgment action. In Mark Scafella v. Erie Insurance Company and Stanley Geho, No. 22-ICA-173, West Virginia Intermediate Court of Appeals (November 14, 2023) the West Virginia Court of Appeals resolved the dispute by reading the full policy. FACTUAL BACKGROUND In 2017, Mr. Scafella purchased the Terra Alta property known as "Country Chapel Farm" ("Farm"). The property included a residential home, a large barn with an adjacent milk house, several sheds or smaller barns, and a small country church. The underlying case arises from a fire on Scafella's real property. The insurance claims Scafella made following that fire loss did not provide the result he desired and litigation followed. THE POLICY The property was insured under a homeowner's policy of insurance issued by Erie, identified as the "ErieSecure Home Insurance Policy" ("policy"). The policy included other structures coverage limits of $101,400, and coverage for personal property of up to $380,250. The PROPERTY PROTECTION-SECTION 1, OUR PROMISE- Other Structures provision of the policy contained a standard business pursuits exclusion, which excluded loss to property “1. used in whole or in part for "business" purposes …; or 2. used to store "business" property.” It was undisputed that Mr. Scafella's then fiance (Ms. Lisa Smith), obtained two insurance quotes from Erie for the property, one including an incidental farming endorsement and one without the endorsement. Ultimately, Mr. Scafella chose the insurance quote that did not include the incidental farming endorsement, a less costly option. It is further undisputed that in completing his application for insurance with Erie for the property at issue, that Mr. Scafella averred that there were no farm animals or pets on the premises and that he did not conduct "any business or occupational pursuits at the premises." IT IS NOT NICE TO LIE TO YOUR INSURER Despite indicating to the contrary in his application for insurance, Mr. Scafella does not deny that after taking possession of the property, he began operating a business out of the milk house. That business, Olivia's, LLC ("Olivia's"), was a retail store selling meat, cheese, and sandwiches. Prior to the fire, Mr. Scafella alleges that he had begun to renovate the large barn structure into a catering hall and restaurant (to be known as Sophie's Serendipity, LLC), as part of his plan to develop the farm into a destination wedding venue. There is no question that the February 2, 2019, fire caused significant structural damage to the large barn and resulted in the loss of numerous items of Mr. Scafella's personal property, which were stored in the large barn structure. Although the milk house was adjacent and physically abutted the barn, Mr. Scafella claims that it was not affected by the fire and that the origin of the fire had nothing to do with the business operations therein. THE CLAIMS Shortly after the fire loss, Mr. Scafella filed an insurance claim with Erie for that loss. Property adjuster Stanley Geho was assigned by Erie to handle the claim. As part of his investigation, Mr. Geho visited the fire-damaged property and drew a diagram that depicted the milk house as an addition to the barn structure with an interior doorway connecting the two areas. Mr. Geho's depiction of the premises was consistent with a statement made by Ms. Smith who, during a recorded statement taken by Mr. Geho, described Olivia's as being "in a different part of the [barn] building," but "in the barn itself." Erie denied the portion of the fire loss claim for the structure of the large barn, under the business pursuits exclusion of the Other Structures provision of the policy, as Mr. Scafella was operating a business (Olivia's) out of the structure. The circuit court found that the "milk house and the barn are one structure" and the court concluded that the evidence on the record did not support Mr. Scafella's claims. DISCUSSION The Court of Appeals concluded that Mr. Scafella failed to meet his burden to establish waiver, the court of appeals found no error in the circuit court's award of summary judgment to Erie and Mr. Geho. Other Structures Provision The Court of Appeals concluded that the large barn area where the fire occurred and the milk house (where Mr. Scafella operated Olivia's) are the same structure. In fact, when providing a recorded statement to Erie after the fire loss, Ms. Smith identified the barn and the milk house as being part of one building. Claw-Back Provision Here, Mr. Scafella represented that the property within the large barn was his personal property to collect $67,640.80 under the personal property coverage in his Erie policy, possibly to avoid the $2,500.00 limit to "business" personal property under the SPECIAL LIMITS - Personal Property Coverage section of policy. The Court of Appeals concluded that to permit Mr. Scafella to change his classification of the property at issue to recover under corresponding portions of the policy is impermissible and would permit him a windfall and coverage for which he did not pay. Finding no error the trial court's decision was affirmed. ZALMA OPINION When a person is given a choice of available coverages and chooses the one less expensive he or she is gambling that the loss will fit within the lesser coverages, and misrepresents the facts at the site of loss to obtain the less expensive coverage the insured is committing fraud. After the loss Scafella attempted to change the policy he purchased into the policy he refused to pay for, with multiple legal machinations that the courts of West Virginia refused to honor. The moral: always tell the truth to your prospective insurer and never buy a policy that does not provide coverage for the risks the property faces. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

MURDAUGH'S FRAUD DESTROYS ANOTHER LAWYER Cory Howerton Fleming (State Bar No. 292955) asked for voluntary discipline by the Supreme Court before the issuance of a formal complaint. In the petition, Fleming admitted that during his representation of a client in South Carolina, he violated Rules 1.4 (a) (3), 1.5 (c) (1), 1.7 (a), 1.8 (b), 1.15 (I) (c), 5.4 (c), and 8.4 (a) (4) of the Georgia Rules of Professional Conduct ("GRPC") found in Bar Rule 4-102 (d). As discipline, Fleming requested that the Court accept the voluntary surrender of his license to practice law. In The Matter Of Cory Howerton Fleming, No. S23Y0970, Supreme Court of Georgia (November 7, 2023) the Supreme Court was asked to accept attorney Fleming's request that he be disbarred to avoid a trial since his guilt was obvious. The State Bar filed a response, stating that the Supreme Court should accept the petition. UNETHICAL CONDUCT With regard to the conduct at issue in this case, Fleming admitted that he was asked by R. Alexander Murdaugh, a lawyer then-licensed in South Carolina to represent a woman injured at his property. The woman-who was a long-time employee of Murdaugh's died from her injuries, leaving two sons. Murdaugh had two insurance policies providing coverage for this type of incident, one providing $505,000 and an excess providing an additional $5,000,000. At some