I am Thankful Thanksgiving Wishes from the Zalma Family Post 4938 Posted on November 27, 2024 by Barry Zalma See the full video at and at 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. My family and I have much to be thankful for this year. My first born daughter, Stephanie Zalma, continues to care for my wife 24 hours a day 7 days a week with love and patience as Thea continues as Nana to our two grandchildren and the loving mother of our three children. After receiving a new Aortic Heart Valve I am personally in good health, walking about 25 miles a week. Exercising my, apparently unusual, mode of retirement, I work 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. To me, I am thankful for you, my friends, clients and readers of “Zalma’s Insurance Fraud Letter,” my blog “Zalma on Insurance,” and my books and other writing including the third Edition of the ten volumes of my treatise, “Zalma on Insurance Claims” and the Fourteenth Edition of “Property Investigation Checklists.” 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 have 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 continue to give thanks for: 1. I have loved my wife of almost 57 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 who put up with my wife and I, and are healthy, successful, and mostly happy in what they do. 5. My almost eight-year-old granddaughter and my 22 year-old grandson live nearby, my grandson is now a successful college graduate from Puget Sound University in Washington state and working full time in I.T. 6. My clients who, for the more than 57 years have allowed me to earn a living doing what I love. I practiced law until I let my license go inactive, acting as a consultant, testifying as an expert witness and writing materials to help others provide excellence in claims services as members of the insurance profession. 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 82 years, for allowing me to have my home and grow my family, and the ability to pay California’s high taxes for the privilege. 11. Those of you who read what I write and gain something from it. 12. Eighty two years of mostly good health, but for a small heart attack,clogged arteries, a failed Aortic heart valve, ant the surgeons that gave me the ability to continue to work – albeit at a reduced rate. 13. Allowing me the health and ambition to avoid my cardiologist by walking every day and working on my garden and bonsai with one of my Chinese Elms in a pot for more than 49 years. 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, 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 and some good food. 17. That most of you who I know only by my publications can also gather with your families to express your thanks. When I enlisted in the U.S. Army in 1964, I volunteered ostensibly to avoid the draft and volunteered to serve anywhere in the world. Fortunately, the Army made assignments in alphabetical order and I was sent by the U.S. Army Intelligence Corps 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, who fortunately for me, accepted. 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 American Insurance Company who spent the time to train me to be a claims adjuster. The training was, unlike modern insurers, 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 to learn as they adjusted claims, and eventually allowed to deal with the public under close supervision. Contrary to the requirements of the insurance industry at the time, Fireman’s Fund allowed me to study law 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 catastrophe 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 be 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 be able 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 and, who, when I arrived, assigned 250 of the matters to me and pointed me to the firm’s library to learn what to do. At the time new technology was an IBM Selectric 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 drove to the County Law Library in downtown Los Angeles to adequately research legal questions . 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 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 Selectric 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 sure of when I moved into my new office, was my sister’s rear-ender from which I could not, and did 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, from Alan Worboys, a claims person speaking for Certain Underwriters at Lloyd’s, London and my practice began. Alan became, and still is, a long time friend. 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 counsel concerning interpretation of insurance contracts and how to deal with attempted fraud. I, and the lawyers who joined the firm also provided defense to insureds of our clients and defense of suits against the insurers for tort, including the tort of bad faith. 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 back 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 49 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 57th 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 grandchildren and all live close. My son, and his business shares my office building and has time to visit with me as allowed by his busy schedule. (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 This is a long article so go to https://www.linkedin.com/pulse/i-am-thankful-barry-zalma-esq-cfe-bzysc, to read the full article.

