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USAA Punished for it Claims Handling Punitive Damages Should be Awarded With Caution and Within Narrow Limits Read the full article at https://www.linkedin.com/pulse/usaa-punished-claims-handling-barry-zalma-esq-cfe-nbp2c, see the full video at and at and at https://zalma.com/blog plus more than 4950 posts. Posted on December 19, 2024 by Barry Zalma DISPUTE OVER HURRICANE DAMAGES RESULTS IN MAJOR PUNITIVE DAMAGES FOR BAD FAITH Although he Mississippi Supreme Court recognized the need to only award punitive damages with caution and within narrow limits, it did not limit its award in accordance with that maxim. After almost 19 years of litigation the last appeal resolved the various disputes. FACTS Hurricane Katrina destroyed Paul and Sylvia Minor’s home on August 29, 2005. The Minors had a homeowner’s insurance policy with United Services Automobile Association (USAA). The USAA policy covered damage caused by wind but excluded damage caused by storm surge or flood. The Minors reported their loss with USAA, which resulted in a years-long coverage dispute. USAA ultimately issued payments for damage it concluded was caused by wind but not for damage it concluded was caused by storm surge or flood. The Minors maintained that they suffered a total loss caused by wind and demanded that USAA pay the policy limits. The case proceeded to trial in 2013, and the jury awarded the Minors $1,547,293.37 in compensatory damages. In United Services Automobile Association v. Estate Of Sylvia F. Minor, Kathryn Minor and Stephen Minor, No. 2023-CA-00049-SCT, Supreme Court of Mississippi, En Banc (December 5, 2024) resolved the bad faith claims. The issue was ultimately presented to a jury. The jury awarded the Minors $10,000,000 in punitive damages and $457,858.89 in extra-contractual damages (solely attorneys’ fees). USAA appealed, raising several assignments of error. Trial To establish its bad faith claim, the Minor Estate introduced various USAA documents, including (1) portions of the USAA underwriting file; (2) the confidential email regarding (a) the engineer’s March 2006 findings and (b) Bergstrom’s conclusion that USAA would be responsible for paying for all the windows and the contents in rooms with windows; and (3) USAA’s letter to the Minors in June 2006 indicating the majority of damage was due to flooding. Punitive Damages Punitive damages are considered an ‘extraordinary remedy’ and should be awarded ‘with caution and within narrow limits.'” The Supreme Court found that the evidence presented at trial demonstrates a type of conduct for which punitive damages were designed. The Minor Estate provided sufficient proof that USAA acted in bad faith, with complete disregard for the Estate’s rights. Whether The $10 Million Punitive Damages Award Should Be Reversed Or, Alternatively, Reduced. USAA alternatively argues that the $10 million verdict should be reduced because it claims that the damages award is a 22:1 ratio and therefore unconstitutionally disproportionate to the extra-contractual damages awarded ($457,858.89). USAA relies on State Farm Mutual Auto Insurance Co. v. Campbell, 538 U.S. 408, 425, 123 S.Ct. 1513, 1524, 155 L.Ed.2d 585 (2003), which states that “[s]ingle-digit multipliers are more likely to comport with due process.” USAA argued that a 1:1 ratio should apply to the damages award here. The Supreme Court found that punitive damages is less than seven times the amount of compensatory damages, which it concluded clearly falls within the guideline provided in Campbell. A punitive damages award not only serves as a deterrent, it also compensates the plaintiff for its public service in bringing the action. The Supreme Court found the trial court’s decision to force the Minor Estate to use nearly half of its award to pay attorneys’ fees does not adequately compensate the Estate for bringing this action against USAA for its bad faith conduct in handling the Minors’ insurance claim from 2005. Therefore, the Supreme Court concluded that the trial court erred by denying the Estate’s post-trial motion for attorneys’ fees. CONCLUSION In sum, the trial judge did not err as a matter of law by submitting the issue of punitive damages to jury, and the $10 million award of punitive damages is not unconstitutionally disproportionate. The Supreme Court affirmed the jury verdict awarding the Minor Estate $10 million in punitive damages and $457,858.89 in extra-contractual damages as to attorneys’ fees and reverse the judgment of the trial