point in 2018, Fleming filed suit against Murdaugh-presumably on behalf of the woman's estate-and, in November 2018, the primary paid its policy limits to settle Fleming's client's claims against Murdaugh. Fleming did not inform his client about this fact. Instead Fleming allowed Chad Westendorf to replace the son as the Personal Representative for the estate. Fleming admitted that the petition to the probate court detailed payments of $166,000 to his law firm for legal fees and $11,500 for "prosecution expenses"; that those figures were misrepresentations; and that there were no legitimate prosecution expenses. In March 2019 a mediation with the excess insurer ultimately led to an additional settlement in Fleming's client's case that involved a total payment by the excess of $3,800,000. Fleming admitted that the presentation to the court was false. MURDAUGH TAKES THE SETTLEMENT After both settlements, Murdaugh, a defendant in the lawsuit, requested that Fleming make the net settlement proceeds check payable to "Forge," apparently explaining that he had created structured settlement or annuity accounts for the woman's surviving sons with Michael E. Gunn of Forge Consulting, LLC ("Forge Consulting"). Murdaugh apparently converted the funds to his own benefit. Although it was clear that the money was removed from Flemming's IOLTA account and that it was not used for the purposes it was supposed to be used for, Fleming did not specify whether he retained the $26,200 for his own benefit or passed some of the money to Murdaugh, as suggested by the Bar's response to the petition. He did admit, however, that he agreed to hold monies in his firm's IOLTA account from the settlement that would be accessible to Murdaugh. Fleming claimed that from the time of the settlement until September 2021, he was under the impression that Murdaugh was handling the creation of structured settlement annuities with Forge Consulting for the benefit of the heirs of Fleming's client (the plaintiff). He asserted that, on September 3, 2021, he learned from one of Murdaugh's law partners that the firm had discovered that Murdaugh was stealing money from it by using a fictitious bank account in the name of "FORGE dba R. Murdaugh." Fleming then stated that thereafter, he was informed that Forge Consulting did not have any accounts related to this matter and had never received the funds from either settlement. By this conduct Fleming admitted that his failure to reasonably communicate with the Personal Representative of the woman's estate. Fleming stated that he has admitted facts sufficient to allow the imposition of discipline and offers to surrender his license as a way of streamlining the disciplinary process. The Supreme Court concluded that Fleming admitted conduct sufficient to establish violations of the Rules of Professional Conduct and that the underlying facts may well be more egregious than Fleming admits. Regardless, the Supreme Court found no need to delve into those details because the conduct to which Fleming admitted was sufficient to establish the violations that Fleming's conduct was worse than he acknowledges because he admitted that he warranted the most serious sanction the Supreme Court can impose in a bar discipline matter: disbarment. As a result it ordered that the name of Cory Howerton Fleming be removed from the rolls of persons authorized to practice law in the State of Georgia. ZALMA OPINION Murdaugh was convicted of murder of his wife and son while trying to avoid prosecution for the theft of funds from his law firm and insurance fraud perpetrated on his professional liability insurers. He convinced Flemming to join in his crime and steal more than $4 million from the estate of his late housekeeper who, with the evidence of wrongdoing overwhelming sought to save the money and time to defend a disbarment proceeding, voluntarily asked the court to remove his license. The sad destruction of a lawyer who trusted a prominent lawyer who turned out to be a murder, thief and insurance fraudster. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

ZIFL - Volume 27 Issue 22

No Written Agreement Ends Claim as an Additional Insured The Chicago White Sox, Ltd., et al (the White Sox plaintiffs), and State Automobile Mutual Insurance Company (State Auto), the insurer for defendant We Clean Maintenance and Supplies, Inc. (We Clean) disputed whether the White Sox were additional insureds of We Clean's policy with State Auto. After a patron was injured at a Chicago White Sox game, he filed a lawsuit against the White Sox plaintiffs alleging that State Auto had wrongfully denied coverage. The circuit court granted summary judgment in favor of State Auto, finding that the White Sox plaintiffs were not "additional insureds." In Chicago White Sox, Ltd.; Chisox Corporation; et al v. State Automobile Mutual Insurance Company et al, No. 1-23-0101, 2023 IL App (1st) 230101-U, Court of Appeals of Illinois, First District, Third Division (November 8, 2023) BACKGROUND Beginning in 2008 and continuing at least through 2012, the White Sox plaintiffs entered into a series of written agreements with We Clean pursuant to which We Clean agreed to provide cleaning services for all home games played by the Chicago White Sox during the applicable baseball season. In 2011, while at U.S. Cellular Field, Raymond Myles was injured as he was walking down a ramp. Myles sued. The lawsuit was ultimately settled for an undisclosed amount. In 2014, the White Sox plaintiffs tendered the defense of the underlying lawsuit to State Auto, the insurer for We Clean, as additional insureds under We Clean's insurance policy. We Clean was insured by State Auto under a commercial general liability insurance policy. While We Clean was the sole named insured on the policy, the policy contained an endorsement adding as an additional insured "[a]ny person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract or written agreement that such person or organization be added as an additional insured on your policy." No "Indemnification and Insurance Agreement" for either 2010 or 2011 is contained in the record on appeal, and an affidavit from a White Sox representative indicates that the White Sox plaintiffs were unable to locate such a document. The circuit court granted State Auto's motion for summary judgment. ANALYSIS In this case, the sole issue is whether the White Sox plaintiffs qualified as additional insureds under We Clean's insurance policy. The language of the service contract merely requires We Clean to "comply with all insurance requirements set forth" by the White Sox plaintiffs and does not expressly require We Clean to name the White Sox plaintiffs as additional insureds under its insurance policy. Without a written agreement that the White Sox plaintiffs were to be named as additional insureds under We Clean's policy, there is no basis for finding that they were, in fact, additional insureds and the circuit court properly granted summary judgment in favor of State Auto. CONCLUSION The circuit court properly granted summary judgment in favor of the defendant insurance company where the plaintiffs were not additional insureds under the insurance policy, as there was no written agreement between the plaintiffs and the insured requiring them to be named as such. Since there was no written agreement between We Clean and the White Sox plaintiffs requiring the White Sox plaintiffs to be named as additional insureds under We Clean's policy, the White Sox plaintiffs were not entitled to coverage by State Auto. ZALMA OPINION Reading the full policy is a requirement of everyone who is involved in acquiring or making claims against an insurance policy. The White Sox failed to create a contract with We Clean requiring it to make the White Sox an additional insured. Since it failed to include that requirement in the We Clean contract the White Sox gave up the right to be an additional insured of We Clean and the Sox and its insurer was obligated to defend it without help from We Clean's insurer. