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

CHUTZPAH: GET AWAY WITH MURDER AND COMPLAIN ABOUT SENTENCE Burn Husband to Death for Insurance Money & Plea to Avoid Jail Post 4942 Posted on December 10, 2024 by Barry Zalma See the full video at and at FACTS Mendy Powell Neal, who was charged with the first degree premeditated and felony murder of her husband and the aggravated arson of their home, entered a North Carolina v. Alford, 400 U.S. 25, 37 (1970), best interest plea to voluntary manslaughter, a Class C felony, in exchange for the dismissal of the felony murder and aggravated arson counts of the presentment and an agreed range of three to four years, with the trial court to determine the length and manner of service of the sentence. At the conclusion of the sentencing hearing, the trial court denied the Defendant’s request for judicial diversion, determined that she was not a suitable candidate for probation or other alternative sentencing, and sentenced her as a Range I, standard offender to four years at 30% in the Tennessee Department of Correction. In State Of Tennessee v. Mendy Powell Neal, No. M2023-01176-CCA-R3-CD, Court of Criminal Appeals of Tennessee, Nashville (November 26, 2024) the Court of Criminal Appeals affirmed the trial court. The Defendant’s husband, Matthew Neal, died in a house fire that totally consumed the couple’s Charlotte log home. The Defendant was charged with the first degree premediated murder of the victim, the first degree felony murder of the victim during the perpetration of an aggravated arson, and the aggravated arson of the home. The Defendant proceeded to a jury trial where the State presented evidence for three days establishing the crimes. The neighbor, Mr. Swan and a responding deputy, who could hear the victim moaning on the other side of the closed front door, attempted to enter the home but were unable due to the intensity of the fire. The next day, the victim’s burned body was found within ten feet of the front door. The victim was burned over 95% of his body and died of carbon monoxide toxicity and thermal injury. Autopsy showed he was drugged and couldn’t escape. Regardless of the evidence of premeditated murder the trial court found that the Defendant’s lack of a criminal history was an applicable mitigating factor and enhancement factors that the victim was particularly vulnerable because of age or physical or mental disability, that the Defendant treated or allowed the victim to be treated with exceptional cruelty during the commission of the offense, that the Defendant had no hesitation about committing the crime when the risk to human life was high, and that the Defendant abused a position of private trust that significantly facilitated the commission of the offense. The trial court found that sentencing the Defendant to the maximum length in the Tennessee Department of Correction “was the just and proper sentence due to the Defendant’s misrepresentation and dishonesty as well as the overwhelming circumstantial proof of Defendant’s conniving and forethought regarding the crime.” ANALYSIS The Court of Criminal Appeals found that there was nothing that warranted waiver of the timely notice of appeal requirement with respect to the trial court’s original sentencing determinations and the trial court acted well within its discretion in declining to reduce or modify the Defendant’s sentence. The Defendant did not show any circumstances, warranting the alteration of her sentence in the interest of justice. ZALMA OPINION It takes a massive amount of chutzpah (Yiddish for unmitigated gall) to drug your husband so he could not escape being burned to death after setting fire to the house to kill him and collect on a life insurance policy, and then, when damning evidence was presented offer a Alford plea to manslaughter. To then complain that court imposed the maximum sentence even though her agreement with the court changed the aggravated, premeditated murder that could have resulted in life in prison to manslaughter and only 4 years. (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.

Putin is Terrified as China Gains Ground in Siberia 961,269 views Nov 5, 2024 #militarydevelopments #themilitaryshow #militaryanalysis China and Russia claim a "strategic partnership without limits," yet China's true aim may lie far beyond diplomacy. Underneath the alliance, Beijing eyes the vast resources and strategic value of Siberia and the Russian Far East. This YouTube video dives deep into China's historic grievances, resource needs, and long-term strategy that could reshape its relationship with Russia. From unequal treaties to subtle revanchist tactics, discover why Siberia may be the next frontier in China's quest for global dominance.

