• EUO is a Material Condition Precedent

    Claim Properly Denied for Refusal to Testify at EUO

    Post 4936

    Read the full article at https://www.linkedin.com/pulse/euo-material-condition-precedent-barry-zalma-esq-cfe-exccc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.

    See the full video at and at

    Erin Hughes appealed from the grant of summary judgment in favor of defendant and respondent Farmers Insurance Exchange (Farmers) on her causes of action for breach of contract and bad faith arising after Farmers’ denial of Hughes’s property insurance claim because she refused to testify at a second examination under oath (EUO).

    In Erin Hughes v. Farmers Insurance Exchange, B331168, California Court of Appeals (November 8, 2024) the condition precedent was enforced.

    FACTUAL BACKGROUND

    Hughes is the owner of real property in Malibu (the property). In December 2020, Hughes obtained an insurance policy to cover the property for fire loss through the California FAIR Plan Association (FAIR Plan). Also in December 2020, Hughes obtained a homeowner’s insurance policy from Farmers to cover perils other than fire, including losses due to theft (the policy).

    One month later, in January 2021, the property sustained significant fire damage. Hughes contacted Farmers, which advised her that fire loss was not covered by her Farmers policy, and she would have to pursue any such claim through her FAIR Plan policy. Unhappy, on January 21, 2021, Hughes tendered a theft claim under the Farmers policy, asserting in excess of $2 million worth of personal property was stolen from the property.

    Farmers ultimately denied the claim on January 5, 2022, on the ground that Hughes failed to cooperate with Farmers’ investigation, including by failing to participate in a second examination under oath as required by the policy.
    Hughes’s Complaint Against Farmers

    One week after the denial of her claim, Hughes sued Farmers and alleged Farmers demanded “duplicative, onerous and/or unnecessary” documentation of stolen items. Further, she alleged Farmers subjected her to “two confrontational, accusatory and grueling examinations under oath.” Hughes alleged her second examination under oath had been “suspended due to [her] medical condition,” but Farmers disregarded her condition and demanded a third examination.

    Farmers’ Motion for Summary Judgment

    Farmers moved for summary judgment contending it properly denied Hughes’s theft claim based on her failure to cooperate with Farmers’ investigation of her claim as well as her material misrepresentations in obtaining the Farmers policy.

    In May 2021, as part of Farmers’ theft claim investigation, Hughes participated in an examination under oath. During the examination, Hughes’s counsel informed the Farmers attorney he had just sent more than 40 additional receipts that the attorney would be receiving shortly. Recognizing they would not have time to go through the new items that day and the examination would need to continue on a future date, the Farmers attorney proposed “continu[ing] to work with one another to identify what’s missing.” In response, Hughes and her counsel agreed, with Hughes stating she would be happy to get “every single thing that you need and I’ll send it to my attorney right away.”

    In October 2021, a second session of the examination under oath was held regarding documentation Hughes had produced during and after the first session. Hughes appeared remotely with counsel and before any questions were asked of her, she objected to a further examination.

    Hughes accused the Farmers attorney of interrogating her “like a fucking criminal” and stated, “if you want to take my deposition . . . you are going to take a second deposition in court, and that’s going to be a formal deposition.” Hughes’s remote connection then cut out, and her counsel indicated she would not proceed with the examination.

    Farmers informed Hughes that it was denying coverage based on her failure to cooperate with Farmers’ investigation and particularly her refusal to proceed with the second examination under oath.
    Trial Court’s Grant of Summary Judgment and Denial of Hughes’s Continuance Request and Motion for New Trial

    The trial court granted summary judgment in favor of Farmers. Noting an insurer has “an absolute right” to require the insured to submit to an examination under oath “as long as the insurer exercises the right reasonably,” the court determined Hughes had not shown Farmers acted unreasonably. The court concluded summary judgment was appropriate “based solely on failure to cooperate.”