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Insurance Fraudsters Convicted of Other Crimes INSURANCE CRIME DOES NOT PAY In my experience those who commit property or casualty insurance fraud are seldom arrested, even more rarely are they tried and convicted. Roberto Torner was an insurance criminal who avoided arrest for his insurance fraud activities but, because he was a serious criminal and dangerous, was arrested, tried and convicted of violent crimes. He filed a motion to vacate his conviction and sentence in United States Of America v. Roberto Torner, CRIMINAL No. 3:17-343, United States District Court, M.D. Pennsylvania (November 1, 2023) and the USDC kept Torner in Prison. BACKGROUND In June 2015, the Luzerne County Drug Task Force commenced an investigation into Roberto Torner after receiving information about his heroin trafficking and firearms activity from a confidential informant (C.I.). Investigators subsequently used the C.I. to conduct a controlled purchase of approximately five grams of heroin from Torner, his girlfriend Liza Robles, and his associate David Alzugaray-Lugones. The controlled buy and conversations leading up to the event were captured in a series of recorded phone calls and body camera videos obtained by the C.I. The ATF commenced an investigation into Torner, Robles, and Alzugaray-Lugones involving suspected arson, insurance fraud, and firearms offenses. On August 28, 2017, after obtaining information about Robles's historical firearms purchases and activities, and after interviewing witnesses who reported recent instances of Torner possessing firearms, the ATF executed search warrants at Torner's properties. During the execution of those warrants, the ATF recovered multiple firearms and ammunition. The ATF interviewed additional witnesses, who relayed accounts of Torner possessing firearms. Torner was granted pretrial release after being charged in a criminal complaint and subsequent indictment. Thereafter, the ATF obtained information from witnesses that Torner possessed C-4 explosives while on pretrial release. On January 5, 2018, law enforcement officials executed a search warrant at one of Torner's properties, where they recovered approximately 1.5 pounds of stolen U.S. military C-4 plastic explosives. Following a 12-day trial, Torner and his codefendants were convicted of all counts and Torner was sentenced to 270 months of imprisonment, five years of supervised release, and a $20,000 fine. Torner challenged his conviction and sentence on direct appeal, only to have Third Circuit Court of Appeals affirm his conviction and sentence. Torner alleged that counsel provided ineffective assistance at trial for failing to seek suppression of recordings. DISCUSSION A review of the motion and the government's brief, as well as the law and the claims make it clear that Torner's claims are without merit. Torner has not shown either the denial of a constitutional right nor that jurists of reason would disagree with this court's resolution of his claims and the court denied Torner's motion to vacate. ZALMA OPINION I have spent the last 55 years working to help insurers and police authorities to defeat those who commit insurance fraud and disabuse authorities of the fact that insurance fraud is a non-violent crime and a crime without victims. Judges have been known to say from the bench that an insurance company can't be a victim. In this case the ATF took on an insurance fraudster and convicted him of crimes of violence and possession of weapons and stolen explosives. His activities defrauding insurers and dealing drugs were ignored and his other criminal conduct stopped the fraud by putting Torner and his co-defendants in prison and stopped his work as an insurance fraud perpetrator. A small victory for the defrauded insurers. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Ambiguous Policy Wording Results in Adoption of Continuous Trigger of Coverage The United States Court of Appeals for the Fourth Circuit certified a question to the Supreme Court of Appeals of West Virginia asking: "[a]t what point in time does bodily injury occur to trigger insurance coverage for claims stemming from chemical exposure or other analogous harm that contributed to the development of a latent illness?" In Westfield Insurance Company v. Sistersville Tank Works, Inc.; et al, No. 22-848, Supreme Court of Appeals of West Virginia (November 8, 2023) the Court answered the question. The Supreme Court answered the question with the conclusion that a "continuous-trigger" theory applies to the policy, as the policy is ambiguous as to when coverage is triggered. OPINION The gateway to coverage under every standardized, commercial general liability (or "CGL") policy issued in the United States since 1966 is proof that a bodily injury or property damage has "occurred." FACTUAL BACKGROUND Sistersville Tank Works ("STW") has, since late 1984, been a family-owned and -operated West Virginia corporation. STW manufactures, installs, and repairs various types of tanks at industrial sites throughout world, including at several chemical plants in West Virginia. Beginning on the first day of 1985, STW was protected under a commercial general liability ("CGL") policy it purchased from Westfield Insurance Company ("Westfield"), an Ohio corporation. Westfield thereafter renewed STW's coverage under a series of CGL policies with one-year (or more) coverage periods. The CGL policy defines a "bodily injury" as a "bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time." At different points in 2014, 2015, and 2016, three men were diagnosed with various forms of cancer. In 2016 and 2017, the "claimants" (the men with cancer and/or their spouses) sued STW in three separate lawsuits in West Virginia state courts. The claimants alleged the cancers were, in some part, caused by STW's tanks. STW asked Westfield to provide a defense and indemnification to the three lawsuits under its previously purchased CGL policies. Westfield denied coverage under its CGL policies for the three suits and, in June 2018, filed a complaint against STW for declaratory relief and after discovery, the parties filed competing motions for summary judgment. In an order dated September 4, 2020, the district