NORTH Koreans Had Enough - They Want To Go Home https://www.youtube.com/watch?v=JGPlwEV5jAU 1,218,379 views Dec 2, 2024 #militarydevelopments #themilitaryshow #militaryanalysis What happens when poorly trained North Korean soldiers are thrown into the brutal conflict between Russia and Ukraine? In this video, we dive into the shocking reality of North Korean troops sent to Kursk as part of Russia's desperate war efforts. From language barriers and inadequate training to their unpreparedness for Ukraine’s battle-hardened forces, these soldiers face a terrifying fate. Watch as we uncover their struggles, fears, and the devastating consequences of their deployment.

#ClimateChange and #GlobaklWarming is a #HOAX! You have mentally ill people around the world claiming that CO2 is causing this BS "Climate Change" yet these same people generally have NO IDEA how much CO2 is even in our atmosphere! It's a mere 0.04% by the way, very little CO2 is a gas of LIFE! It is what humans exhale after breathing in oxygen... And in PERFECT BALANCE the plants BREATHE IN CO2 AND EXHALE OXYGEN! It's a perfect system. Yet, we have zealots bent on #Eugenics who want to kill us all... and if not KILL, they definitely want to CONTROL everyone! Their fictional "Climate Change" narrative is designed to give them FULL CONTROL OVER THE EARTH AND EVERYONE IN IT! These #Criminals will do whatever it takes to gain control over all of mankind! And that includes spraying TOXINS into our skies, poisoning the entire agricultural system, all men and women, and even the water! These lunatics have been trying to accomplish this #Evil plan for over 150 years! And it is time they are STOPPED! These morons have no more rights to this earth than we do.... And there are BILLIONS OF US opposed to poisoning our earth and ourselves! It's about time that we start acting like it! These people belong in PRISON Here's the short list of LIES we have been told about how "Climate is going to kill us all" PURELY FICTION AND LIES! Scientists seeking funding and journalists seeking an audience agree: panic sells. “Global cooling is going to kills us all!” “No, wait: global warming is going to kill us all!” Here's the list - an amazing chronology of the last 120 years of scare-mongering on climate 1895 - Geologists Think theWorld May Be Frozen Up Again – New York Times, February 1895 1902 - “Disappearing Glaciers…deteriorating slowly, with a persistency that means their final annihilation…scientific fact…surely disappearing.” – Los Angeles Times 1912 - Prof. Schmidt Warns Us of an Encroaching Ice Age – New York Times, October 1912 1923 - “Scientist says Arctic ice will wipe out Canada” – Professor Gregory of Yale University, American representative to the Pan-Pacific Science Congress, – Chicago Tribune 1923 - “The discoveries of changes in the sun’s heat and the southward advance of glaciers in recent years have given rise to conjectures of the possible advent of a new ice age” – Washington Post 1924 - MacMillan Reports Signs of New Ice Age – New York Times, Sept 18, 1924 1929 - “Most geologists think the world is growing warmer, and that it will continue to get warmer” – Los Angeles Times, in Is another ice age coming? 1932 - “If these things be true, it is evident, therefore that we must be just teetering on an ice age” – The Atlantic magazine, This Cold, Cold World 1933 - America in Longest Warm Spell Since 1776; Temperature Line Records a 25-Year Rise – New York Times, March 27th, 1933 1933 – “…wide-spread and persistent tendency toward warmer weather…Is our climate changing?” – Federal Weather Bureau “Monthly Weather Review.” 1938 - Global warming, caused by man heating the planet with carbon dioxide, “is likely to prove beneficial to mankind in several ways, besides the provision of heat and power.”– Quarterly Journal of the Royal Meteorological Society 1938 - “Experts puzzle over 20 year mercury rise…Chicago is in the front rank of thousands of cities thuout the world which have been affected by a mysterious trend toward warmer climate in the last two decades” – Chicago Tribune 1939 - “Gaffers who claim that winters were harder when they were boys are quite right… weather men have no doubt that the world at least for the time being is growing warmer” – Washington Post 1952 - “…we have learned that the world has been getting warmer in the last half century” – New York Times, August 10th, 1962 1954 - “…winters are getting milder, summers drier. Glaciers are receding, deserts growing” – U.S. News and World Report 1954 - Climate – the Heat May Be Off – Fortune Magazine 1959 - “Arctic Findings in Particular Support Theory of Rising Global Temperatures” – New York Times 1969 - “…the Arctic pack ice is thinning and that the ocean at the North Pole may become an open sea within a decade or two” – New York Times, February 20th, 1969 1969 – “If I were a gambler, I would take even money that England will not exist in the year 2000″ — Paul Ehrlich (while he now predicts doom from global warming, this quote only gets honorable mention, as he was talking about his crazy fear of overpopulation) 1970 - “…get a good grip on your long johns, cold weather haters – the worst may be yet to come…there’s no relief in sight” – Washington Post 1974 - Global cooling for the past forty years – Time Magazine 1974 - “Climatological Cassandras are becoming increasingly apprehensive, for the weather aberrations they are studying may be the harbinger of another ice age” –Washington Post 1974 - “As for the present cooling trend a number of leading climatologists have concluded that it is very bad news indeed” – Fortune magazine, who won a Science Writing Award from the American Institute of Physics for its analysis of the danger 1974 - “…the facts of the present climate change are such that the most optimistic experts would assign near certainty to major crop failure…mass deaths by starvation, and probably anarchy and violence” – New York Times Cassandras are becoming increasingly apprehensive, for the weather aberrations they are studying may be the harbinger of another ice age 1975 - Scientists Ponder Why World’s Climate is Changing; A Major Cooling Widely Considered to Be Inevitable – New York Times, May 21st, 1975 1975 - “The threat of a new ice age must now stand alongside nuclear war as a likely source of wholesale death and misery for mankind” Nigel Calder, editor, New Scientist magazine, in an article in International Wildlife Magazine 1976 - “Even U.S. farms may be hit by cooling trend” – U.S. News and World Report 1981 - Global Warming – “of an almost unprecedented magnitude” – New York Times 1988 - I would like to draw three main conclusions. Number one, the earth is warmer in 1988 than at any time in the history of instrumental measurements. Number two, the global warming is now large enough that we can ascribe with a high degree of confidence a cause and effect relationship to the greenhouse effect. And number three, our computer climate simulations indicate that thegreenhouse effect is already large enough to begin to effect the probability of extreme events such as summer heat waves. – Jim Hansen, June 1988 testimony before Congress, see His later quote andHis superior’s objection for context 1989 -“On the one hand, as scientists we are ethically bound to the scientific method, in effect promising to tell the truth, the whole truth, and nothing but – which means that we must include all doubts, the caveats, the ifs, ands and buts. On the other hand, we are not just scientists but human beings as well. And like most people we’d like to see the world a better place, which in this context translates into our working to reduce the risk of potentially disastrous climate change. To do that we need to get some broad based support, to capture the public’s imagination. That, of course, means getting loads of media coverage. So we have to offer up scary scenarios, make simplified, dramatic statements, and make little mention of any doubts we might have. This “double ethical bind” we frequently find ourselves in cannot be solved by any formula. Each of us has to decide what the right balance is between being effective and being honest. I hope that means being both.” – Stephen Schneider, lead author of the Intergovernmental Panel on Climate Change,Discover magazine, October 1989 1990 - “We’ve got to ride the global warming issue. Even if the theory of global warming is wrong, we will be doing the right thing – in terms of economic policy and environmental policy” – Senator Timothy Wirth 1993 - “Global climate change may alter temperature and rainfall patterns, many scientists fear, with uncertain consequences for agriculture.” – U.S. News and World Report 1998 - No matter if the science [of global warming] is all phony . . . climate change [provides] the greatest opportunity to bring about justice and equality in the world.” —Christine Stewart, Canadian Minister of the Environment, Calgary Herald, 1998 2001 - “Scientists no longer doubt that global warming is happening, and almost nobody questions the fact that humans are at least partly responsible.” – Time Magazine, Monday, Apr. 09, 2001 2003 - Emphasis on extreme scenarios may have been appropriate at one time, when the public and decision-makers were relatively unaware of the global warming issue, and energy sources such as “synfuels,” shale oil and tar sands were