Elon Musk JUST LAUNCHED Top Secret SR-72 DARKSTAR & SHOCKS Russia & China! In a world where technological marvels emerge at a breakneck pace, few innovations have left the world utterly speechless—until now. Imagine a plane that can travel six times the speed of sound, reaching the edge of space faster than anything humanity has ever created. A machine so advanced, it could render current military defenses obsolete. Today, that imagination becomes reality. Elon Musk, the man who redefined electric cars and made space travel look easy, has just unveiled the SR-72 Darkstar. But what does this hypersonic beast mean for the future of aviation, global security, and beyond? Could this be the dawn of a new era in human achievement? https://imgflip.com/i/9bkjis

Elon Musk JUST LAUNCHED Top Secret SR-72 DARKSTAR & SHOCKS Russia & China! In a world where technological marvels emerge at a breakneck pace, few innovations have left the world utterly speechless—until now. Imagine a plane that can travel six times the speed of sound, reaching the edge of space faster than anything humanity has ever created. A machine so advanced, it could render current military defenses obsolete. Today, that imagination becomes reality. Elon Musk, the man who redefined electric cars and made space travel look easy, has just unveiled the SR-72 Darkstar. But what does this hypersonic beast mean for the future of aviation, global security, and beyond? Could this be the dawn of a new era in human achievement? https://imgflip.com/i/9bkjis

Requiring an Insurer to Waive its Right to Subrogation is a Valid & Enforceable Contract Waiver of Subrogation Applies in Marine Insurance Policy Post 4938 Read the full article at https://www.linkedin.com/pulse/requiring-insurer-waive-its-right-subrogation-valid-zalma-esq-cfe-gkn3c/, see the full video at and at and at https://zalma.com/blog. Competing motions for summary judgment were presented to the USDC for the Eastern District of Louisiana in a limitation-of-liability action arising from the listing and capsizing of the liftboat RAM XVIII. The motions present the principal question whether Fieldwood (charterer of the liftboat) must defend and indemnify Aries (owner of the liftboat) and U.S. Specialty (Aries’s insurer) under a master time charter agreement from the personal-injury claims brought by employees of Fluid Crane & Construction, Inc. and United Fire and Safety, LLC (Fieldwood’s subcontractors) who were aboard the RAM XVIII when it capsized. Fieldwood moved for partial summary judgment enforcing waivers of subrogation in the master time charter agreement and the relevant U.S. Specialty insurance policy. In The Matter Of Aries Marine Corporation, et al., Civil Action Nos. 19-10850, 19-13138, United States District Court, E.D. Louisiana (November 20, 2024) the USDC resolved the disputes. BACKGROUND The USDC resolved a five-year-old limitation-of-liability action that arose from the listing and capsizing of the liftboat RAM XVIII in the Gulf of Mexico. Aries chartered the RAM XVIII to Fieldwood under a master time charter agreement (the “Time Charter”) in relation to work being performed on one of Fieldwood’s offshore platforms. Under those Master Services Contracts, Fluid Crane and United Fire sent employees to work on Fieldwood’s platform; those employees were aboard the RAM XVIII when it capsized. U.S. Specialty, for its part, underwrote an insurance policy (the “Policy”) that provided Aries with certain coverages in effect when the RAM XVIII capsized. Six employees of Fluid Crane and one employee of United Fire-all of whom were aboard the RAM XVIII when it capsized-brought personal injury claims against Aries. The motions before the Court present the principal question whether Fieldwood must defend and indemnify Aries and U.S. Specialty from those personal-injury claims. THE TIME CHARTER Section 10 features a waiver-of-subrogation provision mandating that “[u]nderwriters of all policies of insurance required [by Section 10] shall waive their rights of subrogation against the Charterer Group,” which includes Fieldwood. THE POLICY The Policy provides coverage to Aries for protection and indemnity, including coverage for personal-injury liability. The Policy includes a waiver-of-subrogation provision that applies to the protection-and-indemnity coverage. A separate section of the Policy-governing hull-insurance coverage contains a waiver-of-subrogation provision and a provision naming Fieldwood as an additional insured. THE MASTER SERVICES CONTRACTS. Fieldwood executed the Master Services Contracts with Fluid Crane and United Fire, respectively. Fluid Crane and United Fire agreed to indemnify the other entities involved from claims asserted by their own employees, as well as to