court granted a judgment in favor of STW and found Westfield owed STW a duty to defend and to indemnify under all of its policies issued from 1985 through 2010. The district court concluded that Westfield's promise to cover a bodily injury that "occurs during the policy period" was ambiguous in light of the latent disease claims asserted against STW. The district court ruled that the language in Westfield's policy did not clearly identify when coverage was "triggered" in instances where a claimant alleged repeated chemical exposures and the gradual development of a disease over successive policy periods. The Supreme Court had never addressed the question raised before the district court. Nevertheless, the district court calculated that this Court would apply the continuous-trigger theory to clarify the ambiguous language in Westfield's policy. DISCUSSION Occurrence-based CGL policies provide coverage if the event insured against takes place during the policy period, irrespective of when a claim is presented. The certified question raises a different, more complicated set of circumstances. Westfield contends that manifestation of a disease is the sole trigger of coverage under its occurrence-based CGL policies. On the other hand, STW takes the position that the occurrence language incorporates a "continuous" trigger theory of coverage. STW's argument encompasses the entirety of Westfield's insuring agreement. STW points out that, by definition, an "occurrence" under Westfield's policy includes "continuous or repeated exposure" to a "harmful condition []" that results in "bodily injury, sickness or disease." It is evident from the parties' competing positions that the meaning of the policy's insuring agreement is uncertain or doubtful in the context of latent or progressive diseases, as the parties have shown the occurrence language used is susceptible to at least two plausible constructions. Here, the occurrence and bodily injury provisions that Westfield chose to incorporate into its insuring agreement fail to precisely articulate a trigger of coverage. They are, the Supreme Court concluded, ambiguous. History shows that the "occurrence" language incorporated into the CGL policy was designed with the goal of affording coverage for singular, repeated, or continuous exposures to hazardous substances if those exposures cause either a singular or a progressive bodily injury, sickness, or disease. The Supreme Court concluded, after review of the history of the drafting of the CGL, that the drafters of the occurrence language used by Westfield intended to incorporate a continuous trigger of coverage. The Policy Language Supports A Continuous Trigger The reasoning of the Supreme Court’s recognition of the continuous trigger of coverage has the effect of spreading the risk of loss widely to all of the occurrence-based insurance policies in effect during the entire process of injury or damage. As one court said, the continuous trigger theory is the most efficient doctrine for allocation of liability amongst insurers for toxic waste cases, because it encourages all insurers to monitor risks and charge appropriate premiums. Therefore, an occurrence based CGL policy covers all injuries, sicknesses, or diseases that occur during coverage, not merely those that become manifest. Under the continuous-trigger theory, when a claim is made alleging a progressive injury caused by chemical exposure or other analogous harm, every occurrence-based policy in effect from the initial exposure, through the latency and development period, and up to the manifestation of the bodily injury, sickness, or disease, is triggered and must cover the claim. ZALMA OPINION It is axiomatic that when a court finds an ambiguity in an insurance policy it must be interpreted in favor of coverage for the insured. West Virginia found the policy was ambiguous as to trigger and therefore, overruling a strenuous dissent, and applied the continuous trigger expanding the coverages available to STW for the claims of the plaintiffs that STW was responsible for the illnesses because under the continuous-trigger theory of coverage every moment from the first exposure to the harmful chemicals up to and including the date of diagnosis would be covered by Westfield's 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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Plea of Guilty of Murder for Insurance Cannot Be Withdrawn In State Of Ohio v. Darin Brusiter, No. 112410, 2023-Ohio-3794, Court of Appeals of Ohio, Eighth District, Cuyahoga (October 19, 2023) Darin Brusiter ("Brusiter") appealed for the third time from the trial court's denial of his post-sentence motion to withdraw his guilty plea. FACTS In April 2011, Brusiter was charged with two counts of aggravated murder, with murder-for-hire and firearm specifications, kidnapping, insurance fraud, and tampering with evidence in relation to the killing of Asia Harris ("Harris"). Harris's husband Samuel Wilson was also charged in the same indictment. Brusiter filed a motion to suppress the statements he made to the police as being in violation of Miranda v. Arizona, 384 U.S. 436, 86 S.Ct. 1602, 16 L.Ed.2d 694 (1966). On May 2, 2012, the court denied Brusiter's motion and that same day he pled guilty to one count each of aggravated murder, kidnapping, insurance fraud, and tampering with evidence. The court sentenced Brusiter to an agreed term of "33 years to life" in prison. Brusiter filed a direct appeal of the trial court's denial of his motion to suppress and the Court of Appeals earlier affirmed Brusiter's convictions, finding that he waived his right to appeal pretrial rulings when he pled guilty. In finding that Brusiter waived his right to challenge the denial of his motion to suppress, the Court of Appeals also concluded that "the record on appeal affirmatively demonstrates that [Brusiter] entered a voluntary, knowing and intelligent guilty plea as required by Crim.R. 11." Brusiter filed a second motion to withdraw guilty plea. In this motion, Brusiter argued that there are two, apparently specious, reasons he should be allowed to withdraw his guilty plea. The trial court summarily denied both motions to withdraw guilty plea ANALYSIS Appellate courts review a trial court's ruling on a motion to withdraw a guilty plea for an abuse of discretion. The presumption of prejudice recognized in precedent applies regardless of whether a defendant has signed an appeal waiver. Brusiter's 2020 motion to withdraw his guilty plea, which alleged ineffective assistance of counsel and the improper denial of his motion to suppress, is barred by the doctrine of res judicata. Brusiter filed a direct appeal in which he challenged the trial court's denial of his motion to suppress. The Court of Appeals three times affirmed Brusiter's convictions, finding that he waived his right to challenge the denial of his motion to suppress by pleading guilty. The Court of Appeals also found that Brusiter's guilty plea was voluntary, knowing, and intelligent. Therefore, the trial court did not abuse its discretion by denying Brusiter's motion to withdraw his guilty plea without holding a hearing. The motion was filed almost nine years after he pled guilty to aggravated murder and other offenses associated with the death of Harris. ZALMA OPINION Although life insurance fraud by murder is a seriously and violent crime Mr. Brusiter decided it was important to plead guilty with a guaranteed sentence of only 33 years rather than a death sentence, he abused the kindness of the courts of Ohio by filing multiple motions and appeals to withdraw his plea. Since he's in jail for at least 20 more years it made no sense to punish him further or seek monetary sanctions he could not pay, but any further appeals or motions should be summarily dismissed without an opinion. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

