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

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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.

I am Thankful Thanksgiving Wishes from the Zalma Family Post 4938 Posted on November 27, 2024 by Barry Zalma See the full video at and at hope, on this Thanksgiving weekend, that you can join my family and me remembering that it is more important to think about our blessings and those things that we have to be thankful for than to get in line for “Black Friday” to buy an inexpensive flat screen t.v. or tablet. Enjoy the holiday and your family as I will. My family and I have much to be thankful for this year. My first born daughter, Stephanie Zalma, continues to care for my wife 24 hours a day 7 days a week with love and patience as Thea continues as Nana to our two grandchildren and the loving mother of our three children. After receiving a new Aortic Heart Valve I am personally in good health, walking about 25 miles a week. Exercising my, apparently unusual, mode of retirement, I work only six to eight hours a day doing what I love the most, writing about insurance, insurance claims, insurance law and acting as an insurance claims consultant and expert witness. To me, I am thankful for you, my friends, clients and readers of “Zalma’s Insurance Fraud Letter,” my blog “Zalma on Insurance,” and my books and other writing including the third Edition of the ten volumes of my treatise, “Zalma on Insurance Claims” and the Fourteenth Edition of “Property Investigation Checklists.” As a first generation American I am honored to join with all Americans the ability to celebrate Thanksgiving that started when the United States was a dream and just a colony of Great Britain, to give thanks for the good things in life at least once a year. It took Abraham Lincoln, our greatest President to make it an official holiday. The Thanksgiving holiday gives me and my family the opportunity to consider the blessings we have received and to thank all who have made it possible. Please allow me this opportunity to explain to you all the things I, and my family, can continue to give thanks for: 1. I have loved my wife of almost 57 years since we first met when she was nine and I was twelve. 2. I am thankful that she still loves me and lets me make clear every day that I love her more now than I did when she ignored me when I was 12. 3. My three adult children who are successes in their own right. 4. That my three children who put up with my wife and I, and are healthy, successful, and mostly happy in what they do. 5. My almost eight-year-old granddaughter and my 22 year-old grandson live nearby, my grandson is now a successful college graduate from Puget Sound University in Washington state and working full time in I.T. 6. My clients who, for the more than 57 years have allowed me to earn a living doing what I love. I practiced law until I let my license go inactive, acting as a consultant, testifying as an expert witness and writing materials to help others provide excellence in claims services as members of the insurance profession. 7. My publishers the American Bar Association, Full Court Press, Fastcase.com, Thomson Reuters and Amazon.com. 8. My dearly departed parents and grandparents for having the good sense to leave the Ottoman Empire at the beginning of the 20th Century so we could avoid the Holocaust and I could be born American. 9. My country for giving me a place to live and work in peace and complain about it without fear. 10. The state of California, where I was born, and have lived for 82 years, for allowing me to have my home and grow my family, and the ability to pay California’s high taxes for the privilege. 11. Those of you who read what I write and gain something from it. 12. Eighty two years of mostly good health, but for a small heart attack,clogged arteries, a failed Aortic heart valve, ant the surgeons that gave me the ability to continue to work – albeit at a reduced rate. 13. Allowing me the health and ambition to avoid my cardiologist by walking every day and working on my garden and bonsai with one of my Chinese Elms in a pot for more than 49 years. 14. The hundreds of friends I have never met but with whom the Internet has allowed me to communicate in parts of the world I have never visited. 15. The wonder of the Internet that allows me to publish E-books, ZIFL and my blog instantly on line. 16. That my family can get together to express our thanks for each other and our happiness this year again without a need for anything but enjoying each other’s company and some good food. 17. That most of you who I know only by my publications can also gather with your families to express your thanks. When I enlisted in the U.S. Army in 1964, I volunteered ostensibly to avoid the draft and volunteered to serve anywhere in the world. Fortunately, the Army made assignments in alphabetical order and I was sent by the U.S. Army Intelligence Corps to Peoria, Illinois where I became a Special Agent in Charge of an office investigating people who sought security clearances. I was trained to be an investigator and enjoyed every minute of the job. Until the Army I had never seen a river without a concrete bottom only to see the mighty Mississippi as my first real river. I had never seen snow other than in the distance on mountains only to find myself shoveling the snow off the driveway in the small half-of-a-house I rented from an old couple who could not do it themselves. My investigative assignments required me to travel throughout Central Illinois from the Iowa to the Indiana borders. I stopped at court houses along the way, all of which had signs that Abraham Lincoln practiced law