court and render attorneys’ fees on behalf of the Estate in the amount of $4,500,000, plus post-judgment interest at an annual rate of 4 percent from October 3, 2022, the date of judgment, until paid. ZALMA OPINION This case that dragged on through the courts of Mississippi for 19 years and resulted in compensatory damages based upon an interpretation finding coverage for the estate and that the insurer’s conduct was so egregious that the estate was entitled to tort damages plus punitive damages many times more than the compensatory damages. The Supreme Court astonishingly concluded that punitive damages were not limited to punishing the insurer but were payment to the estate for its action on behalf of everyone in the state of Mississippi and that they should not be required to pay their lawyers but that payment should come from the insurer as part of its punishment. The Supreme Court ignored the fact that as a result the estate must pay income taxes on the punishment damages since they are not designed to make the insured whole and punished each member and insured of USAA. In my opinion it’s time the courts of the USA do away with the tort of bad faith to avoid excessive judgments and allow contract disputes to be enlarged into a major amount of punishment for an insurer who rejected a claim based on interpretation of contract terms and the facts of a loss, like this case. In that regard see my book, It’s Time to Abolish The Tort of Bad Faith Available as a paperback here. Available as a Kindle book here. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

Inadequate Litigant’s Cases Dismissed Plaintiff, by her Litigation Appears to Establish the Report for a Mental Health Evaluation Was Appropriate Read the full article at https://lnkd.in/gECRyZ-f, see the full video at https://lnkd.in/gs_4Bby9 and at https://lnkd.in/g67dDK8q, and https://zalma.com/blog plus more than 4950 posts. Post 4950 In Samreen Riaz v. State Of California, et al., F087504, California Court of Appeals, Fifth District (December 2, 2024) the California Court of Appeals found itself asked to resolve suits against an individual and the state of California from an inadequate but excessively litigious plaintiff. FACTS Samreen Riaz was a licensed dentist – she lost her license to practice because of the facts underlying this case. According to her, there is an elaborate conspiracy to harass, stalk, threaten, and ultimately prevent her from testifying in a separate “whistleblower” case involving “OSHA and HIPPA Violations” at a medical facility. Riaz sued raising numerous claims against numerous individuals and government entities. The opposing parties challenged the complaint’s viability through demurrer and anti-SLAPP proceedings. The trial court sustained the demurrers and granted the anti-SLAPP motion, leaving Riaz with no viable claim. Riaz appealed. BACKGROUND The facts underlying this case involve four discrete events. First: Riaz sued a medical facility and suffered an alleged eye injury while attempting to testify in that case. Second: She sought treatment for that eye injury but was refused service and then sued that doctor in small claims court. Third: That doctor reported Riaz to the Dental Board of California which, in turn, initiated mental health competence proceedings against Riaz. Fourth: Riaz’s license to practice dentistry was revoked, and she filed the complaint at issue in this case. Initial Lawsuit Against Medical Facility Acting as a “whistleblower,” Riaz “disclosed … OSHA, Hippa, recruited patient, potential insurance fraud and anti-competent activities in the market” at a medical facility. After filing a lawsuit on that basis, Riaz claimed she suffered “organized harassment,” culminating in “permanent eye damage” after a sheriff-department employee pointed a finger in her face while attempting to enter the courthouse in her “whistleblower” case. Visiting Doctor for Eye Injury Riaz visited Dr. Cantrell to treat an eye injury. She claimed Cantrell became combative, refused to answer Riaz’s questions, and declined to treat Riaz. The next day, Riaz filed a complaint with the Medical Board of California. Several days later, she filed a small claims case against Cantrell, essentially alleging discrimination, negligence, and retaliation. A small claims judgment was eventually entered in Cantrell’s favor. Report to Dental Board Cantrell reported Riaz to the Dental Board. The Dental Board issued an order to Riaz to comply with a mental health examination “to evaluate her fitness to practice safely ….” (See Bus. &Prof. Code, § 820.) Riaz failed to comply with the order. Since Riaz continued to disobey the order, her license to practice dentistry was ultimately revoked. Instant Complaint and Judgment Riaz sued Cantrell, various government entities, and several individuals working for those entities (collectively, the State). The complaint alleged an elaborate conspiracy among all the defendants to injure Riaz, to intimidate her to prevent her from testifying, and to retaliate against her for the “whistleblower” case. The trial court sustained the demurrers and granted the anti-SLAPP motion resulting in total dismissal. DISCUSSION Did the trial court err in granting the anti-SLAPP motion? Did it err in sustaining the demurrers? The California Court of Appeals concluded the trial court did not err. Anti-SLAPP Motion In the anti-SLAPP motion, Cantrell argued his furnishing information to the Dental Board was protected activity and defeated claims “for discrimination, fraud, defamation, retaliation[,] and intentional infliction of emotional distress[.]” In opposition to the anti-SLAPP motion, Riaz claimed again Cantrell “made inaccurate, knowingly misleading statements to the [D]ental [B]oard to defame and harm [Riaz] based on disclosing patient information.” The trial court concluded furnishing those documents to the board constituted protected activity. ANALYSIS Litigation of an anti-SLAPP motion involves a two-step process. First, the moving defendant bears the burden of establishing that the challenged allegations or claims that arise from protected activity in which the defendant has engaged. Second, for each claim that does arise from protected activity, the plaintiff must show the claim has at least minimal merit. If the plaintiff cannot make this showing, the court will, and did, strike the claim. If there is no merit, the claim is stricken. The Court of Appeals noted that Riaz failed to adduce any evidence-including exhibits, declarations, judicial notice, and testimony-to substantiate her allegation Cantrell reported her to the Dental Board for retribution. She failed to adduce admissible evidence on the point. DEMURRERS Both Cantrell and the State filed demurrers to Riaz’s complaint.. Additional Background A small claims plaintiff is collaterally estopped from relitigating the same issue in superior court where the record is sufficiently clear to determine that the issue was litigated and decided against plaintiff in the small claims action. Governmental immunity is an affirmative defense properly raised by demurrer. Government Code section 821.6 immunizes public employees from liability for ‘instituting or prosecuting any judicial or administrative proceeding’ within the scope of their employment, even if the employees act ‘maliciously and without probable cause. Riaz alleged her claims arose in July 2022. Her written government claim was submitted in April 2023, more than six months later. Accordingly, the claims were barred, at least insofar as they stemmed from the section 820 order. CONCLUSION AND SUMMARY Riaz failed to allege colorable claims against either Cantrell or the State. The potential claims against Cantrell were either tried and resolved against her in small claims court or dismissed pursuant to the anti-SLAPP statute. The potential claims against the State were either barred for failure to timely present them under the Government Claims Act, or the State was immune under Government Code sections 821.6, 818.4, and 821.2. ZALMA OPINION It is axiomatic that a person who represents himself has a fool for a client. The litigation history, the multiple actions, and the lack of consistency and evidence, establish that Dr. Cantrell was correct when he advised the Dental Board that a mental health examination to evaluate her fitness to practice safely…” was correct. She refused to fulfill her obligation to the Dental Board to be evaluated because she was concerned she would not pass. This case is an abuse of Doctor Cantrell and the state and should have resulted in serious sanctions. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

Everything Needed by the Insurance Claims Professional from Barry Zalma The Insurance Claims Library Barry Zalma Dec 17, 2024 https://zalma.com/blog/insurance-claims-library/ Over the last 57 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the Insurance Claims Library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals. All of the books are available at the insurance claims library with links to Amazon or the publishers.

