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Latest from Zalma on Insurance

The Mitchell Case See the full video at https://youtu.be/DeErhclZO44. By affirming the rescission of an insurance policy because of the misrepresentation or concealment of material fact by Mr. Mitchell. The court in Mitchell defeated an argument that statutory language in a policy of insurance changed the law of rescission. The Court of Appeal summarized its holding as follows: [A]n insurer may, under Insurance Code sections 331 and 359 [of the California Insurance Code], rescind a…
“Owned Vehicle” Exclusion Applies to Title Owner Devan Aslin (“Aslin”) appealed from the judgment of the trial court, finding that Aslin—who was involved in a motorcycle accident—”owned” the motorcycle at issue, and was therefore excluded from underinsured motorist (“UIM”) coverage under three automobile insurance policies Aslin had with Shelter Mutual Insurance Co. (“Shelter”). On appeal, Aslin claims he did not “own” the motorcycle at issue under the Shelter policies, even though the parties agree that…
Duty to Defend See the full video at https://youtu.be/Zys-LAUSNno When liability insurance was first offered to the public it was concerned only with indemnity. As liability insurance developed, the concern about defense costs matured into clauses promising defense as well as indemnity—so-called dual-promise policies. These clauses, although relatively recent, have led to the development of a considerable body of law interpreting the agreements to defend. To properly investigate a casualty or liability claim for defense…
Neither “Waiver” nor “Estoppel” May Modify or Enlarge Risks Covered Claims Made and Reported general liability policies are different from occurrence general liability policies because the reporting requirement defines the limits of the insurer’s obligation—if there is no timely notice, there is no coverage. No excuses are allowed. No argument available that the insurer was not prejudiced by the late report will be honred. In Topp’s Mechanical, Inc., a Nebraska Corporation v. Kinsale Insurance Company,…
Everything Needed by the Insurance Claims Professional from Barry Zalma Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it for insurers and their claims staff to become insurance claims professionals. “Zalma’s Mold & Fungi Handbook” Understanding mold, fungi, and bacteria infestations and what to do about them. This…
The Nature of Underwriting See the full video at https://youtu.be/P8h7Z_4q1NI Before the insurance claims adjuster begins a claims investigation he or she must understand the nature of underwriting because it is how an insurance policy comes into existence. Underwriting is defined as the process of accepting or rejecting risks. It requires a determination by the underwriter of the risks for which insurance is sought and the terms under which the insurance will be written if…
Claiming Loss of Property that Did Not Exist After a Fire Sends Insured to Jail To successfully defraud an insurance company the fraudster must use a modicum of skill, intelligence, and effort. When an insured presents a claim for expensive property he did not own, and did not have sufficient income and assets to own, resulted in arrest and conviction of the insured in The People Of The State Of New York v. Terrell L.…
Attempt to Avoid Sentence Because of Pandemic by Insurance Criminal Fails Mikhail Zemlyansky is serving a 15-year sentence of imprisonment which was imposed in January 2016. He is currently incarcerated at the Federal Correctional Institution at Fairton, New Jersey. Defendant has moved for compassionate release under the First Step Act in light of the COVID-19 pandemic. The Government opposee the motion. In United States Of America v. Mikhail Zemlyansky, 12-CR-171-01 (JPO), United States District Court…
Applying Ethics to the Work of the Insurance Professional See the full video at https://youtu.be/cwo71d82wK4 When the insurance professional has a well-developed ethical compass he or she can always apply that ethical compass to his or her work and will almost always treat the insureds and claimants he or she comes in contact with fairly and in good faith. Failure to do so avoids the essence of insurance. The insurance professional must comply with the…
Pollution Exclusion Enforced by Fifth Circuit A plaintiff sued its insurance company for breach of contract, breach of good faith and fair dealing, and tortious breach of contract due to the company’s failure to pay a claim after its property was damaged by gaseous hydrochloric acid. The insurer’s motion for summary judgment applying the total pollution exclusion was granted and the insured appealed. The Fifth Circuit resolved the dispute in Burroughs Diesel, Incorporated v. The…