    DISCUSSION

    The trial court properly concluded there was no genuine dispute that Hughes’s failure to participate in an examination under oath constituted a material breach of the policy; accordingly, Farmers was excused from having to pay on Hughes’s claim. The right to require the insured to submit to an examination under oath concerning all proper subjects of inquiry is reasonable as a matter of law.

    An insured’s compliance with a policy requirement to submit to an examination under oath is a prerequisite to the right to receive benefits under the policy.
    Because Hughes refused to cooperate with Farmers’ investigation by participating in and completing her examination under oath, she cannot establish her own performance under the policy.
    Breach of Implied Covenant Claim

    The implied covenant of good faith and fair dealing is based on general contract law and the long-standing rule that neither party will do anything which will injure the right of the other to receive the benefits of the agreement. Hughes’s claim for bad faith fails as a matter of law.

    ZALMA OPINION

    Wildfires tend to destroy everything. That is why insurers are unwilling to write fire insurance in Malibu and other areas prone to wildfires and obtain fire insurance from the Fair Plan, an organization designed to cover uninsurable risks. Because of the destruction done by a wildfire or a dwelling fire a $2 million dollar theft loss after a fire is questionable and a good reason to take a thorough EUO. Farmers tried to do so and Hughes refused without reason after admitting she left open much investigation elements at the agreed conclusion of the first session and an agreement to a second only to refuse.