Falsely Claiming to Be an Insurer Can be Criminal To Sue for Business Disparagement Evidence is Required Post 4951, Posted on December 17, 2024 by Barry Zalma Read the full article at https://www.linkedin.com/pulse/falsely-claiming-insurer-can-criminal-barry-zalma-esq-cfe-3bwrc, see the full video at and at and at https://zalma.com/blog plus more than 4950 posts. See the full video at and at Plaintiff Route App, Inc.’s (“Route”) moved the USDC to Dismiss two counterclaims asserted by OrderProtection.com, Inc. (“OrderProtection”). In Route App, Inc. v. Orderprotection.Com, Inc.; Julian Wilson, et al, No. 2:23cv606 DAK, United States District Court, D. Utah (December 9, 2024) found no evidence supporting a claim of business disparagement or business defamation. BACKGROUND This case involves a dispute between Route, a post-purchase shipping insurance provider, and a competitor, OrderProtection. In its Complaint, Route alleges that OrderProtection and several of Route’s former employees misappropriated trade secrets to create a competing business. In response to Route’s Complaint, OrderProtection filed an Answer and Counterclaims, asserting four causes of action: (1) Unfair Competition in Violation of the Lanham Act; (2) Defamation Per Se/Defamation/Business Disparagement; (3) Tortious Interference with Existing and Prospective Economic Relations; and (4) Negligent Misrepresentation. The facts pertaining to OrderProtection’s claim for “Defamation/Defamation Per Se/Business Disparagement” are essentially that Route employees have allegedly told OrderProtection customers and potential customers that they should work with Route instead of OrderProtection because Route is a “legal insurance provider” and OrderProtection is not. OrderProtection argued that Route is not a licensed insurance company and that, at best, Route affiliates with an insurance producer to procure its own insurance coverage (which does not benefit customers or merchants). More importantly both Route and OrderProtection in essence both self-fund the warranty protection they provide, and thus a customer is no better off with Route’s protection package than with OrderProtection’s competitive offering. DISCUSSION Specifically, while OrderProtection’s Opposition Memorandum does not explicitly state that it conceded its defamation and defamation per se claims, OrderProtection never addresses Route’s argument that it could not properly maintain these causes of action in the context of this case. Even if OrderProtection had not conceded these claims, it failed to establish that these claims are viable in the context of this case. Further, OrderProtection made no argument that Utah law recognizes a “hybrid” cause of action for “Defamation Per Se/Defamation/Business Disparagement,” wherein a business disparagement claim may be analyzed using defamation or defamation per se case law rather than case law pertaining to a business disparagement claim. Business Disparagement The parties agree that to state a claim for business disparagement (sometimes called injurious falsehood), OrderProtection must allege (1) falsity of the statement made; (2) malice by the party making the statement; and (3) special damages. According to Route, while OrderProtection has made allegations of lost customers, it has not named specific individuals, nor has it alleged with particularity any financial losses, which is required under Rule 9(b) of the Federal Rules of Civil Procedure. The court declined to recognize a “business disparagement per se” cause of action in which special damages need not be alleged, and it declined to recognize a business disparagement claim that relies on a statement that is “false by implication,” which is a concept that has been recognized in defamation cases. Route’s Motion to Dismiss was granted and OrderProtection’s claims for defamation and defamation per se were dismissed with prejudice. Its claim for business disparagement was dismissed without prejudice, and OrderProtection may file a Motion for Leave to Amend by January 10, 2025, if it is able to allege a proper business disparagement claim, as discussed above. ZALMA OPINION Two businesses claiming to be issuers of insurance who were not licensed insurers claimed to be victims of disparagement by the other. Customers, because of the various claims shifted from one party to the other who, contrary to their claims, were self funding what they alleged was insurance of shipments of goods. The court in a Solomon-like decision ignored the fact that both claimed to be insurers when they were not and used the false claims to take over clients. Both lost and the court gave OrderProtection the attempt to state a business disparagement claim implying that the court did not believe OrderProtection would be able to plead a viable cause of action. The State of Utah Department of Insurance should consider this case. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