The Florida Supreme Court was asked to resolve a certified question from a lower court about whether a personal injury damages award must be reduced by a payment the plaintiff received to settle a bad faith claim against his uninsured motorist insurance carrier. In Alberta S. Ellison v. Randy Willoughby, No. SC2021-1580, Supreme Court of Florida (November 2, 2023) the Supreme Court answered the questions posed. FACTS Respondent/plaintiff Randy Willoughby was badly injured in a car crash. After the accident, he sued Petitioner/defendant Alberta Ellison, bringing a vicarious liability claim based on Ellison's co-ownership of the other car in the crash. Willoughby also sued his own uninsured motorist insurance carrier to recover policy benefits and for statutory bad faith damages. Willoughby and his insurer settled before trial for $4 million. The subsequent trial against Ellison resulted in a $30 million jury verdict for Willoughby. Ellison then asked the trial court to set off the $4 million insurance settlement against the damages award, but the court denied the motion. The Second District Court of Appeal affirmed the denial of the set off request. It also certified this two-part question as one of great public importance. Is a settlement payment made by an uninsured motorist insurer to settle a first-party bad faith claim subject to set off under section 768.041(2) or a collateral source within the meaning of section 768.76? The court answered no to both parts of the question, holding that neither statute authorized a set off in this case. The Second District explained that, writing on a blank slate, it would have found Ellison entitled to a set off under section 768.041(2), but it decided that the Supreme Court's case law precluded that result. Based on the parties' arguments and the Supreme Court's review of the record, the Supreme Court determined that Ellison did not ask the trial court for a set off under section 768.041(2) and refused to consider the issue. The Supreme Court rephrased the question posed to it to read: “Is a settlement payment made by an uninsured motorist insurer to settle a first-party bad faith claim a collateral source within the meaning of section 768.76(2)(a)2.?” Although Willoughby sued his uninsured motorist insurance carrier both for the $10,000 limit allowed under his policy and for bad faith damages, his $4 million insurance settlement was undifferentiated (as to claims and categories of damages). Subject to certain exceptions, section 768.76(1) mandates damage award reductions for sums that the plaintiff has received from "collateral sources." The Supreme Court noted that bad faith damages are not "benefits" for purposes of the collateral source definition in section 768.76(2)(a)2. First-party bad faith claims like Willoughby's are a creature of statute, not of the underlying insurance contract between the parties. In particular, the damages recoverable in an uninsured motorist insurance bad faith claim are set out in a statute to be "the total amount of the claimant's damages, including the amount in excess of the policy limits, any interest on unpaid benefits, reasonable attorney's fees and costs, and any damages caused by a violation of a law of this state." The Florida Supreme Court characterized statutory bad faith damages as a penalty. By "extracontractual," the Supreme Court meant that first-party bad faith damages are over and above the amount owed pursuant to the express terms and conditions of the policy after all of the conditions precedent of the insurance policy in respect to payment are fulfilled. The Supreme Court answered its rephrased question with a "no" and concluded that a settlement payment made by an uninsured motorist insurer to settle a first-party bad faith claim is not a collateral source and the judgment could not be offset. ZALMA OPINION The $30 Million verdict was not offset by the $4 Million bad faith settlement. Randy Willoughby was entitled to collect, if possible, the full $34 million in damages and punishment damages. The Supreme Court wisely concluded that punishment damages were not damages for bodily injury and could not be used to reduce the trial court's verdict in the bodily injury suit. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Charge of Insurance Fraud, if True, Not Defamatory In RMS Insurance Services, Inc., d/b/a Flanders Insurance Agency, and Owen G. Costanza, an Individual v. Donald G. Sattler, an Individual, Marion L. Thornberry, an Individual, Elisabeth M. Rodgers, an Individual, and Cheryl Russell-Smith, an Individual, No. 4-23-0143, 2023 IL App (4th) 230143-U, Court of Appeals of Illinois, Fourth District (October 17, 2023) a suit claim of defamation by a politician failed. THE SUIT Plaintiffs RMS Insurance Services, Inc., d/b/a Flanders Insurance Agency (Flanders), and Owen G. Costanza, in his individual capacity, filed a 17-count complaint against defendants Donald G. Sattler, Marion L. Thornberry, Elisabeth M. Rodgers, and Cheryl Russell-Smith. Defendants Sattler, Thornberry, and Rodgers filed a motion for summary judgment asking the court to dismiss plaintiffs' first amended complaint with prejudice the court granted defendants' motions and dismissed plaintiffs' entire amended complaint with prejudice. BACKGROUND According to plaintiffs' complaint, Costanza was the former president of the Village of Poplar Grove. During the 2020 election, Sattler ran against Costanza for the office of village president. Costanza was the incumbent village president at that time. The complaint outlined animosity that existed between Costanza and defendants prior to and after the election. Plaintiffs alleged defendants made defamatory statements about Costanza including accusations Costanza committed criminal acts, including insurance fraud. Sattler defeated Costanza in the election. However, plaintiffs alleged defendants continued to post the allegations against Costanza after the election was over. The trial court (Judge Stephen E. Balogh presiding) found plaintiffs alleged the three defendants wanted to ruin Costanza's career in local politics. The crux of the defendants' motion for summary judgment is that their statements are all privileged because those statements are indisputably, materially and substantially true. Under Illinois law, recovery for a defamatory statement in this case will only be allowed if there is a showing of actual malice. This