    (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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    EUO is a Material Condition Precedent Claim Properly Denied for Refusal to Testify at EUO Post 4936 Read the full article at https://www.linkedin.com/pulse/euo-material-condition-precedent-barry-zalma-esq-cfe-exccc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. See the full video at and at Erin Hughes appealed from the grant of summary judgment in favor of defendant and respondent Farmers Insurance Exchange (Farmers) on her causes of action for breach of contract and bad faith arising after Farmers’ denial of Hughes’s property insurance claim because she refused to testify at a second examination under oath (EUO). In Erin Hughes v. Farmers Insurance Exchange, B331168, California Court of Appeals (November 8, 2024) the condition precedent was enforced. FACTUAL BACKGROUND Hughes is the owner of real property in Malibu (the property). In December 2020, Hughes obtained an insurance policy to cover the property for fire loss through the California FAIR Plan Association (FAIR Plan). Also in December 2020, Hughes obtained a homeowner’s insurance policy from Farmers to cover perils other than fire, including losses due to theft (the policy). One month later, in January 2021, the property sustained significant fire damage. Hughes contacted Farmers, which advised her that fire loss was not covered by her Farmers policy, and she would have to pursue any such claim through her FAIR Plan policy. Unhappy, on January 21, 2021, Hughes tendered a theft claim under the Farmers policy, asserting in excess of $2 million worth of personal property was stolen from the property. Farmers ultimately denied the claim on January 5, 2022, on the ground that Hughes failed to cooperate with Farmers’ investigation, including by failing to participate in a second examination under oath as required by the policy. Hughes’s Complaint Against Farmers One week after the denial of her claim, Hughes sued Farmers and alleged Farmers demanded “duplicative, onerous and/or unnecessary” documentation of stolen items. Further, she alleged Farmers subjected her to “two confrontational, accusatory and grueling examinations under oath.” Hughes alleged her second examination under oath had been “suspended due to [her] medical condition,” but Farmers disregarded her condition and demanded a third examination. Farmers’ Motion for Summary Judgment Farmers moved for summary judgment contending it properly denied Hughes’s theft claim based on her failure to cooperate with Farmers’ investigation of her claim as well as her material misrepresentations in obtaining the Farmers policy. In May 2021, as part of Farmers’ theft claim investigation, Hughes participated in an examination under oath. During the examination, Hughes’s counsel informed the Farmers attorney he had just sent more than 40 additional receipts that the attorney would be receiving shortly. Recognizing they would not have time to go through the new items that day and the examination would need to continue on a future date, the Farmers attorney proposed “continu[ing] to work with one another to identify what’s missing.” In response, Hughes and her counsel agreed, with Hughes stating she would be happy to get “every single thing that you need and I’ll send it to my attorney right away.” In October 2021, a second session of the examination under oath was held regarding documentation Hughes had produced during and after the first session. Hughes appeared remotely with counsel and before any questions were asked of her, she objected to a further examination. Hughes accused the Farmers attorney of interrogating her “like a fucking criminal” and stated, “if you want to take my deposition . . . you are going to take a second deposition in court, and that’s going to be a formal deposition.” Hughes’s remote connection then cut out, and her counsel indicated she would not proceed with the examination. Farmers informed Hughes that it was denying coverage based on her failure to cooperate with Farmers’ investigation and particularly her refusal to proceed with the second examination under oath. Trial Court’s Grant of Summary Judgment and Denial of Hughes’s Continuance Request and Motion for New Trial The trial court granted summary judgment in favor of Farmers. Noting an insurer has “an absolute right” to require the insured to submit to an examination under oath “as long as the insurer exercises the right reasonably,” the court determined Hughes had not shown Farmers acted unreasonably. The court concluded summary judgment was appropriate “based solely on failure to cooperate.” DISCUSSION The trial court properly concluded there was no genuine dispute that Hughes’s failure to participate in an examination under oath constituted a material breach of the policy; accordingly, Farmers was excused from having to pay on Hughes’s claim. The right to require the insured to submit to an examination under oath concerning all proper subjects of inquiry is reasonable as a matter of law. An insured’s compliance with a policy requirement to submit to an examination under oath is a prerequisite to the right to receive benefits under the policy. Because Hughes refused to cooperate with Farmers’ investigation by participating in and completing her examination under oath, she cannot establish her own performance under the policy. Breach of Implied Covenant Claim The implied covenant of good faith and fair dealing is based on general contract law and the long-standing rule that neither party will do anything which will injure the right of the other to receive the benefits of the agreement. Hughes’s claim for bad faith fails as a matter of law. ZALMA OPINION Wildfires tend to destroy everything. That is why insurers are unwilling to write fire insurance in Malibu and other areas prone to wildfires and obtain fire insurance from the Fair Plan, an organization designed to cover uninsurable risks. Because of the destruction done by a wildfire or a dwelling fire a $2 million dollar theft loss after a fire is questionable and a good reason to take a thorough EUO. Farmers tried to do so and Hughes refused without reason after admitting she left open much investigation elements at the agreed conclusion of the first session and an agreement to a second only to refuse. (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
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    https://oneway2day.com/2024/11/19/agreeing-with-doug-billings-concerning-q/

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    #DougBillings #QDeception
    Agreeing With Doug Billings Concerning Q https://oneway2day.com/2024/11/19/agreeing-with-doug-billings-concerning-q/ SUMMARY: I’m a Conservative-Patriot. By Left-Wing standards I would probably be considered Far Right because I believe in the primacy of the Bible, an Originalist Constitution interpretation… I soon realized that ZERO important Q-predictions concerning the actually 2020-elected Donald Trump would NOT happen and in fact DID NOT HAPPEN! … AND SO, I whole heartedly agree with the Billings Q-evaluation. …TAKE A LOOK! #DougBillings #QDeception
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    Agreeing With Doug Billings Concerning Q
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  • Recent congressional hearings have focused on the alleged recovery and reverse engineering of unidentified anomalous phenomena (UAPs), commonly referred to as UFOs. Witnesses have claimed the existence of secret government programs aimed at understanding and replicating advanced technologies from these objects. However, the Pentagon has denied these claims, stating that they have no verifiable information to support them. The topic of UAPs and potential reverse engineering has sparked debate and speculation. Some believe that the government is withholding crucial information from the public, while others remain skeptical of the claims.