Intent to Move is not a Residence Residence Premises Requires the Insured to Live in Residence Post 4944 Read the full article at https://www.linkedin.com/pulse/intent-move-residence-barry-zalma-esq-cfe-qmlxc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. In Paul Villalobos v. Clear Blue Insurance Company, No. 24-20125, United States Court of Appeals, Fifth Circuit (December 10, 2024) the the Fifth Circuit affirmed the district court’s dismissa of Plaintiff-Appellant Paul Villalobos’s breach of contract claim following a coverage dispute between himself and his insurer, Clear Blue Insurance Company, because he admitted he did not live in the insured premises. FACTS Villalobos is named on a Clear Blue homeowners’ policy, which provides coverage for property located at 7503 Muirwood Lane in Houston, Texas (the “Property”). The policy’s “Property Coverages” section states in pertinent part: “We cover . . . [t]he dwelling on the ‘residence premises’ shown in the Declarations.” The policy defines “residence premises,” also in pertinent part, as “[t]he one-family dwelling where you reside . . . on the inception date of the policy period shown in the Declarations.” The Declarations page lists Villalobos as the insured, his mailing address as the Property, and the inception date as September 21, 2021. In mid-November 2021, Villalobos reported to Clear Blue that wind and hail had damaged the Property’s roof earlier that month. Clear Blue denied coverage after Villalobos admitted he lived in Colorado and had never resided at the Property. Villalobos sued Clear Blue, alleging breach of contract, breach of the duty of good faith and fair dealing, violations of the Texas Deceptive Trade Practices Act and the Texas Insurance Code, fraud, and ongoing conspiracy to commit illegal acts. ANALYSIS During his deposition, Villalobos testified that he lived in Colorado for over nine years and did not reside at the Property when the Clear Blue policy went into effect. Clear Blue moved for summary judgment on Villalobos’s claims, arguing there was no insurance coverage for Villalobos’s property damage as a matter of law. Applying Louisiana law, the Fifth Circuit has previously determined that an identical residence requirement in a homeowners’ insurance policy required “more than purchasing a home or intending to move into it.” GeoVera Specialty Ins. Co. v. Joachin, 964 F.3d 390, 393 (5th Cir. 2020). Applying Joachin the Fifth Circuit agreed with the district court that the Property did not satisfy the policy’s residence requirement and was not a covered “residence premises” because: it is undisputed that Villalobos did not reside on the Property on the inception date of the Clear Blue policy; and Villalobos’s only material argument on appeal is that he intended to move onto the Property. Joachin held that “intending to move” is not enough. The Fifth Circuit concluded that there is no coverage under the policy. Accordingly, Villalobos’s breach of contract claim failed and the USDC’s judgment was affirmed. ZALMA OPINION That something as obvious as a home in Texas cannot be the residence premises of a person who lives full time in Colorado. Insurers issue property insurance policies providing coverage similar to a homeowners policy to the owner of a rental property while a homeowners policy limits coverage to the person who actually resides at the property. That this case went to the Fifth Circuit was the waste of Plaintiff’s time and money, the waste of the time of the trial court, and the waste of the time of the Fifth Circuit who rendered a concise and clear opinion. A less kind judge or appellate court would have imposed sanctions on the party plaintiff and his counsel. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

What is the Meaning of “Void” An article For Subscribers to Excellence in Claims Handling You can Subscribe for only $5 a month to Excellence in Claims Handling at https://barryzalma.substack.com/subscribe “Void” can mean either void or voidable. Void is defined as “of no legal force or effect and so incapable of confirmation or ratification.” Voidable is defined as “capable of being adjudged void, invalid and of no force (a voidable contract may be set aside usually at the option of one party).”[1] The Restatement 2d of Contracts defines a “voidable contract” as a valid transaction with legal consequences until the power of avoidance is exercised. Although jurisdictions are split as to the meaning of void in this context the distinction is largely semantic since the actions required of insurers wishing to dispose of a void or voidable insurance contract are ultimately the same. The full article is available only to subscribers to Excellence in Claims Handling at substack and you can Subscribe for only $5 a month to Excellence in Claims Handling at https://barryzalma.substack.com/subscribe