requires proof by the plaintiff that has established both that the utterance was false and that it was made with knowledge of its falsity or in reckless disregard of whether it was false or true. The trial court indicated it was undisputed that Costanza had been accused of, administratively disciplined for, and fired for committing fraud in the general sense of the word while working in the insurance industry. Costanza had a misdemeanor criminal record and has engaged in fraud, as that term is generally understood, in his work as an insurance professional. ANALYSIS When a party moving for summary judgment supplies facts which, if not contradicted, would entitle the moving party to a judgment as a matter of law, the nonmoving party may not rely on his pleadings alone to raise issues of material fact. A plaintiff must present a factual basis that would arguably entitle the plaintiff to a judgment. Applicable Law To state a defamation claim, a plaintiff must present facts showing that the defendant made a false statement about the plaintiff, that the defendant made an unprivileged publication of that statement to a third party, and that this publication caused damages. Qualified Privilege Even if a statement is defamatory, the statement cannot support a defamation claim if it is true. Regardless, even if a defamatory statement is not substantially true, the statement is not actionable if protected by a qualified privilege. Courts must look at the alleged defamatory statements in context, giving the words of the statement, and any implications arising from them, their natural and obvious meaning. The Court of Appeal concluded that the plaintiffs failed to establish the trial court erred in examining all of the statements made in the flyer. The foundation for all of plaintiffs' claims in their amended complaint was defendants' alleged defamation. As a result, defendants' motion for summary judgment challenged all of plaintiffs' claims. Plaintiffs failed to establish the trial court erred in granting defendants' motion for summary judgment as to the entire amended complaint. ZALMA OPINION Accusing a person of the crime of insurance fraud is per se defamatory. However, if, as in this case, the charge is true the defamation charge fails. Costanza was not convicted of the crime of insurance fraud but lost his license to act as an insurance agent as a result of insurance fraud and was disciplined for the acts. Since the charge was true there was no way for Costanza to succeed in his defamation suit. Politics, Mr. Costanza, learned is a dirty game and will succeed if the allegations against him of insurance fraud was true. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Excess Insurer Owes Nothing Until Primary Insurer's Limits Are Exhausted Vizio, Inc. appealed the district court's order granting Arch Insurance's motion to dismiss. Arch issued an insurance policy to Vizio and provided coverage excess to Navigators Insurance's primary policy, meaning that Arch only covered losses that exceeded the $5 million limit of the Navigators Policy. The Arch Policy "followed form" to Navigators' policy, so it has the same terms except for those specifically contradicted by the Arch Policy. Vizio also had a separate line of general liability coverage with Chubb. In VIZIO, INC. v. ARCH INSURANCE COMPANY, et al., No. 22-55755, United States Court of Appeals, Ninth Circuit (October 30, 2023) Vizio sought coverage from an excess insurer after reaching a settlement with plaintiffs in a class action suit without first getting permission from the excess insurer. FACTS After consumers filed class action lawsuits against Vizio in connection with its Smart TV products (the "Smart TV Litigation"), Vizio notified both Navigators and Arch of its potential insurance claims in a February 2016 email. Arch requested more information, while Navigators denied coverage, citing a policy exclusion. Vizio twice forwarded Navigators' denial letter to Arch, but Vizio never provided Arch with any substantive updates about the Smart TV Litigation. Arch, in turn, failed to convey a coverage decision, though internal records show that Arch decided to deny coverage. About two years later, without seeking or receiving Arch's consent, Vizio settled the Smart TV Litigation for $17 million. On Arch's motion the district court dismissed Vizio's fourth amended complaint with prejudice, holding (among other things) that Vizio failed to properly notify Arch of its claim after the underlying policy limit was exhausted. The District Court Erred In Holding That Providing Notice Prior To Exhaustion Was Improper. Finding that notice was given the district court incorrectly concluded Vizio failed to give proper notice but rightly determined that Arch at that time had no duty to defend or indemnify because the primary policy limit had not yet been exhausted. Vizio's February 2016 email was adequate notice. Vizio Failed To Comply With The Consent Provision Before Settling. First, Vizio admits that it did not obtain Arch's consent prior to settling the Smart TV Litigation as required under the Arch Policy. Since a following form excess policy has the same terms and conditions as the underlying primary policy and, therefore, the Navigators Policy's consent provision is incorporated into the Arch Policy. Second, Vizio argues that Arch's policy conflicts with Navigators' policy. Not so. Lastly, Vizio argues that, if the consent provision applies, Vizio was excused from performing because Arch allegedly breached the policy first by not properly responding to Vizio's February 2016 email. However, Vizio failed to allege facts that would plausibly show that Arch breached any of its duties under the policy. Moreover, even if Arch breached the policy as alleged, this would not excuse Vizio from seeking Arch's consent to the settlement. ANALYSIS Insurance contracts in the state of California incorporate the terms of California's insurance regulations. Vizio relies on California Code of Regulations Title 10, Section 2695.7(b) for the proposition that an insurer's failure to accept or deny a claim within 40 days of tender is a breach of the insurance policy. But Section 2695.7(b) only applies after an insurer receives a "proof of claim," which is defined as evidence of a claim that "reasonably supports the magnitude or the amount of the claimed loss." 10 C.C.R. § 2695.2(s). A "notice of claim" is not a proof of claims. Vizio's February 2016 email to Arch was a notice of claim, not a proof of claim. Vizio also alleged Arch breached the contract when it internally denied coverage and never informed Vizio. Arch's alleged breach would only excuse Vizio's non-consensual settlement if Vizio had requested and been denied coverage. But Arch never informed Vizio that it would deny coverage, and Vizio never followed up or provided Arch with any substantive updates about the Smart TV Litigation. Thus, Vizio, having never been notified of a denial of coverage, still had an obligation to obtain Arch's consent to any settlement, notwithstanding Arch's alleged breach. Without notice, Arch was denied the opportunity to participate in the settlement