be responsible for defense costs for such claims. ANALYSIS Fieldwood’s Motion Fieldwood moved the Court to grant partial summary judgment enforcing waivers of subrogation in the Time Charter and Policy and dismissing Aries’s crossclaim and U.S. Specialty’s complaint-in-intervention. The Court held that Fieldwood is entitled to partial summary judgment because a review of the Time Charter and the Policy confirms that both Aries and U.S. Specialty have waived their rights of subrogation against Fieldwood. U.S. Specialty Waived Its Rights of Subrogation The Policy unambiguously waives U.S. Specialty’s right of subrogation in favor of Fieldwood. The Policy features a waiver-of-subrogation provision. The Time Charter qualifies as a “written contract” that “require[s]” U.S. Specialty to waive its rights of subrogation against Fieldwood because the Time Charter features a waiver-of-subrogation provision mandating that “[u]nderwriters of all policies of insurance required [by Section 10 of the Time Charter] shall waive their rights of subrogation against the Charterer Group,” which is defined to include Fieldwood. Because a review of the Time Charter and the Policy confirms that U.S. Specialty unambiguously waived its rights of subrogation against Fieldwood, and because the claims asserted in U.S. Specialty’s complaint-in-intervention rest on a subrogation theory, the Court granted Fieldwood’s motion for summary judgment and dismissed with prejudice U.S. Specialty’s complaint-in-intervention. The USDC concluded that the waivers of subrogation in Fieldwood’s favor are enforceable, and Aries and U.S. Specialty have not adequately presented any argument that would allow the Court to hold that their claims for defense and indemnity can survive despite the enforceability of those waivers of subrogation. Fieldwood’s motion for partial summary judgment was GRANTED. ZALMA OPINION Insurance policies like the marine policy interpreted in this case contain standard language authorizing the insured to waive the insurers’ right of subrogation if it does so before there is a loss. Since the litigants sought subrogation recovery which it had waived by the standard language of its policy this five year long litigation was resolved by the acceptance of the waiver. (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

https://www.youtube.com/watch?v=KusixGQ1GjE

https://jihadwatch.org/2024/11/pakistan-muslim-security-guard-rapes-six-year-old-christian-girl-at-her-school

John Chapter Six – I Am The Bread Of Life https://pilgrimdevotions.com/john-chapter-six-i-am-the-bread-of-life/

Zalma’s Insurance Fraud Letter September 15, 2024 Zalma’s Insurance Fraud Letter A ClaimSchool™ Publication © 2024 Barry Zalma & ClaimSchool, Inc. Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkycVolume 28, Issue 21 – November 15, 2024 “Honor, justice, and humanity, forbid us tamely to surrender that freedom which we received from our gallant ancestors, and which our innocent posterity have a right to receive from us. We cannot endure the infamy and guilt of resigning succeeding generations to that wretchedness which inevitably awaits them if we basely entail hereditary bondage on them.” Thomas Jefferson Insurance Fraud Requires Doctor to Lose his License Sexual Misconduct, Fraud, Bribery & Unnecessary Surgery Revokes License Louis Quartararo appealed from an August 22, 2022 final agency decision of the State Board of Medical Examiners (Board), revoking his license to practice medicine and surgery in New Jersey. The Superior Court of New Jersey, in In The Matter Of The Suspension Or Revocation Of The License Of Louis Quartararo, M.D. License No. 25MA07137700 To Practice Medicine And Surgery In The State Of New Jersey, No. A-0425-22, Superior Court of New Jersey, Appellate Division (October 31, 2024) affirmed the revocation. The Board charged Dr. Quartararo with engaging in sexual contact with patients; negligent acts by performing surgeries with co-surgeons who lacked the requisite privileges; and acts of fraud, deception and misrepresentation by miscoding procedures on patient operative reports and listing procedures in the reports he had not performed for the purpose of ensuring insurance coverage. FACTS Quartararo was a physician and Board-certified orthopedic surgeon licensed to practice medicine in New Jersey. Approximately one week before K.D. was scheduled to meet with Board investigators, Quartararo gave K.D. $20,916, which K.D. told an investigator was “for school.” Later, Quartararo’s attorney offered her more money to retract the statement she had made to the Board about her relationship with Quartararo. THE OAL HEARING At a formal hearing, the Board’s expert, Dr. Ashraf addressed Quartararo’s treatment of patient