Trial Must Proceed Under Plaintiff’s True Name Fraud Defense Insufficient to Allow Plaintiff to Sue Under Pseudonym Post 4944 Read the full article at https://www.linkedin.com/pulse/trial-must-proceed-under-plaintiffs-true-name-barry-zalma-esq-cfe-zc7ic/, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. LITIGANTS MUST NOT HIDE THEIR IDENTITY Plaintiff sued State Farm under a pseudonym. The Court subsequently issued an order requiring Plaintiff to proceed using his actual name. Plaintiff appealed that order, and he now seeks to stay the Court’s order while his appeal is pending in James Doe v. State Farm General Insurance Company, No. 23-cv-04734-JSC, United States District Court, N.D. California (November 26, 2024). BACKGROUND Plaintiff alleged State Farm improperly and in bad faith denied coverage for his claim involving a lost wristwatch that retails at approximately $30,300. He filed his complaint under the pseudonym “James Doe,” insisting a pseudonym was necessary “to protect his privacy, his family, his reputation, and his livelihood, because he has been struggling with mental illnesses.” The Court rescinded its order permitting Plaintiff to proceed anonymously. At a ZOOM hearing the Court informed Plaintiff his actual name appeared on the Zoom screen. Although Plaintiff had yet to file a motion to stay the Court’s order requiring him to proceed under his actual name. The Court denied State Farm’s motion as to the breach of contract and wrongful policy cancellation claims. Jury trial is scheduled to commence in May 2025. DISCUSSION Parties may use pseudonyms in the unusual case when nondisclosure of the party’s identity is necessary to protect a person from harassment, injury, ridicule or personal embarrassment. Plaintiff based his claim for anonymity on two grounds: 1. Plaintiff argues anonymity is necessary because he has revealed highly sensitive and personal matters about himself, his mental illnesses and physical injuries in the course of the case. Yet, Plaintiff did not identify where in the record those highly sensitive matters are discussed. Plaintiff has not sought to redact any portions of his filings, assuming anything in them may be concealed from the public. So, Plaintiff is unlikely to prevail on this theory. 2. Plaintiff argues anonymity is necessary because the accusation of insurance fraud will ruin his reputation for honesty before a jury has passed judgment on his credibility and honesty at trial. Plaintiff states the case involves grave social stigmatization to Plaintiff because he has been accused of committing or seeking to commit insurance fraud. The USDC noted that Plaintiff showed no reasonable probability that an insurer’s material misrepresentation defense transforms a breach of contract claim into a matter of sensitive and highly personal nature, Here, Plaintiff is seeking coverage for a lost wristwatch. If an accusation of insurance fraud were sufficiently stigmatizing to warrant anonymity, then plaintiffs could proceed anonymously virtually anytime they challenge an insurer’s denial of coverage on the basis of a material misrepresentation. The Ninth Circuit’s mandate requires that parties only use pseudonyms in the unusual case. IRREPARABLE INJURY Plaintiff failed to demonstrate he will be irreparably injured absent a stay. The injury Plaintiff fears has already occurred to some extent by Plaintiff’s own doing. He appeared at a public hearing using his actual name. Further, in its recent summary judgment order, the Court concluded there was a dispute of fact as to whether Plaintiff intentionally concealed or misrepresented a material fact or circumstance relating to his insurance. At this point in this proceeding, there has been no finding of insurance fraud. HOIST ON HIS OWN PETARD Given that Plaintiff himself proceeded at a public hearing without taking steps to prevent the very disclosure he claims is so injurious, Plaintiff has not met his burden on the irreparable injury factor. As summary judgment was denied on the breach of contract claim, the case is proceeding to trial. The public interest lies in transparent and public court proceedings, especially trials. The Court denied Plaintiff’s motion to stay the order requiring Plaintiff to proceed under his actual name. ZALMA OPINION Pursuing litigation under a pseudonym because the defendant insurer claimed the Plaintiff attempted insurance fraud because his mental health and reputation would be harmed by the claims is insufficient. First, Plaintiff chose to sue State Farm. He could protect his mental health and reputation by not suing. Second, he was willing to attend a Zoom hearing with his true name showing, thereby effectively waiving the claim of anonymity. It could easily be concluded that he has sued under a pseudonym because he was embarrassed he was caught. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

Lose if You Fail to Respond to Motion for Summary Disposition INSURERS FIND FRAUDSTERS ARE OFTEN INCOMPETENT Post 4943 Read the full article at https://www.linkedin.com/pulse/lose-you-fail-respond-motion-summary-disposition-zalma-esq-cfe-rhstc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. In Chris Kallco v. Melissa Lynn Pugh, Chris Kallco, and Precise MRI Of Michigan, LLC v. Citizens Insurance Company Of The Midwest and Melissa Lynn Pugh, No. 368156, Court of Appeals of Michigan (October 30, 2024) the Court of Appeals resolved the dispute. In a consolidated first-party and third-party no-fault action, plaintiff appealed from two orders granting summary disposition in favor of defendants, including the fraud of the plaintiff. FACTUAL BACKGROUND After a motor vehicle accident involving plaintiff and Pugh. Plaintiff alleged that he sustained injuries from the accident. A year after the accident, plaintiff brought a negligence claim against Pugh, alleging that, because of Pugh’s negligence, plaintiff sustained “severe permanent and progressive personal injuries and serious impairment of a body function, including but not necessarily limited