    The potential implications of successful UAP reverse engineering are significant. It could lead to revolutionary advancements in various fields, including propulsion, materials science, and energy technology. However, it could also raise ethical concerns about the use of such advanced technology and its potential impact on society.
    Recent congressional hearings have focused on the alleged recovery and reverse engineering of unidentified anomalous phenomena (UAPs), commonly referred to as UFOs. Witnesses have claimed the existence of secret government programs aimed at understanding and replicating advanced technologies from these objects. However, the Pentagon has denied these claims, stating that they have no verifiable information to support them. The topic of UAPs and potential reverse engineering has sparked debate and speculation. Some believe that the government is withholding crucial information from the public, while others remain skeptical of the claims. The potential implications of successful UAP reverse engineering are significant. It could lead to revolutionary advancements in various fields, including propulsion, materials science, and energy technology. However, it could also raise ethical concerns about the use of such advanced technology and its potential impact on society.
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  • 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.
    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.
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  • 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
    🚨🚨 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
    BROWNSTONE.ORG
    The CDC Planned Quarantine Camps Nationwide ⋆ Brownstone Institute
    In four years of research, and encountering truly shocking evidence of what happened, this one certainly ranks up at the top of the list.
    Angry
    2
    0 Yorumlar 0 hisse senetleri 2K Views
  • In Italy a significant forgery network involving fake artworks attributed to renowned artists such as Banksy, Andy Warhol, and Amedeo Modigliani. Spanned multiple countries, underscoring the widespread nature of the network. This ring specialized in producing high-quality counterfeit pieces that were then sold to unsuspecting buyers, potentially fetching considerable sums due to the fame of these artists.

    International experts costumers have likely seized numerous artworks and may have made as part of the probe, which reveals both the complexities and the scale of the forgeries. The involvement of Andy Warhol, modern and classical artists such as Banksy, known for his street art , and Modigliani, a painter celebrated for his distinct portraits, highlights the diverse range of styles targeted by the counterfeiters.

    This case not only emphasizes the challenges art markets face in authenticating works but also points to ongoing concerns about fraud within the global art world.
    In Italy a significant forgery network involving fake artworks attributed to renowned artists such as Banksy, Andy Warhol, and Amedeo Modigliani. Spanned multiple countries, underscoring the widespread nature of the network. This ring specialized in producing high-quality counterfeit pieces that were then sold to unsuspecting buyers, potentially fetching considerable sums due to the fame of these artists. International experts costumers have likely seized numerous artworks and may have made as part of the probe, which reveals both the complexities and the scale of the forgeries. The involvement of Andy Warhol, modern and classical artists such as Banksy, known for his street art , and Modigliani, a painter celebrated for his distinct portraits, highlights the diverse range of styles targeted by the counterfeiters. This case not only emphasizes the challenges art markets face in authenticating works but also points to ongoing concerns about fraud within the global art world.
    0 Yorumlar 0 hisse senetleri 418 Views

  • No Breach of Contract no Bad Faith

    Happy Veterans Day to My Fellow Veterans

    Some Claims Proper Some Not

    Read the full article at https://www.linkedin.com/pulse/happy-veterans-day-my-fellow-barry-zalma-esq-cfe-ovpec, shttps://www.linkedin.com/pulse/happy-veterans-day-my-fellow-barry-zalma-esq-cfe-ovpec and at https://zalma.com/blog plus more than 4900 posts.

    Post 4929

    Vepo Design Corporation and its officers (collectively, “Vepo”) appealed the district court’s grant of summary judgment on their breach of contract and bad faith claims against American Economy Insurance Company (“AEIC”). Vepo’s claims relate to AEIC’s denial of coverage following a fire in a laundromat, known as the “Central Laundromat,” which Vepo was developing.

    In Vepo Design Corporation, et al. v. American Economy Insurance Company, No. 23-55634, United States Court of Appeals, Ninth Circuit (November 4, 2024) the issues were resolved serially.