Y.O. revealed that the surgical procedures Quartararo performed were not medically necessary. In reviewing the description of Quartararo’s procedure on Y.O.’s spine, Dr. Ashraf concluded that Quartararo’s surgery on Y.O.’s completely normal spine “is gross negligence.” Regarding the fraud claims alleging that Quartararo had failed to properly code surgical procedures that he performed on E.S., D.C., Y.O., L.V., D.E., and V.C., Dr. Ashraf testified that the “whole function” of the “operations” section on the first page of the operative report was to list the procedures that were performed during the operation and he testified that, despite “laminotomy” appearing on the first page of V.C.’s and D.C.’s reports, their post-surgery MRIs revealed that laminotomies had not been performed. THE ALJ’S DECISION The Administrative Law Judge (ALJ) issued a comprehensive seventy-nine-page decision and concluded that Quartararo had “engaged in gross malpractice, professional misconduct, failure to comply with regulations administered by the Board, and failure to be of good moral character.” On August 22, 2022, the Board filed its final decision, revoking Quartararo’s license for a minimum of seven years from the date of voluntary surrender, April 5, 2019. The Board concluded that Quartararo’s “misconduct warrants a serious penalty in excess of that recommended by [the ALJ]” and that he “flagrantly ignored, and in fact shattered professional norms when he engaged in sexual misconduct with patients Y.R. and K.D.” The Board found Quartararo’s conduct was “so egregious that the only appropriate discipline is a license revocation.” The Board also imposed an aggregate monetary sanction of $343,909.75, comprised of a civil penalty of $90,000, $61,684.75 in costs, and $192,225 in attorney’s fees. Quartararo Argued The Board determined that revocation was warranted because he preyed on two vulnerable patients employed intimidation and coercion tactics to dissuade at least one of his victims-K.D.- from testifying about the true nature of their relation and resorted to making threats resulting in the issuance of a temporary restraining order against him. Quartararo admitted he had not performed laminotomies and that he had used the laminotomy code to ensure that he would be paid by insurance carriers. He did so rather than correctly coding the procedures he actually performed because of the risk he would otherwise not be paid. ZIFL OPINION Quartararo admitted before the ALJ that he committed fraud by billing insurers for laminotomies that he did not perform. As such he admitted to committing a federal as well as a New Jersey felony that should be presented to the US Attorney and the local District Attorney for prosecution. He lost his license because he took advantage sexually of vulnerable patients, committed gross acts of malpractice and profited from knowing insurance fraud. The people of New Jersey are now safe from his criminal and unprofessional conduct for a few more years, and in my opinion he should be prosecuted and sentenced to prison for the fraud. Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkyc IT PAYS INSURER DEFENDANTS TO INVESTIGATE INJURY CLAIMS 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) affirmed the trial court’s decision. Plaintiff appealed from two orders granting summary disposition in favor of defendants even though he failed to respond to either motion. FACTUAL BACKGROUND This case arises out of a motor vehicle accident that occurred on March 9, 2020 involving plaintiff and Pugh. Plaintiff alleges 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 and Citizens 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. Pugh submitted the deposition testimony of the plaintiff and the report of an independent medical examination (IME) conducted by Dr. James Bragman on December 27, 2021. Dr. Bragman further observed that plaintiff had “near full range of motion” in his neck and that he was “eminently capable” of standing and touching his toes despite his refusal to do so. Dr. Bragman noted that plaintiff had “very little” medical treatment documented in his records and that he had been undergoing physical therapy for six months with no medical basis for doing so. An investigator’s report includes pictures of plaintiff walking, riding a child’s bicycle, squatting, bending over, lifting a bicycle out of a minivan unassisted, playing with a dog, driving a car, and twisting his neck. Citizens’ motion argued that plaintiff made material misrepresentations to Citizens regarding the extent of his injuries, which rendered him ineligible for benefits. The trial court found that, based upon the evidence presented, plaintiff failed to establish that he sustained a serious impairment of body