there. Those experiences with the courts, law enforcement officers, and court personnel probably gave me the incentive to become a lawyer. When I finished my three year enlistment I returned home, proposed marriage to the love of my life, who fortunately for me, accepted. I began the study of law at night and found my first real job where I could use the skills I learned in the Army. I was hired as a claims trainee at the Fireman’s Fund American Insurance Company who spent the time to train me to be a claims adjuster. The training was, unlike modern insurers, thorough. I was required to read a treatise on insurance and insurance claims handling. I was sent out with experienced adjusters in all types of insurance Fireman’s Fund wrote to learn as they adjusted claims, and eventually allowed to deal with the public under close supervision. Contrary to the requirements of the insurance industry at the time, Fireman’s Fund allowed me to study law at night while I worked as a full-time insurance adjuster. I was fortunate enough to work for a claims manager – Coleman T. Mobley – who did not require me to go out of state to adjust major storm claims if it interfered with my law school studies. Since I was in law school 50 weeks a year the only catastrophe storm duty I was required to work was a fire storm that burned from the San Fernando Valley to the ocean at Malibu. Because of Mr. Mobley and the Fireman’s Fund I was able to complete my studies and pass the California Bar in 1971 and be admitted to the California Bar on January 2, 1972. I took a cut in pay to get my first job as an Associate Attorney with a law firm that was willing to teach me to be a lawyer handling every kind of problem a new lawyer could face from wills, tort claims, divorce, drunk driving, trials, depositions, and dozens of orders to show cause in multiple courts around the Inland Empire of California. By doing so, when I started practicing law in 1972, I became a lawyer who could deal with any issue brought to me. I was fortunate enough to be able to move to an insurance law firm in Century City where I was assigned to a coverage lawyer who was trying to deal with over 500 active matters and, who, when I arrived, assigned 250 of the matters to me and pointed me to the firm’s library to learn what to do. At the time new technology was an IBM Selectric typewriter that could erase errors from the keyboard without the need to use white-out paint. I did legal research in the firm’s large library which, when it was inadequate for the task, I drove to the County Law Library in downtown Los Angeles to adequately research legal questions . Research in a large library took days to find support for an issue. I needed three professional legal secretaries to keep up with my dictation. Now, using modern technology, I can do the same legal research in 30 minutes on Fastcase.com, need no secretary, and can operate my consulting, writing, training and publishing businesses with no employees. In 1979 I decided it was time to be my own boss. I started a law firm called Barry Zalma, Inc. with a secretary who came from my last firm and brought an IBM Selectric typewriter with her into a small windowless office. I had obtained a line of credit from a bank that I hoped would carry us until the practice started since the only case I was sure of when I moved into my new office, was my sister’s rear-ender from which I could not, and did not, take a fee. The office was furnished with a file cabinet from my father-in-law’s dental practice and a dining room table from my wife’s grandmother who had passed away. I received my first call at 8:10 a.m. on the first day, October 1, 1979, from Alan Worboys, a claims person speaking for Certain Underwriters at Lloyd’s, London and my practice began. Alan became, and still is, a long time friend. I had nothing to do on October 3, 1979 so I wrote an article for publication. After that, I had no peace and the firm quickly grew to 9 lawyers and a staff to serve them all defending people who were insured and acting as coverage counsel for insurers who needed advice and counsel concerning interpretation of insurance contracts and how to deal with attempted fraud. I, and the lawyers who joined the firm also provided defense to insureds of our clients and defense of suits against the insurers for tort, including the tort of bad faith. I was more successful than I ever expected. I, whose experience was limited to Los Angeles County and Central Illinois, found a need to travel to Taipei, Taiwan and London, England on behalf of my clients. I worked, as I had learned from my father who survived the Depression, 16 hours a day, six or seven days a week. When I became 75 years old my firm had been reduced back to a sole practice and I decided it was time to stop practicing law and become a consultant and fulfill my childhood dream to be an author. I am a very lucky and happy man. I do work that I love. I fulfilled my childhood dreams. I Live in a home I have owned for more than 49 years that my wife and I adapted and increased as children were born to meet our needs. I have the love of my life with me and look forward to celebrating our 57th wedding anniversary next month. I am honored that my eldest daughter has come back to live with us and care for my wife and I who are not able to do everything we used to do. I have three wonderful children, two grandchildren and all live close. My son, and his business shares my office building and has time to visit with me as allowed by his busy schedule. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk This is a long article so go to https://www.linkedin.com/pulse/i-am-thankful-barry-zalma-esq-cfe-bzysc, to read the full article.