negotiations, which the insurance contract established as a prerequisite to Arch's duty to pay. Vizio's Claim For The Breach Of The Implied Covenant Of Good Faith And Fair Dealing Fails. Under California law, without a breach of the insurance contract, there can be no breach of the implied covenant of good faith and fair dealing. Because Vizio breached the policy by not soliciting Arch's consent prior to settlement, no benefits were due, and Arch therefore did not breach the contract. Vizio's Equitable Contribution Claim Fails. Equitable contribution is the right to recover, not from the party primarily liable for the loss, but from a co-obligor who shares such liability with the party seeking contribution. However, as a general rule, there is no contribution between a primary and an excess carrier. Arch was indisputably an excess insurer because it only had an obligation to indemnify Vizio once the $5 million limit of the Navigators Policy was exhausted. ZALMA OPINION The Ninth Circuit read the two policies: the primary and the following excess policy. Both policies required that the insured advise the insurers of their intent to settle, obtain permission from the insurer, or lose the right to indemnity. The settlement of the class action may have been a wise decision by Vizio but its failure to seek the participation and consent of Arch cost them any possibility of obtaining contribution from Arch and deprived Arch of the ability to reject coverage or pay. (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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Not Wise to Burden Appellate Court with Multiple Frivolous Motions\ After appellant Donya Entertainment, Inc. noticed a "very significant . . . water intrusion" in a restaurant it had owned and operated for several months, Donya submitted a claim to its insurer, respondent Farmers Insurance Exchange. Farmers denied the claim, asserting it was not covered under Donya's policy. Donya sued Farmers alleging Farmers insufficiently investigated the claim before denying it. Farmers moved for summary judgment, arguing that the policy excluded claims for water seepage that had been occurring for 14 days or more, and the undisputed evidence demonstrated the water seepage had been occurring for at least a year. The trial court granted Farmers' motion, holding there could be no liability for a defective investigation if there was no coverage under the policy. In Donya Entertainment, Inc. v. Farmers Insurance Exchange, B315381, California Court of Appeals (October 27, 2023) the Court of Appeals dealt with multiple incompetent appellate motions and ruled in favor of Farmers. FACTUAL BACKGROUND In May 2020, Donya sued Farmers, alleging that Donya operated a franchise restaurant in Rancho Cucamonga. Donya claimed it purchased the operation from Bacon-Up Corporation in July 2019. Donya alleged Bacon-Up had an insurance policy issued by Farmers when it operated the restaurant, and that Donya had also insured itself with Farmers "under policy number 0606749543," which "provided coverage for Donya with respect to losses caused by water intrusion." Several months after Donya began operating the restaurant, "a very significant experience of water intrusion occurred [,] adversely affecting the kitchen and dining areas." Donya submitted a claim to Farmers. Donya also alleged that "during this time," it learned the restaurant "had experienced similar water intrusion during the ownership and operation" of Bacon-Up, and that Bacon-Up "had made alterations to the physical structure of the flooring in relation to that previous water intrusion." In July 2020, Farmers filed its verified answer. Farmers Moves for Summary Judgment In February 2021, Farmers moved for summary judgment. As to Donya's claim on its own insurance policy, Farmers contended "[t]here can be no tort liability in the absence of coverage" and "the undisputed material facts establish that no coverage exists under the Policy" for Donya's claim. Farmers claimed that the water leaking had been going on for at least a year before Plaintiff reported it." As to Donya's claim against Farmers on Bacon-Up's policy, Farmers argued the obvious: that "a third-party claimant cannot sue the insurer of its litigation adversary for breach of contract or bad faith, or failure to properly investigate." Relevant here are the "Back Up of Sewers or Drains Coverage Endorsement" and the "Limited Coverage for Fungi, Wet Rot, Dry Rot and Bacteria." The former added coverage for "water that . . . backs up or overflows from your sewer or drain" and deleted a provision in the "Exclusions" section excluding such coverage. The latter added an exclusion for "Continuous or repeated seepage or leakage of water . . . that occurs over a period of 14 days or more." Farmers also submitted declarations from three employees of the restaurant who had been employed when it was operated by Bacon-Up. Each of these employees attested that Bacon-Up had concealed from Donya "physical defects that existed at the franchise location, including a very serious water leak coming up from under the slab in the kitchen area going out to the first table in the dining area." These declarations corroborated allegations in Donya's federal complaint that, prior to Donya's purchase of the restaurant, the "restaurant building was contaminated from sewage spills through failing plumbing" and such defects were concealed from Donya. In its sworn pleading, Donya admitted that the claim it submitted on its own policy "alleged that the previous owner of the restaurant location intentionally tampered with the subject restaurant location's plumbing . . . causing the dysfunction resulting in the loss suffered by Donya," but claimed this would be a "covered loss." That sworn statement worked to prove the exclusion applied. The court granted Farmers' motion. Finally, the court found Donya provided no evidence to support a claim against Farmers for denying its claim on Bacon-Up's policy. DISPOSITION The judgment was affirmed. Respondent was awarded its costs on appeal. Respondent was additionally awarded $6,466 in sanctions against Donya's counsel, Amir Pasha Vafaei, only for filing frivolous motions to the Court of Appeals. ZALMA OPINION When I was a young adjuster in 1968-1972 I had to advise insureds there could be no coverage for losses due to water intrusion that had continued for more than 14 days. It was a logical exclusion to help an insured understand the need to properly maintain their property. No one was happy with the decision. Donya admitted in its pleading, plus the testimony of three employees, that the water leaks had been going on for more than a year before the claim was made. The decision of the trial court was affirmed and because Donya's counsel was punished for using frivolous or inept motions to the court of appeal on a case where the insured and insurer obviously knew there was no 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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or 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; 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library.