function and therefore summary disposition in favor of Pugh was appropriate. THRESHOLD INJURY Plaintiff argued that the trial court erred by granting summary disposition in favor of Pugh. Under the no fault statute, the threshold question of whether the person has suffered a serious impairment of body function should be determined by the court as a matter of law as long as there is no factual dispute regarding the nature and extent of the person’s injuries that is material to determining whether the threshold standards are met. Plaintiff was obligated to respond to Pugh’s motion in order to meet his burden of demonstrating that a fact question existed as to whether he suffered a serious impairment of body function. The parts of plaintiff’s deposition identified by Pugh do not establish a genuine issue of material fact as to whether he suffered a serious impairment of body function. The relevant portions of plaintiff’s deposition testimony fail to rebut the evidence and instead set forth, at best, mere subjective complaints of pain. FRAUDULENT INSURANCE ACT The fraud statute finds that a person who presents or causes or to be presented an oral or written statement knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act under that is subject to the penalties imposed under the statute. A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment of PIP benefits. 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 MAIPF. 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. ZIFL OPINION The evidence presented by the defendants were damning since they established the injuries claimed were false. Plaintiff failed to respond to the motions to his detriment and sought reconsideration without any admissible evidence that he was truly injured. The defendants established that the Plaintiff committed fraud and he is lucky that this was a civil finding not a criminal proceeding that, in my opinion, should be presented by the prosecutor. More McClenny Moseley & Associates Issues This is ZIFL’s thirty seventh installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. Health Insurance Fraud Convictions Pharmacist and Brother Convicted of $15M Medicare, Medicaid, and Private Insurer Fraud Scheme Raad Kouza, a pharmacist in Wayne County, Michigan, and his brother, Ramis Kouza, of Oakland County, Michigan, billed Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for prescription medications that they did not dispense at pharmacies they owned or operated in Michigan. A federal jury convicted the pharmacy owner and his brother November 8, 2024 for conspiracy to commit health care fraud and wire fraud. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Indicators of Bad Faith Set Up Some of the more common red flags of a bad faith set-up include the following: The claimant makes a policy limits settlement demand quickly after an accident, thereby depriving the insurer of the ability to conduct a full investigation. Quick demands that are combined with a limited amount of time to accept, again, in the hopes that records cannot be obtained and the investigation cannot be completed within that limited time period, and the settlement will be refused. The claimant makes a settlement offer with one or more unusual acceptance conditions. The involvement of the claimant’s counsel pre-dates certain medical or psychiatric care (e.g., testing and treatment for alleged mild traumatic brain injury) Read the full article and the full issue of ZIFL at http://https//zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024.pdf Convictions of Other Than Health Insurance Fraud Star in Reality TV Series Pleads Guilty Crop Insurance Fraud Steve A. McBee, 52, waived his right to a grand jury and pleaded guilty to a federal information that charges him with one count of federal crop insurance fraud. McBee, a Missouri farmer who appears in a reality TV show about his family’s farming operation pleaded guilty this week to a multi-million dollar fraud scheme involving federal crop insurance benefits. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Chutzpah – STOLI Fraudster Claims Hardship Felon Seeks Release from Home Confinement in Luxury Apartment in New York City Insurance Fraud is a serious crime, especially when it takes advantage of the elderly to defraud insurers in a Stranger Originated Life Insurance (STOLI) scheme. In United States Of America v. Michael Binday, No. 12 CR 152 (CM), United States District Court, S.D. New York (November 4, 2024) the defendant continued to use the wealth he gained from his fraud to impose on the courts of the United States with frivolous and unfounded motions. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Barry Zalma, Esq., CFE Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.