Insurer Properly Sanctioned for Failure to Obey Court Order It is Never Proper to Fail to Comply With Court Order Post 4937 Read the full article at https://www.linkedin.com/pulse/insurer-properly-sanctioned-failure-obey-court-order-barry-vefvc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. Insurer Privilege Underwriters took its name too far trying to obtain privileges from the Arkansas Court of Appeals to which it was not entitled and acted contumaciously by disobeying the Circuit Court’s discovery order. In Privilege Underwriters Reciprocal Exchange v. Brandon Adams, No. CV-23-474, 2024 Ark.App. 571, Court of Appeals of Arkansas, Division I (November 20, 2024) the circuit court granted appellee Brandon Adams’s motion to enforce court order and motion for sanctions, imposed a “sanction fee in the amount of $5,000” against appellant Privilege Underwriters Reciprocal Exchange (“Privilege”), and awarded Adams $2,500 in attorneys’ fees and costs under Arkansas Rule of Civil Procedure 37; denied Privilege’s motion for summary judgment; and denied Privilege’s motion for protective order, which sought to bar Adams from taking any depositions. FACTS In an insurance-coverage action in which Adams sued Privilege, his insurer, for failing to provide him a defense in a lawsuit filed against Adams and several other individuals and entities. Privilege answered Adams’s coverage complaint denying that it owed Adams a duty to defend the lawsuit and asserting a number of the subject policies’ exclusions as affirmative defenses to coverage. Adams served written discovery on Privilege. Privilege responded with objections and inadequate responses to Adams’s discovery requests. Adams moved to compel Privilege to respond and produce documents and the Court of Appeals ordered Privilege respond and to pay Adams’s attorneys’ fees and costs in the amount of $2,000. Privilege produced its supplemental interrogatory answers and supplemental privilege log on March 2, 2022 but did not comply with the circuit court’s discovery order. Contrary to the court’s order Privilege refused to amend its privilege log, provide full and complete answers to Adams’s interrogatories, or produce any witnesses for deposition, and instead, Privilege moved for summary judgment. Adams then filed his “Motion to Enforce Court Order and Motion for Sanctions and Incorporated Brief” on April 25, 2022. On December 20, 2022, the circuit court held a hearing on Adams’s motion for sanctions and Privilege’s motions for summary judgment and for protective order. The circuit court announced that it would sanction Privilege for its failure to comply with the circuit court’s February 2022 discovery order. From the bench, the circuit court made specific findings that Privilege had failed to comply with the provisions of that order requiring Privilege to amend its privilege log to provide sufficient information to allow the circuit court and Adams to evaluate Privilege’s claims of attorney-client privilege and work-product protection and to fully answer Adams’s interrogatories. TO ESTABLISH CONTEMPT Generally, in order to establish contempt, there must be willful disobedience of a valid order of a court. Contempt is a matter between the court and the litigant, and not between the two opposing litigants. Before one can be held in contempt for violating the court’s order, the order must be definite in its terms, clear as to what duties it imposes, and express in its commands. Contempt is divided into criminal contempt and civil contempt. The standard of review on appeal depends on whether the contempt sanction was civil or criminal in nature. The circuit court imposed a fine and fees that were to be paid to Adams. A contempt fine for willful disobedience that is payable to the complainant is remedial and therefore constitutes a fine for civil contempt. Privilege refused to comply with a valid discovery order from the circuit court because Privilege disputed Adams’s entitlement to the discovery underlying that order. Instead, Privilege moved for summary judgment, attempting to render moot that prior discovery order. The circuit court rightly held Privilege in contempt for its willful disobedience of the circuit court’s February 2022 discovery order and imposed a fine of $5,000. Once the February 2022 discovery order was entered, Privilege was required to comply with that order, not question the propriety of that order or when Privilege should comply with it. The circuit court was unequivocal in finding at the December 2022 hearing that it was sanctioning Privilege for its violation of the February 2022 discovery order. The circuit court then went on to explain that Privilege had disobeyed its February 2022 order by failing to provide contact information for the witnesses identified in response to Interrogatory No. 1 and by failing to provide a privilege log with sufficient information to allow the circuit court and Adams to evaluate the claim of attorney-client privilege and work-product protection. Thus, the Court of Appeals held that the circuit court did not clearly err in holding Privilege in contempt. The circuit court had ample authority to use its contempt powers to enforce its February 2022 discovery order. ZALMA OPINION This order must be more than embarrassing to Privilege and to the insurance industry. Parties to litigation are not entitled to refuse to fulfill an order of the court. Regardless of the name of the insurer it had no special privileges and must fulfill the order to the letter and pay the sanctions including the extra sanctions placed by the Court of Appeals. (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

