• 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
    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
    WWW.LINKEDIN.COM
    Discover thousands of collaborative articles on 2500+ skills
    Discover 100 collaborative articles on domains such as Marketing, Public Administration, and Healthcare. Our expertly curated collection combines AI-generated content with insights and advice from industry experts, providing you with unique perspectives and up-to-date information on many skills and their applications.
    0 Comentários 0 Compartilhamentos 863 Visualizações
  • absolutely!
    The psychopathic #Parasite class don't care WHO you #Vote for!
    Their witchcraft has blinded your eyes!

    They ONLY CARE that you continue "voting" to be RULED!
    You should look into the etymology of the word "vote"

    I'll help you some!
    What "god" are you making a promise to?
    How about "solemn engagement to devote oneself to a religious order or life"

    You are GIVING YOUR SOLEMN PLEDGE to #Evil,
    and liars, and who knows what "god"

    vote (n.)
    mid-15c., "formal expression of one's wish or choice with regard to a proposal, candidate, etc.," from Latin votum "a vow, wish, promise to a god, solemn pledge, dedication," noun use of neuter of votus, past participle of vovere "to promise, dedicate" (see vow (n.)). The meaning "totality of voters of a certain class or type" is from 1888.

    also from mid-15c.
    vote (v.)

    1550s, "give a vote to;" 1560s, "enact or establish by vote;" see vote (n.). Earlier it meant "to vow" to do something (mid-15c.). Related: Voted; voting.

    also from 1550s
    Entries linking to vote
    vow (n.)
    "solemn promise," c. 1300, from Anglo-French and Old French voe (Modern French vœu), from Latin votum "a promise to a god, solemn pledge, dedication; that which is promised; a wish, desire, longing, prayer," noun use of neuter of votus, past participle of vovere "to promise solemnly, pledge, dedicate, vow," from PIE root *wegwh- "to speak solemnly, vow, preach" (source also of Sanskrit vaghat- "one who offers a sacrifice;" Greek eukhē "vow, wish," eukhomai "I pray"). The meaning "solemn engagement to devote oneself to a religious order or life" is from c. 1400; earlier "to bind oneself" to chastity (early 14c.).
    absolutely! The psychopathic #Parasite class don't care WHO you #Vote for! Their witchcraft has blinded your eyes! They ONLY CARE that you continue "voting" to be RULED! You should look into the etymology of the word "vote" I'll help you some! What "god" are you making a promise to? How about "solemn engagement to devote oneself to a religious order or life" You are GIVING YOUR SOLEMN PLEDGE to #Evil, and liars, and who knows what "god" vote (n.) mid-15c., "formal expression of one's wish or choice with regard to a proposal, candidate, etc.," from Latin votum "a vow, wish, promise to a god, solemn pledge, dedication," noun use of neuter of votus, past participle of vovere "to promise, dedicate" (see vow (n.)). The meaning "totality of voters of a certain class or type" is from 1888. also from mid-15c. vote (v.) 1550s, "give a vote to;" 1560s, "enact or establish by vote;" see vote (n.). Earlier it meant "to vow" to do something (mid-15c.). Related: Voted; voting. also from 1550s Entries linking to vote vow (n.) "solemn promise," c. 1300, from Anglo-French and Old French voe (Modern French vœu), from Latin votum "a promise to a god, solemn pledge, dedication; that which is promised; a wish, desire, longing, prayer," noun use of neuter of votus, past participle of vovere "to promise solemnly, pledge, dedicate, vow," from PIE root *wegwh- "to speak solemnly, vow, preach" (source also of Sanskrit vaghat- "one who offers a sacrifice;" Greek eukhē "vow, wish," eukhomai "I pray"). The meaning "solemn engagement to devote oneself to a religious order or life" is from c. 1400; earlier "to bind oneself" to chastity (early 14c.).
    0 Comentários 0 Compartilhamentos 677 Visualizações
  • UKRAINE IS NOT A COUNTRY. IT WAS CREATED BY TH E DEEP STATE TO HIDE THEIR EVIL INTENTIONS FOR DESTROYING THE WORLD...
    I’m hoping Trump is dealing with Putin behind the scenes, not to undermine America but to stop any further conflict from escalating.
    UKRAINE IS NOT A COUNTRY. IT WAS CREATED BY TH E DEEP STATE TO HIDE THEIR EVIL INTENTIONS FOR DESTROYING THE WORLD... I’m hoping Trump is dealing with Putin behind the scenes, not to undermine America but to stop any further conflict from escalating.
    Like
    2
    0 Comentários 0 Compartilhamentos 558 Visualizações 4
  • Once Upon a Time in the West
    Directed by Sergio Leone, this epic Western re-established the genre, and still stands as one of the greatest, artistic films of all time. Henry Fonda stars as Frank, a ruthless murderous psychopath who feels no remorse, even after annihilating Mrs. McBain’s (Claudia Cardinale) entire family. Charles Bronson plays The Man, a harmonica wielding loner who will never forget how his brother was savagely tortured. The Man joins forces with Cheyenne (Jason Robards), the man wrongfully accused of murdering Mrs. McBain’s family, to put an end once and for all to Frank’s reign of terror.
    https://youtu.be/Gzk0f9xuIFg?si=dwyLYSpMEAedKeC5
    Once Upon a Time in the West Directed by Sergio Leone, this epic Western re-established the genre, and still stands as one of the greatest, artistic films of all time. Henry Fonda stars as Frank, a ruthless murderous psychopath who feels no remorse, even after annihilating Mrs. McBain’s (Claudia Cardinale) entire family. Charles Bronson plays The Man, a harmonica wielding loner who will never forget how his brother was savagely tortured. The Man joins forces with Cheyenne (Jason Robards), the man wrongfully accused of murdering Mrs. McBain’s family, to put an end once and for all to Frank’s reign of terror. https://youtu.be/Gzk0f9xuIFg?si=dwyLYSpMEAedKeC5
    0 Comentários 0 Compartilhamentos 678 Visualizações
  • Food Shortages In 2025? 20% Of U.S. Food Imported; Impact Of Tariffs | Joel Salatin