    DECISIONS

    Business Income

    The Ninth Circuit reversed the district court’s grant of summary judgment in favor of AEIC on Vepo’s business income claim, which concerns income Vepo contends it would have earned operating the Central Laundromat if the fire had not occurred. AEIC argued that Vepo’s claim for lost income was too speculative given that the Central Laundromat was still under construction and Vepo had not secured additional financing to own and operate it.

    Construing the facts in the light most favorable to Vepo as the non-moving party the Ninth Circuit concluded that there is sufficient evidence to create a genuine dispute of material fact and that Vepo’s claim for lost business income is not unduly speculative.

    There is evidence that Vepo was contemplating an arrangement under which it would own and operate the Central Laundromat for a period of time before selling it, and that Vepo later engaged in similar arrangements for other laundromats. Vepo, which was experienced in the laundromat industry, also demonstrated that it had a history of securing financing for its laundromat projects and that it intended to refinance the Central Laundromat once a certificate of occupancy was received. Although Vepo had not secured refinancing for the Central Laundromat as of the time of the fire, Vepo’s Principal Owner stated in her declaration and confirmed at her deposition that it was too early to do so in the project timeline. That Vepo had yet to refinance does not render its claim too speculative as a matter of law and its losses are for a jury to decide.

    Extra Expense

    The Ninth Circuit affirmed the district court’s grant of summary judgment in favor of AEIC for the extra expenses that Vepo allegedly incurred in storing laundry equipment in a warehouse owned by Vepo’s sister company following the fire. While the policy only required the expense to be incurred, not paid, there was insufficient evidence to create a triable issue over whether the expense was incurred at all. No payment changed hands between the two entities, and there is no accounting record showing that Vepo was liable for the storage amount. When the same person signed as representative of both entities, does not create a genuine dispute of material fact.

    Lost Profits

    The Ninth Circuit concluded that the district court properly granted summary judgment on Vepo’s claim for lost profits on the prospective sale of the laundromat. Even assuming that such a loss would be covered under the policy, the claim fails because the policy limited coverage to losses that occur within one year of the incident. Vepo’s plan called for it to own and operate the Central Laundromat for at least one year after opening, which would place any hypothetical sale more than a year after the pre-opening fire.

    Individual Personal Property Claims

    The Ninth Circuit affirmed summary judgment for AEIC on the claims by the individual plaintiffs for their own personal property that was allegedly lost in the fire. As the district court correctly found, Vepo did not identify what individual property was lost or its worth. The individual plaintiffs’ claims were too unsupported to create a triable issue.

    Bad Faith

    The Ninth Circuit partially reversed the district court’s grant of summary judgment on Vepo’s bad faith claim, to the extent of the single insurance claim it allowed to go forward-the business income claim.

    The district court may permit any further motions practice on the bad faith claim as it deems appropriate. However, it affirmed the district court’s grant of summary judgment on the bad faith claim insofar as that claim is premised on any of the other breach of contract claims to which AEIC is entitled to judgment as a matter of law.

    There is never a claim for breach of the implied duty of good faith and fair dealing if there was no improper denial of coverage under the policy.

    ZALMA OPINION

    The importance of this case is the reiteration of the law that there can never be a viable tort of bad faith if there is no improper denial of a claim by breach of the insurance contract. If the one cause of action remaining was breached in bad faith and there was no genuine dispute over coverage, that cause can be brought for bad faith damages. The other decisions of the Ninth Circuit were obvious and well reasoned.