to: Head, Neck, Back, Shoulders ….” Plaintiff also brought a claim against Citizens for PIP benefits, including medical expenses, work loss, and replacement services. Pugh moved for summary disposition arguing that plaintiff could not meet his burden of showing that he sustained a threshold injury under the no-fault act and, therefore, he could not maintain his negligence claim against her. Shortly after Pugh filed her motion, Citizens filed its own motion arguing that plaintiff made material misrepresentations to Citizens regarding the extent of his injuries, which rendered him ineligible for benefits under the statute. The trial court concluded that plaintiff failed to establish that he sustained a serious impairment of body function and therefore summary disposition in favor of Pugh was appropriate. With regard to Citizens’ motion, the trial court found “that absolutely no genuine issue of material fact exists as to whether Plaintiff knowingly made numerous materially false statements in his claims for PIP benefits relative to his alleged injuries and physical restrictions” arising out of the car accident. THRESHOLD INJURY Plaintiff argued that the trial court erred by finding that there was no genuine issue of material fact regarding whether plaintiff met the serious-impairment threshold. However, plaintiff’s failure to respond to the motion for summary disposition made it impossible for him to support his argument. The Plaintiff tried to use the defendants evidence as support against the motions. The attempt failed. The objectively manifested requirement means that plaintiffs must introduce evidence that generally requires medical testimony. Pugh presented objective medical records indicating that there was no physical basis for plaintiff’s subjective complaints of pain. Plaintiff’s deposition testimony only set forth mere subjective complaints of pain. Because plaintiff cannot show a factual dispute as to whether he suffered an objectively manifested impairment, he failed to satisfy the threshold serious-impairment requirement. FRAUDULENT INSURANCE ACT A person who presents or causes to be presented an oral or written statement, including computer-generated information, as part of or in support of a claim for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act that is subject to the penalties imposed by statute. An individual commits a “fraudulent insurance act” when: 1 the person presents or causes to be presented an oral or written statement, 2 the statement is part of or in support of a claim for no-fault benefits, and 3 the claim for benefits was submitted to the to the insurer or the state, further, 4 the person must have known that the statement contained false information, and 5 the statement concerned a fact or thing material to the claim. As to both motions for summary disposition, plaintiff failed to show that any genuine issue of material facts exists. Accordingly, the trial court did not err by granting summary disposition in favor of defendants. ZALMA OPINION As I get older the competence of those who attempt to defraud insurers gets less and less competent. Kallco is an example of the lack of competence. He claimed all kinds of injuries and inability to work or play with his children and, when faced with a competent defense, he ignored the motions, failed to respond, and when he lost he appealed claiming the motions against him gave enough evidence to raise a issue of fact. What a waste of the court’s time and I must ask why, with such convincing evidence, no criminal charges were brought. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk Sorry about the delay in posting. I’m recovering from pneumonia and spending most of the last week in bed with pills, Kleenex, coughing and sleep which I couldn’t get in the hospital. Should be act in shape next week but doctors make no promises.

To Prove Fraud a Preponderance of the evidence is Required An article For Subscribers to Excellence in Claims Handling You can Subscribe for only $5 a month to Excellence in Claims Handling at https://barryzalma.substack.com/subscribe A small portion of what was provided to subscribers.The Supreme Court, reviewing the law in other states found: “Although a few jurisdictions require that exclusions from coverage be proved by clear and convincing evidence, the burden of proving insurance policy exclusionary provisions is usually a preponderance of the evidence. Lee R. Russ & Thomas F. Segalla, 17 Couch on Insurance 254:14 (3d ed. 2003) [hereinafter Couch]; compare Rego v. Conn. Ins. Placement Facility, 593 A.2d 491, 494-95 (Conn. 1991) (following the majority of courts and commentators suggesting that insurers must prove policy defenses by a preponderance of the evidence), with Am. Family Mut. Ins. Co. v. Schley, 978 F. Supp. 870, 874-75 (E.D. Wis. 1997).” Applying the preponderance of the evidence burden to a concealment or misrepresentation defense, the Arizona Supreme Court concluded comports with sound reason and is supported by major commentators in the field. In fact, the Supreme Court pointed out that the Arizona Court of Appeals has held that the defense of arson, which by its nature may impute fraudulent representations to the insurer, must be proved only by a preponderance of the evidence.