🚨🚨 From a friend **Please READ the following to the end … It will open your understanding of what the World as a whole suffered in the past four years … and Still Suffer …** **Their Plandemic Failed … but don’t worry … They Still Have PLAN B … starting in 2025 … that will last at least to 2030 …** **Unless We The People … ACT … Immediately …** ***“CDC Planned National Quarantine Camps”*** ***By Jeffrey A. Tucker November 7, 2024*** ***“The plan was to enforce this with a vaccine passport. It broke. Once the news leaked that the shot didn’t stop infection or transmission, the planners lost public support and the scheme collapsed.”*** ***“No matter how bad you think COVID-19 policies were, they were intended to be worse. Consider the vaccine passports alone.*** ***Six cities were locked down to include only the vaccinated in public indoor places. They were New York City, Boston, Chicago, New Orleans, Washington, D.C., and Seattle.*** ***The plan was to enforce this with a vaccine passport. It broke. Once the news leaked that the shot didn’t stop infection or transmission, the planners lost public support and the scheme collapsed.*** ***It was undoubtedly planned to be permanent and nationwide if not worldwide. Instead, the scheme had to be dialled back.*** ***Features of the Centers for Disease Control and Prevention (CDC) edicts did incredible damage. It imposed the rent moratorium. It decreed the ridiculous ‘six feet of distance’ and ‘mask mandates’.*** ***It forced Plexiglas as the interface for commercial transactions. It implied that mail-in balloting must be the norm, which probably flipped the election. It delayed the reopening as long as possible. It was sadistic.*** ***Even with all that, worse was planned. On July 26, 2020, with the George Floyd riots having finally settled down, the CDC issued a plan for establishing nationwide quarantine camps.*** ***People were to be isolated, given only food and some cleaning supplies. They would be banned from participating in any religious services.*** ***The plan included contingencies for preventing suicide. There were no provisions made for any legal appeals or even the right to legal counsel.*** ***The plan’s authors were unnamed but included 26 footnotes. It was completely official. The document was only removed on about March 26, 2023.*** ***During the entire intervening time, the plan survived on the CDC’s public site with little to no public notice or controversy.*** ***It was called ‘Interim Operational Considerations for Implementing the Shielding Approach to Prevent COVID-19 Infections in Humanitarian Settings’.*** ***‘This document presents considerations from the perspective of the U.S. Centers for Disease Control & Prevention (CDC) for implementing the shielding approach in humanitarian settings as outlined in guidance documents focused on camps, displaced populations and low-resource settings. …’*** ***‘This approach has never been documented and has raised questions and concerns among humanitarian partners who support response activities in these settings.’*** ***‘The purpose of this document is to highlight potential implementation challenges of the shielding approach from CDC’s perspective and guide thinking around implementation in the absence of empirical data.’*** ***‘Considerations are based on current evidence known about the transmission and severity of coronavirus disease 2019 (COVID-19) and may need to be revised as more information becomes available.’*** ***By the absence of empirical data, the meaning is: that nothing like this has ever been tried. The point of the document was to map out how it could be possible and alert authorities to possible pitfalls to be avoided.*** ***The meaning of ‘shielding’ is:*** ***‘To reduce the number of severe COVID-19 cases by limiting contact between individuals at higher risk of developing severe disease (‘high-risk’) and the general population (‘low-risk’).’*** ***‘High-risk individuals would be temporarily relocated to safe or ‘green zones’ established at the household, neighborhood, camp/sector or community level depending on the context and setting. … They would have minimal contact with family members and other low-risk residents.’*** ***In other words, this is what used to be concentration camps.*** ***Who are these people who would be rounded up? They are ‘older adults and people of any age who have serious underlying medical conditions’. Who determines this? Public health authorities. The purpose?*** ***The CDC explains: ‘physically separating high-risk individuals from the general population’ allows authorities ‘to prioritize the use of the limited available resources’.*** ***This sounds a lot like condemning people to death in the name of protecting them.*** ***The model establishes three levels. First is the household level. Here high-risk people are physically isolated from other household members’.