    (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
    No Breach of Contract no Bad Faith Happy Veterans Day to My Fellow Veterans Some Claims Proper Some Not Read the full article at https://www.linkedin.com/pulse/happy-veterans-day-my-fellow-barry-zalma-esq-cfe-ovpec, shttps://www.linkedin.com/pulse/happy-veterans-day-my-fellow-barry-zalma-esq-cfe-ovpec and at https://zalma.com/blog plus more than 4900 posts. Post 4929 Vepo Design Corporation and its officers (collectively, “Vepo”) appealed the district court’s grant of summary judgment on their breach of contract and bad faith claims against American Economy Insurance Company (“AEIC”). Vepo’s claims relate to AEIC’s denial of coverage following a fire in a laundromat, known as the “Central Laundromat,” which Vepo was developing. In Vepo Design Corporation, et al. v. American Economy Insurance Company, No. 23-55634, United States Court of Appeals, Ninth Circuit (November 4, 2024) the issues were resolved serially. DECISIONS Business Income The Ninth Circuit reversed the district court’s grant of summary judgment in favor of AEIC on Vepo’s business income claim, which concerns income Vepo contends it would have earned operating the Central Laundromat if the fire had not occurred. AEIC argued that Vepo’s claim for lost income was too speculative given that the Central Laundromat was still under construction and Vepo had not secured additional financing to own and operate it. Construing the facts in the light most favorable to Vepo as the non-moving party the Ninth Circuit concluded that there is sufficient evidence to create a genuine dispute of material fact and that Vepo’s claim for lost business income is not unduly speculative. There is evidence that Vepo was contemplating an arrangement under which it would own and operate the Central Laundromat for a period of time before selling it, and that Vepo later engaged in similar arrangements for other laundromats. Vepo, which was experienced in the laundromat industry, also demonstrated that it had a history of securing financing for its laundromat projects and that it intended to refinance the Central Laundromat once a certificate of occupancy was received. Although Vepo had not secured refinancing for the Central Laundromat as of the time of the fire, Vepo’s Principal Owner stated in her declaration and confirmed at her deposition that it was too early to do so in the project timeline. That Vepo had yet to refinance does not render its claim too speculative as a matter of law and its losses are for a jury to decide. Extra Expense The Ninth Circuit affirmed the district court’s grant of summary judgment in favor of AEIC for the extra expenses that Vepo allegedly incurred in storing laundry equipment in a warehouse owned by Vepo’s sister company following the fire. While the policy only required the expense to be incurred, not paid, there was insufficient evidence to create a triable issue over whether the expense was incurred at all. No payment changed hands between the two entities, and there is no accounting record showing that Vepo was liable for the storage amount. When the same person signed as representative of both entities, does not create a genuine dispute of material fact. Lost Profits The Ninth Circuit concluded that the district court properly granted summary judgment on Vepo’s claim for lost profits on the prospective sale of the laundromat. Even assuming that such a loss would be covered under the policy, the claim fails because the policy limited coverage to losses that occur within one year of the incident. Vepo’s plan called for it to own and operate the Central Laundromat for at least one year after opening, which would place any hypothetical sale more than a year after the pre-opening fire. Individual Personal Property Claims The Ninth Circuit affirmed summary judgment for AEIC on the claims by the individual plaintiffs for their own personal property that was allegedly lost in the fire. As the district court correctly found, Vepo did not identify what individual property was lost or its worth. The individual plaintiffs’ claims were too unsupported to create a triable issue. Bad Faith The Ninth Circuit partially reversed the district court’s grant of summary judgment on Vepo’s bad faith claim, to the extent of the single insurance claim it allowed to go forward-the business income claim. The district court may permit any further motions practice on the bad faith claim as it deems appropriate. However, it affirmed the district court’s grant of summary judgment on the bad faith claim insofar as that claim is premised on any of the other breach of contract claims to which AEIC is entitled to judgment as a matter of law. There is never a claim for breach of the implied duty of good faith and fair dealing if there was no improper denial of coverage under the policy. ZALMA OPINION The importance of this case is the reiteration of the law that there can never be a viable tort of bad faith if there is no improper denial of a claim by breach of the insurance contract. If the one cause of action remaining was breached in bad faith and there was no genuine dispute over coverage, that cause can be brought for bad faith damages. The other decisions of the Ninth Circuit were obvious and well reasoned. (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
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