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

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

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 The Court rescinded its order permitting Plaintiff to proceed anonymously.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

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

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

STRAIGHT OUT OF THE EVIL BABYLONIAN TALMUD YOU were turned into a #Slave by black magic of the Babylonian #Talmud! Where do you think that "Birth Certificates" and "Government #Corporations" come from??? You have been turned into CHATTEL PROPERTY via LIES, DECEPTION, FRAUD, and black magic straight out of the Talmud! How does that make you feel? Do you enjoy being a SLAVE? https://old.bitchute.com/video/dlVcZRQufzwu/

The U.S. government has been caught orchestrating regime change in Guatemala. “This is Ukraine 2.0,” says investigative journalist Ryan Matta. “The Guatemalan government had an election, and they believed that their election was rigged.” When Guatemala’s Attorney General took on the daunting task of investigating [ Election fraud alongside child trafficking ] involving NGOs, U.S. Secretary of State Tony Blinken stepped in—but not to support her efforts. Instead, Blinken flew to Guatemala and demanded that the Attorney General herself be investigated for “corruption.” https://vigilantnews.com/post/us-government-caught-orchestrating-another-regime-change/

CORRUPT JUDGES & WEAPONIZED LEGAL SYSTEM MUST END NOW! Special Guest: Michael Pendleton, Esq. Despite the FACT that our entire "government" is an illegitimate #Corporation, operating #Fraudulently under "Maritime Admiralty Law," it's hard to get most people to realize this FACT! If you choose to continue under this corrupt system then you must know.... The "Grand Jury" belongs to the AMERICAN PEOPLE - NOT "government" The AMERICAN PEOPLE have every right to enforce the law, even against government #Criminals! LET ME SAY THAT AGAIN..... THE GRAND JURY BELONGS TO THE AMERICAN PEOPLE!!! As does our corporate "Law Enforcement" (Technically) If a grand jury of the AMERICAN PEOPLE hand down a conviction of some government #Criminal, it is the DUTY of every law enforcement agent in the United States to see that the convicted party is both ARRESTED and then put in PRISON! And ANY LEO who fails to do his sworn duty (TO THE PEOPLE, NOT the Corporation) he needs to be FIRED first of all.... And then PROSECUTED and sent to prison himself! Because what we currently have is a standing "Foreign ARMY" on US Soil", and just because they claim themselves to be "Police" and "Sheriffs" it does NOT change this FACT! They are currently serving at the pleasure of CRIMINALS, and not the American People, as their oath REQUIRES them to do The real issue in this country is #Corrupt #LawEnforcement who do not do not uphold their #Oath of office AND view the American People as their ENEMY, instead of AS THEIR BOSSES, The way it truly is! Of course some prison time can be handed to THEM as well! And this would be cured real friggin quick! And as far as "Lifetime appointments" of #Judges goes... THEY SERVE AT THE PLEASURE OF THE PEOPLE AS WELL! The American PEOPLE are the bosses here folks! NO LAW or any "tradition" or "Constitution" or "Legal System" can change that FACT! If THE PEOPLE want these MF's removed, then THEY ARE GONE! THE PEOPLE are the deciding vote in ANY SITUATION! And it is high time that we reclaim our position as the FINAL DECISION MAKERS! (In ANY decision) THE PEOPLE have "Veto Power" over ANY "government" law or decision! After all, these people (supposedly) work for US! Just like government secrecy, and their constant, criminal, claim of "National Security" where they refuse to show THE PEOPLE (Their BOSSES) what they are doing! It does NOT work that way folks! EMPLOYEES are not allowed to keep secrets about their activities from THE PEOPLE who employee them! I mean they can TRY..... But the corrective action for this is to FIRE THEM IMMEDIATELY every time they try it! Living under TYRANT SCUM who operates in secrecy, and IN YOUR NAME is unacceptable!!! The problem is really YOU! Your lack of holding these scumbags accountable has led us here! And it's time to take corrective action on that front RIGHT NOW! Your supposed "government" employees JUST TRIED TO MURDER YOU! I would have to say that it's time to re-evaluate their employment, as well as their ability to continue sucking wind! Every last one responsible for this attempt, at the very least, should die in prison! The "government" has grown this corrupt and #Evil because YOU allowed them to! It's 110% OUR FAULT! Now is the time to ADMIT OUR FAILURE, and take immediate corrective actions "Begging our own EMPLOYEES to uphold the law and to be accountable" to the PEOPLE who EMPLOYEE THEM is unacceptable! YOU are the BOSS! It is time that "government" is let in on that little secret! https://youtu.be/-NKBWfyX3Qk

BREAKING EXCLUSIVE: Alex Jones Responds To The CT Appellate Court Upholding $1.35 Billion Of The Fraudulent Judgement Against Him In The Infamous CT Sandy Hook Show Trial https://www.infowars.com/posts/breaking-exclusive-alex-jones-responds-to-the-ct-appellate-court-upholding-1-35-billion-of-the-fraudulent-judgement-against-him-in-the-infamous-ct-sandy-hook-show-trial

Ep. 3517b - Biden Preparing To Preemptively Pardon The [DS], One Problem, Fraud Vitiates Everything https://www.bitchute.com/video/qr9aGDAOQ7FD/?list=notifications&randomize=false The [DS] has been formulating plans to stop Trump before he is inaugurated and after. They have put up many barriers up and they are trying to protect themselves. Biden is looking to preemptively pardon the [DS] people. One problem with all of this, fraud vitiates everything. Plus the states can bring charges.