*** ***That alone is objectionable. Elders need people to take care of them. They need love and to be surrounded by family. The CDC should never imagine that it would intervene in households to force old people into separate places.*** ***The model jumps from households to the “neighborhood level.” Here we have the same approach: forced separation of those deemed vulnerable.*** ***From there, the model jumps again to the ‘camp/sector level’. Here it is different:*** ***‘A group of shelters such as schools, community buildings within a camp/sector (max 50 high-risk individuals per single green zone) where high-risk individuals are physically isolated together.’*** ***‘One entry point is used for exchange of food, supplies, etc. A meeting area is used for residents and visitors to interact while practicing physical distancing (2 meters). No movement into or outside the green zone.’*** ***Yes, you read that correctly. The CDC is here proposing concentration camps for the sick or anyone they deem to be in danger of medically significant consequences of infection.*** ***Further: ‘to minimize external contact, each green zone should include able-bodied high-risk individuals capable of caring for residents who have disabilities or are less mobile. Otherwise, designate low-risk individuals for these tasks, preferably who have recovered from confirmed COVID-19 and are assumed to be immune’.*** ***The plan says in passing, contradicting thousands of years of experience, ‘Currently, we do not know if prior infection confers immunity’.*** ***Therefore the only solution is to minimize all exposure throughout the whole population. Getting sick is criminalized.*** ***These camps require a ‘dedicated staff’ to:*** ***‘Monitor each green zone. Monitoring includes both adherence to protocols and potential adverse effects or outcomes due to isolation and stigma. It may be necessary to assign someone within the green zone, if feasible, to minimize movement in/out of green zones.’*** ***The people housed in these camps need to have good explanations of why they are denied even basic religious freedom.*** ***The report explains:*** ***‘Proactive planning ahead of time, including strong community engagement and risk communication is needed to better understand the issues and concerns of restricting individuals from participating in communal practices because they are being shielded. Failure to do so could lead to both interpersonal and communal violence.’*** ***Further, there must be some mechanisms to prohibit suicide: Additional stress and worry are common during any epidemic and may be more pronounced with COVID-19 due to the novelty of the disease and increased fear of infection, increased childcare responsibilities due to school closures and loss of livelihoods.*** ***Thus, in addition to the risk of stigmatization and feeling of isolation, this shielding approach may have an important psychological impact and may lead to significant emotional distress, exacerbate existing mental illness or contribute to anxiety, depression, helplessness, grief, substance abuse or thoughts of suicide among those who are separated or have been left behind.*** ***Shielded individuals with concurrent severe mental health conditions should not be left alone. There must be a caregiver allocated to them to prevent further protection risks such as neglect and abuse.*** ***The biggest risk, the document explains, is as follows: “While the shielding approach is not meant to be coercive, it may appear forced or be misunderstood in humanitarian settings.”*** ***It should go without saying but this ‘shielding’ approach suggested here has nothing to do with focused protection of the Great Barrington Declaration.*** ***Focused protection specifically says:*** ***‘Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home.’*** ***‘Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.’*** ***In four years of research, and encountering truly shocking documents and evidence of what happened in the COVID-19 years, this one certainly ranks up at the top of the list of totalitarian schemes for pathogenic control prior to vaccination. It is quite simply mind-blowing that such a scheme could ever be contemplated.*** ***Who wrote it? What kind of deep institutional pathology exists that enabled this to be contemplated?*** ***The CDC has 10,600 full-time employees and contractors and a budget of $11.5 billion. In light of this report, and everything else that has gone on there for four years, both numbers should be zero.”*** https://brownstone.org/articles/the-cdc-planned-quarantine-camps-nationwide/ **Here are some links to this article:** - ***“U.S. Developing Vaccine Passport System Using Complex Web of Big Tech Partnerships”*** https://childrenshealthdefense.org/defender/us-developing-vaccine-passport-system/ - ***"Interim Operational Considerations for Implementing the Shielding Approach to Prevent COVID-19 Infections in Humanitarian Settings*** ***Updated July 26, 2020"*** https://web.archive.org/web/20200728203549/https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/shielding-approach-humanitarian.html