    https://www.youtube.com/watch?v=SOf79s6_RnU
    Food Shortages In 2025? 20% Of U.S. Food Imported; Impact Of Tariffs | Joel Salatin https://www.youtube.com/watch?v=SOf79s6_RnU
    Like
    1
    0 Comentários 0 Compartilhamentos 238 Visualizações
  • Food Shortages In 2025? 20% Of U.S. Food Imported; Impact Of Tariffs | Joel Salatin

    https://www.youtube.com/watch?v=SOf79s6_RnU
    Food Shortages In 2025? 20% Of U.S. Food Imported; Impact Of Tariffs | Joel Salatin https://www.youtube.com/watch?v=SOf79s6_RnU
    Like
    Sad
    3
    0 Comentários 0 Compartilhamentos 246 Visualizações

  • 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.
    WWW.LINKEDIN.COM
    Discover thousands of collaborative articles on 2500+ skills
    Discover 100 collaborative articles on domains such as Marketing, Public Administration, and Healthcare. Our expertly curated collection combines AI-generated content with insights and advice from industry experts, providing you with unique perspectives and up-to-date information on many skills and their applications.
    0 Comentários 0 Compartilhamentos 3K Visualizações
  • OUR DAILY OLDIES: THE DIAMONDS, 'LITTLE DARLING' - BY THE LATE 1950s, DOO WOP WAS A VERY POPULAR STYLE OF ROCK & ROLL, DOWN IN HAVANA, LOS ZAFIROS WERE DOING DOO WOP WITH A LATIN FLAVOR (CLICK ON THE LINK, NOT ON THE PHOTO)-----> https://wimkin.com/video/play/431919
    OUR DAILY OLDIES: THE DIAMONDS, 'LITTLE DARLING' - BY THE LATE 1950s, DOO WOP WAS A VERY POPULAR STYLE OF ROCK & ROLL, DOWN IN HAVANA, LOS ZAFIROS WERE DOING DOO WOP WITH A LATIN FLAVOR (CLICK ON THE LINK, NOT ON THE PHOTO)-----> https://wimkin.com/video/play/431919
    0 Comentários 1 Compartilhamentos 282 Visualizações
  • https://thepeoplesvoice.tv/uk-france-to-push-biden-into-escalating-ukraine-conflict-report/
    https://thepeoplesvoice.tv/uk-france-to-push-biden-into-escalating-ukraine-conflict-report/
    THEPEOPLESVOICE.TV
    UK & France To Push Biden Into Escalating Ukraine Conflict - Report
    It looks like British Prime Minister Keir Starmer and French President Emmanuel Macron may be plotting a last-ditch attempt to thwart Donald Trump on Ukraine The pair will be holding talks on Monday about boosting [...]
    0 Comentários 0 Compartilhamentos 238 Visualizações

  • 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
    WWW.LINKEDIN.COM
    Discover thousands of collaborative articles on 2500+ skills
    Discover 100 collaborative articles on domains such as Marketing, Public Administration, and Healthcare. Our expertly curated collection combines AI-generated content with insights and advice from industry experts, providing you with unique perspectives and up-to-date information on many skills and their applications.
    0 Comentários 0 Compartilhamentos 2K Visualizações
Páginas Impulsionadas
Patrocinado

We are 100% funded for October.

Thanks to everyone who helped out. 🥰

Xephula monthly operating expenses for 2024 - Server: $143/month - Backup Software: $6/month - Object Storage: $6/month - SMTP Service: $10/month - Stripe Processing Fees: ~$10/month - Total: $175/month

Xephula Funding Meter

Please Donate Here