receiving strong consideration” – Jim Hansen, NASA Global Warming activist, Can we defuse The Global Warming Time Bomb?, 2003 2006 - “I believe it is appropriate to have an over-representation of factual presentations on how dangerous it is, as a predicate for opening up the audience to listen to what the solutions are, and how hopeful it is that we are going to solve this crisis.” — Al Gore, Grist magazine, May 2006 2006 – “It is not a debate over whether the earth has been warming over the past century. The earth is always warming or cooling, at least a few tenths of a degree…” —Richard S. Lindzen, the Alfred P. Sloan professor of meteorology at MIT 2006 – “What we have fundamentally forgotten is simple primary school science. Climate always changes. It is always…warming or cooling, it’s never stable. And if it were stable, it would actually be interesting scientifically because it would be the first time for four and a half billion years.” —Philip Stott, emeritus professor of bio-geography at the University of London 2006 - “Since 1895, the media has alternated between global cooling and warming scares during four separate and sometimes overlapping time periods. From 1895 until the 1930’s the media peddled a coming ice age. From the late 1920’s until the 1960’s they warned of global warming. From the 1950’s until the 1970’s they warned us again of a coming ice age. This makes modern global warming the fourth estate’s fourth attempt to promote opposing climate change fears during the last 100 years.” –Senator James Inhofe, Monday, September 25, 2006 2007- “I gave a talk recently (on fallacies of global warming) and three members of the Canadian government, the environmental cabinet, came up afterwards and said, ‘We agree with you, but it’s not worth our jobs to say anything.’ So what’s being created is a huge industry with billions of dollars of government money and people’s jobs dependent on it.” – Dr. Tim Ball, Coast-to-Coast, Feb 6, 2007 2008 – “Hansen was never muzzled even though he violated NASA’s official agency position on climate forecasting (i.e., we did not know enough to forecast climate change or mankind’s effect on it). Hansen thus embarrassed NASA by coming out with his claims of global warming in 1988 in his testimony before Congress” – Dr. John S. Theon, retired Chief of the Climate Processes Research Program at NASA, see above for Hansen quotes You can find this article by searching : American Thinker August 4, 2014 "120 years of climate scares" It's time to tell these liars and eugenicists that the jig is up! And their little HOAX is over! Just look at the lunacy these people are printing! It’s Time to Engineer the Sky Global warming is so rampant that some scientists say we should begin altering the stratosphere to block incoming sunlight, even if it jeopardizes rain and crops https://www.scientificamerican.com/article/its-time-to-engineer-the-sky/

Important Analysis https://rumble.com/v5vfpw2-mike-benz-on-hunter-biden-pardongate-w-liz-wheeler.html?e9s=src_v1_upp

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

Occam’s Razor Exclusion for Work Performed by Insured Defeats Claim for Construction Defects Post 4935 Read the full article at https://lnkd.in/gT_NsMHv, see the full video at https://lnkd.in/gqkPHYbp and at https://lnkd.in/gEEXkUe3, and at https://zalma.com/blog plus more than 4900 posts. The question presented to the U.S. First Circuit Court of Appeals was whether a contractor’s CGL insurance policy covers general damage to a non-defective part of the contractor’s project resulting from a subcontractor’s defective work on a different part of that project. APPLICATION OF OCCAM’S RAZOR The analysis technique that proposes that the simplest of competing theories be preferred to the more complex. FACTUAL BACKGROUND Applying Massachusetts law, the district court concluded that Admiral had no duty to defend Tocci in Admiral Insurance Company, Starr Indemnity & Liability Company, Great American Assurance Company v. Tocci Building Corporation, Tocci Residential LLC, John L. Tocci, Sr., No. 22-1462, United States Court of Appeals, First Circuit (November 8, 2024) and Tocci appealed. From 2013 to 2016, Tocci was the construction manager for an apartment project owned by Toll JM EB Residential Urban Renewal LLC (“Toll”). There were several work quality issues and delays on the project, and Toll eventually terminated Tocci in March 2016 for alleged mismanagement of the project. Toll sued with allegations regarding instances of defective work leading to property damage. The allegations included defective work by Tocci’s subcontractors resulting in various instances of property damage to non-defective