Bad Faith Set Up Fails Read the full article at https://www.linkedin.com/pulse/bad-faith-set-up-fails-barry-zalma-esq-cfe-jllxc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. Inadequate Information Made Refusal to Pay Policy Limits Not Bad Faith INADEQUATE MEDICAL AUTHORIZATION USED TO CAUSE INSURER TO REFUSE SETTLEMENT DEMAND Post 4930 Kara Flick appealed from the judgment after a jury rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. Flick contends the judgment should be reversed due to juror misconduct. In KARA FLICK v. UNITED SERVICES AUTOMOBILE ASSOCIATION, B330507, California Court of Appeals, Second District, Sixth Division (November 5, 2024) the Court of Appeals resolved the dispute. FACTUAL HISTORY After sustaining injuries in an automobile accident caused by Francisco Reyes, Jr., Flick had her attorney send Reyes's insurer, the United Services Automobile Association (USAA), a letter explaining the severity of her injuries and an authorization for the release of her medical records. Flick's attorney followed up with a settlement demand two months later, requesting that USAA pay Flick the entirety of Reyes's $100,000 policy limit in exchange for a release of liability. Attached to the demand was a single medical record from Flick's neurologist. USAA investigated Flick's claim and determined it did not have sufficient information to accept or reject her demand. Flick then filed a personal injury lawsuit against Reyes. The jury found in her favor and awarded nearly $1.7 million in damages. Flick, with an assignment from the Reyes, sued USAA for breach of contract and breach of the implied covenant of good faith and fair dealing. TRIAL At trial, a USAA claims adjustor admitted that Reyes was fully at fault for the accident with Flick. Reyes could therefore be exposed to liability in excess of his policy limits-if Flick provided sufficient documentation to support her claim. USAA's expert on insurance claims handling and another of its claims service managers both agreed with the supervisor that Flick's authorization was invalid and inadequate to allow USAA to obtain Flick's medical records. USAA needed additional records before it could determine the value of Flick's claim. Those records could have included the medical bills Flick provided to her own insurance company, the multiple doctor's notes she had excusing her from work, or the thumb drive recording her purported speech problems, all of which were entered into evidence at her personal injury trial. Because they were not provided to USAA, it was "very difficult to place a value on" Flick's claim. Flick's expert testified that USAA's handling of the settlement demand "was clearly unreasonable." Flick also did not respond to USAA's requests for additional information. By a vote of nine to three, the jury found that Flick did not make a reasonable settlement demand of USAA and rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. The trial court polled the jury, and each juror confirmed their vote. DISCUSSION The Court of Appeals concluded the trial court did not abuse its discretion in denying Flick's new trial motion. USAA successfully rebutted the presumption of prejudice by showing there is no reasonable probability that the juror, D.C.'s misconduct by not explaining he did not hear all of the adjuster's testimony, actually harmed Flick. Much of the adjustor's testimony consisted of facts regarding his communications with Flick's attorney - facts that were undisputed. What was disputed-whether Flick's settlement demand was reasonable-was the subject of other witness testimony, including USAA's expert on insurance claims handling, its supervising claims service manager, Flick's personal injury attorney, and her expert witness on insurance claims handling. What the admitted evidence showed was that D.C. confirmed multiple times that he voted that Flick did not make a reasonable settlement demand: Based on this record there was no reasonable probability that D.C.'s alleged juror misconduct actually harmed Flick. ZALMA OPINION The tort of bad faith arose from abuse by insurers on those they insured. Since its adoption in California about three quarters of a century ago, the abuse has been turned on to insurers. Ms. Flick's counsel placed a demand for settlement on USAA that it could not reasonably and in good faith to its insured, Reyes, because it was incomplete and inadequately supported and forced Flick and Reyes go through a trial where she received an uncollectible judgment against Reyes in hopes of a gigantic bad faith judgment. After much litigation and USAA spending a great deal to defend itself she received the $100,000 policy limit. USAA was punished but neither Flick nor her lawyers profited from the scheme or the appeal. (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. 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