Requiring an Insurer to Waive its Right to Subrogation is a Valid & Enforceable Contract Waiver of Subrogation Applies in Marine Insurance Policy Post 4938 Read the full article at https://www.linkedin.com/pulse/requiring-insurer-waive-its-right-subrogation-valid-zalma-esq-cfe-gkn3c/, see the full video at and at and at https://zalma.com/blog. Competing motions for summary judgment were presented to the USDC for the Eastern District of Louisiana in a limitation-of-liability action arising from the listing and capsizing of the liftboat RAM XVIII. The motions present the principal question whether Fieldwood (charterer of the liftboat) must defend and indemnify Aries (owner of the liftboat) and U.S. Specialty (Aries’s insurer) under a master time charter agreement from the personal-injury claims brought by employees of Fluid Crane & Construction, Inc. and United Fire and Safety, LLC (Fieldwood’s subcontractors) who were aboard the RAM XVIII when it capsized. Fieldwood moved for partial summary judgment enforcing waivers of subrogation in the master time charter agreement and the relevant U.S. Specialty insurance policy. In The Matter Of Aries Marine Corporation, et al., Civil Action Nos. 19-10850, 19-13138, United States District Court, E.D. Louisiana (November 20, 2024) the USDC resolved the disputes. BACKGROUND The USDC resolved a five-year-old limitation-of-liability action that arose from the listing and capsizing of the liftboat RAM XVIII in the Gulf of Mexico. Aries chartered the RAM XVIII to Fieldwood under a master time charter agreement (the “Time Charter”) in relation to work being performed on one of Fieldwood’s offshore platforms. Under those Master Services Contracts, Fluid Crane and United Fire sent employees to work on Fieldwood’s platform; those employees were aboard the RAM XVIII when it capsized. U.S. Specialty, for its part, underwrote an insurance policy (the “Policy”) that provided Aries with certain coverages in effect when the RAM XVIII capsized. Six employees of Fluid Crane and one employee of United Fire-all of whom were aboard the RAM XVIII when it capsized-brought personal injury claims against Aries. The motions before the Court present the principal question whether Fieldwood must defend and indemnify Aries and U.S. Specialty from those personal-injury claims. THE TIME CHARTER Section 10 features a waiver-of-subrogation provision mandating that “[u]nderwriters of all policies of insurance required [by Section 10] shall waive their rights of subrogation against the Charterer Group,” which includes Fieldwood. THE POLICY The Policy provides coverage to Aries for protection and indemnity, including coverage for personal-injury liability. The Policy includes a waiver-of-subrogation provision that applies to the protection-and-indemnity coverage. A separate section of the Policy-governing hull-insurance coverage contains a waiver-of-subrogation provision and a provision naming Fieldwood as an additional insured. THE MASTER SERVICES CONTRACTS. Fieldwood executed the Master Services Contracts with Fluid Crane and United Fire, respectively. Fluid Crane and United Fire agreed to indemnify the other entities involved from claims asserted by their own employees, as well as to be responsible for defense costs for such claims. ANALYSIS Fieldwood’s Motion Fieldwood moved the Court to grant partial summary judgment enforcing waivers of subrogation in the Time Charter and Policy and dismissing Aries’s crossclaim and U.S. Specialty’s complaint-in-intervention. The Court held that Fieldwood is entitled to partial summary judgment because a review of the Time Charter and the Policy confirms that both Aries and U.S. Specialty have waived their rights of subrogation against Fieldwood. U.S. Specialty Waived Its Rights of Subrogation The Policy unambiguously waives U.S. Specialty’s right of subrogation in favor of Fieldwood. The Policy features a waiver-of-subrogation provision. The Time Charter qualifies as a “written contract” that “require[s]” U.S. Specialty to waive its rights of subrogation against Fieldwood because the Time Charter features a waiver-of-subrogation provision mandating that “[u]nderwriters of all policies of insurance required [by Section 10 of the Time Charter] shall waive their rights of subrogation against the Charterer Group,” which is defined to include Fieldwood. Because a review of the Time Charter and the Policy confirms that U.S. Specialty unambiguously waived its rights of