work on the project, including (1) damage to sheetrock resulting from faulty roof work; (2) mold formation resulting from inadequate sheathing and water getting into the building; and (3) damage to a concrete slab, wood framing, and underground pipes resulting from soil settlement due to improper backfill and soil compaction. DUTY TO DEFEND Tocci sought defense and indemnity coverage under the Admiral insurance policies. Admiral denied coverage. The district court granted Admiral’s motion on duty to defend because the damage alleged in Toll’s complaint did not qualify as “property damage” as defined in the policy because the allegations consisted entirely of damage at Tocci’s own project. ANALYSIS The First Circuit considered three steps to the coverage analysis: (1) Do the damages alleged in the action fall within the scope of coverage?; (2) if so, do the exclusions to coverage apply?; and (3) if so, do any exceptions to the exclusions apply? The First Circuit noted that there is a sharp split of authority on whether damage to non-defective work resulting from a subcontractor’s defective work constitutes “property damage” or is caused by an “occurrence.” The First Circuit decided to avoid the issues of what constitutes “property damage” by focusing on the exclusions which were sufficient to resolve the complete dispute. THE HOLDING There are two “Damage to Property” exclusions that provide that there is no coverage for “property damage” to: that particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the ‘property damage’ arises out of those operations; or that particular part of any property that must be restored, repaired or replaced because “your work” was incorrectly performed on it. The First Circuit, applying Occam’s Razor, focused its analysis on the exclusion it concluded covers the allegations in the Toll complaint. Since the complaint alleges damage resulting from Tocci’s “incorrectly performed” work on the entire project “[t]hat particular part of any property that must be restored, repaired or replaced because ‘[Tocci’s] work’ was incorrectly performed on it” refers to the entirety of the project where Tocci was the general contractor charged with supervising and managing the project as a whole. Therefore, the First Circuit concluded that Admiral met its burden of establishing that the Toll action only alleges damage falling within the exclusion and that there was no exception to that exclusion that applied. ZALMA OPINION This is a case of a court applying Occam’s Razor, by picking an easy and obvious solution – the application of an exclusion – and avoiding the problem of different court rulings on coverage about “property damage” and “occurence.” Since the exclusion clearly applied there was no duty to defend. (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 Subscribe to my substack at https://lnkd.in/gmmzUVBy

Chiropractor Disciplined for Improper Billing Chiropractor Lies to Board and Loses Right to Practice Post 4930 Read the full article at https://www.linkedin.com/pulse/chiropractor-disciplined-improper-billing-barry-zalma-esq-cfe-4qjdc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. This appeal arises from an attempt by the state of Illinois to impose discipline upon plaintiff Christopher D. Leone, D.C., due to certain improper activities performed as a licensed chiropractor in the state of Illinois. In Christopher D. Leone, D.C. v. The Department Of Financial And Professional Regulation, Division Of Professional Regulation; and Cecilia Abundis, in Her Official Capacity as Acting Director of the Department of Financial and Professional Regulation, No. 4-22-0753, 2024 IL App (4th) 220753-U, Court of Appeals of Illinois, Fourth District (November 6, 2024) the Court of Appeal resolved the multiple claims of the chiropractor. BACKGROUND Leone has practiced as a chiropractor since 1999 and initially practiced in the state of Washington. The matter was resolved pursuant to an informal disposition via stipulation. Leone began practicing in Illinois in 2004, and in 2010 and a consent order was issued pursuant to which Leone admitted to the allegations and was reprimanded with a $5000 fine and a requirement that he undertake 20 hours of continuing education; 10 of those hours were to focus on Medicare billing and insurance coding and another 10 on record keeping. In 2013, the United States alleged that Leone “knowingly and fraudulently” submitted Medicare claims of less than $1000 for one-on-one physical therapy services that were not provided. Following negotiation, the parties entered into a plea agreement, pursuant to which Leone pleaded guilty to the one-count information and stipulated