Statute of Limitations Bars Bad Faith Action PPO Health Insurance Policy Refusal to Pay Starts Running of Statute of Limitation In Christina Terry, individually and on behalf of her minor child, G.T., and on behalf of all others similarly situated v. Health Care Service Corporation, a mutual legal reserve company, d/b/a Blue Cross and Blue Shield of Oklahoma, No. 21-6141, United States Court of Appeals, Tenth Circuit (October 27, 2023) the Tenth Circuit dealt with the Oklahoma Statute of Limitations. THE POLICY A "preferred provider organization" or PPO health insurance plan consists of "networks" made up of healthcare practitioners, facilities, and affiliates who contract with health insurance companies such as Blue Cross and Blue Shield of Oklahoma (BCBSOK) to provide its insureds medical services. Known as "preferred providers," these practitioners, facilities, and affiliates offer healthcare services to PPO policyholders at reduced rates. Preferred providers accept a previously negotiated price from the insurer as payment for covered services. The insured is not responsible for the difference if a preferred provider bills more than the allowable charge. The policy informs the insured that where the policy's allowable charge for a non-contracting provider is less than such provider's billed charges, the insured is responsible for the difference. And according to the policy, "[t]his difference may be considerable." FACTS & THE CLAIM Due to G.T.'s precarious condition, his doctor recommended G.T. be transported via air ambulance to the University of Oklahoma's Children's Hospital in Oklahoma City. Rocky Mountain Holdings (RMH) transported G.T. and billed charges of $49,999.00 for the 109-mile trip. Plaintiff filed a putative class action against BCBSOK on April 27, 2018, alleging breach of contract, bad faith, and fraud. She invoked the district court's diversity jurisdiction by way of her putative class action. The court granted BCBSOK's motion and entered judgment in its favor. The district court held the policy's limitations provision barred Plaintiff's breach of contract claim. The Tenth Circuit noted that a reasonable insured, who by definition has performed due diligence, could readily ascertain from the foregoing language that Plaintiff filed her breach of contract claim later than three years after the expiration of the time within which her policy required her to file an insurance claim. Plaintiff was aware, or certainly should have been aware, of an injury-that is, BCBSOK would not meet her demands-at the time RMH, the emergency air service responsible for transporting her infant, had a garnishment order issued against her in February 2016. Having established Plaintiff's knowledge of an injury, the next inquiry is at what point could Plaintiff have become aware of facts establishing her causes of action for fraud and bad faith. Because Plaintiff's claim rests in large part on the terms of her PPO policy, once she realized her injury, nothing prohibited her at that point from pursuing her bad faith claim based upon the wording of the policy and BSBSOK alleged representations regarding coverage, both of which she says entitle her to relief. Plaintiff argued that BCBSOK was exercising bad faith throughout her ordeal and did not stop until just before she filed suit in April 2018. The plaintiff knew of facts that would put a reasonable person on notice that wrongful conduct caused the harm. In this context, a plaintiff must use reasonable diligence in seeking to discover facts giving rise to a claim for relief. Because Plaintiff's bad faith claim accrued no later than February 2016, the Oklahoma two-year statute of limitations bars such claim. ZALMA OPINION Even health insurance policies are contracts and are contracts subject to state statutes of limitation. Regardless of the conduct of the insurer - even if in bad faith - the insured must file her suit within the times allowed by the state's statutes of limitation. Plaintiff waited too long and it was not enough to claim that the insurer BCBSOK treated her badly by applying its contract 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 to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/s... or at substack at https://barryzalma.substack.com/publi... Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?... Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257 Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claim...

ZIFL Volume 27, Issue 21 The Resource for the Insurance Claims and Insurance Fraud Professionals What a Great Country! This article a fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is posted to help 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. How Insurance Fraud Can Succeed Wo Ping Chen was trained as a physician in Hong Kong. Until Hong Kong was returned by the United Kingdom to the Peoples Republic of China, he was the best-known Orthopedist in the Crown Colony. Fearing problems with the new government he emigrated to Vancouver, British Columbia, Canada as a citizen of the commonwealth. He worked as an employee of the National Health Service for a year and then obtained a work visa to the U.S. and crossed the border into the U.S. only to find he could not work as a physician without a license from a U.S. state and attended a U.S. based medical school. After one year of medical school, one year of internship in a Seattle hospital and one year as a resident Chen was able to restart his life. Read this article and the full 20 pages of this issue at ZIFL in pdf More McClenny Moseley & Associates Issues This is ZIFL’s seventeenth 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. Access Restoration Services U.S., Inc. and MMA Scheme Alleged in Detailed New Orleans Court Pleading and more. Read this article and the full 20 pages of this issue at ZIFL in pdf After Avoiding Prison Fraudster Appeals Unsuccessfully False Lightning Strike Claim Results in Fraud Conviction Sara Weisbeck appealed her convictions for insurance fraud: false material information and identity theft over $1500 and under $10,000, both class “D” felonies. In State of Iowa v. Sara Jo Weisbeck, No. 22-1068, Court of Appeals of Iowa (October 11, 2023) considered her pleas for mercy. Read this article and the full 20 pages of this issue at ZIFL in pdf Health Insurance Fraud Convictions Tampa Pain Management Physician Edward Lubin Agrees to Pay $1.5 Million To Settle False Claims Act Liability for Receiving Bribes and Writing Unnecessary Fentanyl Prescriptions Edward Lubin, a pain management physician agreed to pay the United States $1.5 million to resolve allegations that he violated the False Claims Act (FCA) by causing the submission of claims for fentanyl prescriptions that were written in exchange for kickback payments and that were medically unnecessary. The agreement resolves the United States’ claims against Dr. Lubin under the FCA. The claims resolved by the settlement are allegations only, and there has been no admission or determination of liability. Read this article, and dozens convictions and the full 20 pages of this issue at ZIFL in pdf Read this article and the full 20 pages of this issue at ZIFL in pdf at http://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-11-01-2023.pdf Read this article and the full 20 pages of this issue at ZIFL in pdf Other Insurance Fraud Convictions Claims Adjuster Will Serve Prison Time for Fraud Scheme Paul Richard Massey, of Shady Spring, West Virginia, a former Allstate claims adjuster, will spend one year and a day in prison, forfeit his beach house and pickup truck to the federal government after pleading guilty to wire fraud and money laundering. Federal prosecutors alleged that 51-year-old Massey issued 68 fraudulent checks from Allstate accounts totaling $862,871.29 while he worked as a claims adjuster in 2018 and 2019. Massey had settlement authority for up to $100,000 in his position with Allstate. Read this article, and dozens convictions and the full 20 pages of this issue at ZIFL in pdf Crime Does Not Allow Insurer to Pay Withholding Coverage for Criminal Acts Disincentivizes Criminal Conduct Safeway Insurance Company sought supervisory writs from the judgment of the lower court which denied its motion for summary judgment. In Damien Harris v. Safeway Insurance Company Of Louisiana And Justin Rossette, No. CW 23-165, Court of Appeals of Louisiana, Third Circuit (October 25, 2023) the Louisiana Court of Appeals resolved an insurance coverage dispute over a criminal acts exclusion. Read this article and the full 20 pages of this issue at ZIFL in pdf (c) 2023 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this Newsletter, blog and the videos and let them subscribe to the blog and the videos. Subscribe to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or at substack at https://barryzalma.substack.com/publish/post/107007808 Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01 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; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library