subrogation against Fieldwood, and because the claims asserted in U.S. Specialty’s complaint-in-intervention rest on a subrogation theory, the Court granted Fieldwood’s motion for summary judgment and dismissed with prejudice U.S. Specialty’s complaint-in-intervention. The USDC concluded that the waivers of subrogation in Fieldwood’s favor are enforceable, and Aries and U.S. Specialty have not adequately presented any argument that would allow the Court to hold that their claims for defense and indemnity can survive despite the enforceability of those waivers of subrogation. Fieldwood’s motion for partial summary judgment was GRANTED. ZALMA OPINION Insurance policies like the marine policy interpreted in this case contain standard language authorizing the insured to waive the insurers’ right of subrogation if it does so before there is a loss. Since the litigants sought subrogation recovery which it had waived by the standard language of its policy this five year long litigation was resolved by the acceptance of the waiver. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

Appear for a Scheduled EUO or Lose Failure to Honor Conditions Precedent Voids Coverage in New York Post 4937 Read the full article at https://www.linkedin.com/pulse/appear-scheduled-euo-lose-barry-zalma-esq-cfe-gvkec/, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. State Farm contended that it is entitled to summary judgment because of the failure to appear for examination under oath (EUO) by multiple defendants. State Farm contended that timely notices were properly mailed to the Claimants who failed to appear. In State Farm Mutual Automobile Insurance Company v. Alford A. Smith, M.D., et al, 2024 NY Slip Op 33802(U), Index No. 155607/2020, Motion Seq. No. 003, Supreme Court, New York County, Appellate Division (October 24, 2024) court ruled in favor of State Farm. The Supreme Court of New York County ORDERED that the plaintiff, State Farm Mutual Automobile Insurance Company’s (“State Farm/Plaintiff’), motion for summary judgment was GRANTED against defendants, Alford A. Smith, M.D., P.C., and the multiple other defendants who are doctors, chiropractors and other health services, (hereinafter collectively (“The Defendants”). FACTS The Supreme Court found that the EUO scheduling letters were timely requested and claimants failed to appear at that EUO. The documentary evidence showed that plaintiff sent the EUO scheduling letters to the claimants within 15 business days of receiving the prescribed verification forms as required by New York statute. FRAUD, FAILURE TO APPEAR FOR EUO & FAILURE TO SIGN TRANSCRIPT ARE BREACHES OF MATERIAL CONDITION PRECEDENT The Appellate Division upheld the Supreme Court’s ruling that the failure to appear for an EUO that was requested in a timely fashion by the insurer is a breach of a condition precedent to coverage and voids the policy ab initio. In addition, although claimant Griselda Torres unlike the other defendants, appeared for her EUO, Torres failed to return a subscribed copy of her EUO transcript. State Farm properly and effectively argued that appearing for and testifying at EUO and returning the transcripts of the EUO are conditions precedent to coverage and failure to sign and return the transcript warranted a denial of the claims. State Farm demonstrated in its motion and supporting evidence that multiple claimants breached a condition precedent to coverage by failing to appear for properly noticed EUOs on two separate occasions. Furthermore, claimant Griselda Torres’ failure to subscribe and return the transcript of her EUOsviolated a condition precedent to coverage and warranted denial of the claims. Moreover, there was nothing on the Court’s record to suggest that the scheduled EUOs were not justified, nor held at a place and time that was not reasonably convenient to the defendants. CONCLUSION State Farm’s motion seeking summary judgment in its favor was GRANTED as to THE multiple defendants and it was further ORDERED that any requested relief sought not expressly addressed herein has nonetheless been considered; and it was further ORDERED that the case shall continue against the remaining defendants; and it was further ORDERED that within 30 days of entry, plaintiff shall serve a copy of this decision/order upon the defendants with notice of entry. ZALMA OPINION The defendants in this case were doctors, physicians, chiropractors and other health care providers who billed State Farm for services provided to people who were injured in automobile accidents and assigned their rights to the providers who tried to collect their billings without complying with the EUO condition. They all lost their claims because they refused to appear except one defendant who appeared but failed to sign the transcript of the EUO and return it to State Farm. They all lost their claims and State Farm will continue its actions against many more defendants not subject to the motion. (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

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