to a factual basis for his plea. Shortly after the Medicare fraud charge was filed against Leone, the State filed a five-count complaint alleging multiple violations of the Medical Practices Act of 1987 (Act). During the litigation, Leone applied to renew his chiropractic license. One of the questions on the application asked whether he had been convicted of any criminal offense, state or federal, since July 2011; Leone answered, “No,” failing to document the Medicare fraud conviction. Attempting to explain his federal guilty plea, Leone said that he was unable to modify the language in the plea agreement, as “the time for negotiations had run out” and the plea was a “take-it-or-leave-it” proposition. Leone read the plea agreement line by line and, although he claimed it contained false information, he signed it. ALJ Report and Recommendation The Administrative Law Judge (ALJ) issued his report and recommendation, finding that, pursuant to the guilty plea in the federal case, Leone had admitted that his patients performed physical therapy on their own without supervision. Also, Leone admitted in his plea that entries in patient records indicating that they received hands-on or one-on-one physical therapy were false. Further, the guilty plea established that Leone knowingly submitted claims to Medicare for services that he did not provide. Leone had also billed private insurers numerous times under the same code as Medicare. The conviction also established that he engaged in false billing and false entries in patient records. The ALJ recommended an indefinite suspension of Leone’s license for a minimum of two years. An expert testified that chiropractors who engaged in Medicare fraud violated several tenets of chiropractic ethics. There was a pattern of overcharging for services that were not provided, false notations in patient records to support the false charges, and the submission of false claims to insurance that went on for at least five years. Leone obtained fees by fraud, deceit, or misrepresentation, and those actions fell below the professional and ethical standards required of chiropractors in Illinois. Leone’s conduct, along with his past disciplinary history, “demonstrate[d] a pattern of behavior that [was] not acceptable.” ANALYSIS It was undisputed that Leone submitted charges under billing code 97110. Leone pled guilty to submitting a false demand for payment upon the United States. In his plea, Leone admitted to billing for services that were not actually provided to his patients as claimed, “and the instruments containing the demands for payment of public money, therefore were false when they were submitted” and “were submitted to Medicare with the knowledge that he did not perform the service charged.” The guilty plea supports the conclusion that Leone knowingly and intentionally submitted claims for reimbursement for services provided under code 97110 where the services did not meet the requirements to be paid under that code. This pattern went on for approximately five years, resulting in 1324 false claims in the amount of $93,900. The Department established a violation of the Act where Leone failed to note the federal conviction on his renewal application. Discipline A review of the initial circuit court order in this matter reveals that it merely recommended that the Department consider probation as a punishment; it did not make a ruling to that effect. There was no abuse of discretion in the discipline imposed. For the reasons stated, the Court reversed the circuit court’s judgment and affirm the Director’s decision. ZALMA OPINION Leone successfully committed fraud on the United States, the state of Illinois, and the insurance industry by falsely billing services he did not provide. He pleaded guilty to one count of Federal Health Insurance fraud and then lied to the state of Illinois when he applied to renew his license. With lawyers and retained experts he delayed the sanction for years. The Court of Appeals finally resolved the multiple disputes and applied an appropriate sanction and suspension of his license. He should consider himself lucky that he was not prosecuted criminally by the state and the US Government accepted his plea. (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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Permanent Punishment for Conviction for One Ounce of Cocaine Improper Government Overreach and Abuse Reversed Post 4927 Read the full article at https://www.linkedin.com/pulse/permanent-punishment-conviction-one-ounce-cocaine-zalma-esq-cfe-geq1c, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. After Recovery From Cocaine Abuse Dr. Regained License to Practice CMS Refused to Allow Dr. White to Bill Medicare for Services Dr. Stephen White challenged two unfavorable decisions made by the Secretary for the United States Department of Health and Human Services (the “Secretary”) that denied and revoked his Medicare enrollment. The decisions, rendered by the Appellate Division of the Departmental Appeals Board (“Board”), were based on Dr. White’s 2010 guilty plea and deferred prosecution for possession of less than 1 gram of cocaine, which occurred in Texas in 2007. In Stephen White, M.D. v. Xavier Becerra, Secretary for the United States Department of Health and Human Services, No. 2:19-CV-00037-SAB, United States District Court, E.D. Washington (October 28, 2024) the USDC applied entered a judgment reversing the decision of the Secretary [42 U.S.C. § 405(g).] SUMMARY JUDGMENT Summary judgment is appropriate if the movant shows that there is no genuine dispute as to any material fact. BACKGROUND Dr. White is an orthopedic surgeon. In 2006 and 2007, he was arrested and charged with possession of cocaine in Texas. He was able to rehab and become clean of his problem with the drug. The Texas Medical Board revoked his license, but then monitored his recovery and compliance and allowed him to practice again. Dr. White had no violations for nine years following his arrest. He is currently practicing medicine in Washington state and is an enrolled Medicare supplier. The Administrative Law Judge (ALJ) sustained the denial, finding that CMS had a legitimate basis because Dr. White was convicted of a felony offense. The Board affirmed the ALJ’s decision and Dr. White appealed that decision to the USDC. OVERVIEW OF MEDICARE PROGRAM The Medicare program provides health insurance benefits to people sixty-five years old or older and to eligible disabled persons. Suppliers, such as Dr. White, must be enrolled in the Medicare program and be granted billing privileges to be eligible to receive payment for care and services rendered to a Medicare-eligible beneficiary. DENIALS CMS may deny a supplier’s enrollment for any reason stated in federal statutes that allow that CMS may deny a provider’s or supplier’s enrollment in the Medicare program for the some of the following reasons: Felonies such as insurance fraud and similar crimes. REVOCATIONS The ALJ found CMS had a legitimate basis because White was convicted of a felony offense that CMS determined to be detrimental to the bests interest of the Medicare program and its beneficiaries. Dr. White’s presented equitable arguments to the ALJ that 1 he self-reported and was not practicing; 2 using his self-report to deny would encourage other physicians to not self-report, 3 he has fully complied with the terms of the modified license, and eventually he was allowed to practice medicine without limitations. The Board affirmed the ALJ’s decision, upholding CMS’ denial of Dr. White’s Medicare enrollment and rejected Dr. White’s argument that the timing of the revocation action by CMS was clearly retaliatory and intended to apply pressure on Dr. White for additional monetary penalties. ANALYSIS The USDC found CMS’ decisions to deny Dr. White enrollment in Medicare and revoke his privileges, and the subsequent Board’s affirmations were arbitrary and capricious and not supported substantial evidence. CMS did not have a legitimate reason to deny enrollment or revoke because the record does not support CMS’ assertions that Dr. White’s 2010 conviction for simple possession of a small amount of cocaine was detrimental to the best interest of the Medicare program and its beneficiaries. The USDC understood the deference it owed to administrative agencies as they adjudicate numerous complex cases before them. Yet, a court may not simply act as a rubber stamp for agency decisions. Because CMS failed to provide a reasonable basis for denying Dr. White his enrollment in Medicare or revoking his Medicare privileges, the decision of the Secretary is reversed. ZALMA OPINION A doctor should never get involved or addicted to illegal substances like Cocaine. The Fact that a doctor self reports his involvement with the drug, was rehabilitated, clean for nine years, and practices medicine legally, does not pose a danger to Medicare as do those doctors who are arrested every year for fraud. The decision of Becerra, the ALJ and the Board was clearly retaliatory and abusive and the USDC had no choice but to reverse the Board and let the doctor continue to practice medicine and charge Medicare for his services. Overreach by the administrative agency was stopped by the court. (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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