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.

God Always Has a Plan https://slantedright2.blogspot.com/2024/11/god-always-has-plan.html SUMMARY: My wife Diana and I supplement our Social Security income via her Online Wellness store. Diana sent her testimony [SHARED ON BLOG POST] yesterday. I edited it bit (hopefully that doesn’t get me hot water 😊). Read Diana’s excitement and think about becoming a partner with us. ---TAKE A LOOK – HAPPY COFFEE – EARN HOLIDAY! #DianaWellnessStore #HappyCoffee

Bad Faith Set Up Fails Read the full article at https://www.linkedin.com/pulse/bad-faith-set-up-fails-barry-zalma-esq-cfe-jllxc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. Inadequate Information Made Refusal to Pay Policy Limits Not Bad Faith INADEQUATE MEDICAL AUTHORIZATION USED TO CAUSE INSURER TO REFUSE SETTLEMENT DEMAND Post 4930 Kara Flick appealed from the judgment after a jury rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. Flick contends the judgment should be reversed due to juror misconduct. In KARA FLICK v. UNITED SERVICES AUTOMOBILE ASSOCIATION, B330507, California Court of Appeals, Second District, Sixth Division (November 5, 2024) the Court of Appeals resolved the dispute. FACTUAL HISTORY After sustaining injuries in an automobile accident caused by Francisco Reyes, Jr., Flick had her attorney send Reyes's insurer, the United Services Automobile Association (USAA), a letter explaining the severity of her injuries and an authorization for the release of her medical records. Flick's attorney followed up with a settlement demand two months later, requesting that USAA pay Flick the entirety of Reyes's $100,000 policy limit in exchange for a release of liability. Attached to the demand was a single medical record from Flick's neurologist. USAA investigated Flick's claim and determined it did not have sufficient information to accept or reject her demand. Flick then filed a personal injury lawsuit against Reyes. The jury found in her favor and awarded nearly $1.7 million in damages. Flick, with an assignment from the Reyes, sued USAA for breach of contract and breach of the implied covenant of good faith and fair dealing. TRIAL At trial, a USAA claims adjustor admitted that Reyes was fully at fault for the accident with Flick. Reyes could therefore be exposed to liability in excess of his policy limits-if Flick provided sufficient documentation to support her claim. USAA's expert on insurance claims handling and another of its claims service managers both agreed with the supervisor that Flick's authorization was invalid and inadequate to allow USAA to obtain Flick's medical records. USAA needed additional records before it could determine the value of Flick's claim. Those records could have included the medical bills Flick provided to her own insurance company, the multiple doctor's notes she had excusing her from work, or the thumb drive recording her purported speech problems, all of which were entered into evidence at her personal injury trial. Because they were not provided to USAA, it was "very difficult to place a value on" Flick's claim. Flick's expert testified that USAA's handling of the settlement demand "was clearly unreasonable." Flick also did not respond to USAA's requests for additional information. By a vote of nine to three, the jury found that Flick did not make a reasonable settlement demand of USAA and rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. The trial court polled the jury, and each juror confirmed their vote. DISCUSSION The Court of Appeals concluded the trial court did not abuse its discretion in denying Flick's new trial motion. USAA successfully rebutted the presumption of prejudice by showing there is no reasonable probability that the juror, D.C.'s misconduct by not explaining he did not hear all of the adjuster's testimony, actually harmed Flick. Much of the adjustor's testimony consisted of facts regarding his communications with Flick's attorney - facts that were undisputed. What was disputed-whether Flick's settlement demand was reasonable-was the subject of other witness testimony, including USAA's expert on insurance claims handling, its supervising claims service manager, Flick's personal injury attorney, and her expert witness on insurance claims handling. What the admitted evidence showed was that D.C. confirmed multiple times that he voted that Flick did not make a reasonable settlement demand: Based on this record there was no reasonable probability that D.C.'s alleged juror misconduct actually harmed Flick. ZALMA OPINION The tort of bad faith arose from abuse by insurers on those they insured. Since its adoption in California about three quarters of a century ago, the abuse has been turned on to insurers. Ms. Flick's counsel placed a demand for settlement on USAA that it could not reasonably and in good faith to its insured, Reyes, because it was incomplete and inadequately supported and forced Flick and Reyes go through a trial where she received an uncollectible judgment against Reyes in hopes of a gigantic bad faith judgment. After much litigation and USAA spending a great deal to defend itself she received the $100,000 policy limit. USAA was punished but neither Flick nor her lawyers profited from the scheme or the appeal. (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

Governments Fully Aware COVID was a Control Scam Stefan Homburg Testifies at German Bundestag about RKI Leak https://tinyurl.com/bd5hk39d SUMMARY: On November 11 THE EXPOSÉ shared a John Leake post highlighting Stefan Homburg testimony in the German Bundestag about how Leaked Files from the RKI (German version of CDC) exposes how once-upon-a-time Free World Govts used Political Science NOT Science to control and force a NARRATIVE to comply to a COVID scam & Jab Scam. …READ & WATCH TESTIMONY! #MedicalTyrannyExposed #RKIFiles

Revelation Chapter 1 1 The Revelation of Jesus Christ, which God gave unto him, to shew unto his servants things which must shortly come to pass; and he sent and signified it by his angel unto his servant John: 2 Who bare record of the word of God, and of the testimony of Jesus Christ, and of all things that he saw. 3 Blessed is he that readeth, and they that hear the words of this prophecy, and keep those things which are written therein: for the time is at hand. 4 John to the seven churches which are in Asia: Grace be unto you, and peace, from him which is, and which was, and which is to come; and from the seven Spirits which are before his throne; 5 And from Jesus Christ, who is the faithful witness, and the first begotten of the dead, and the prince of the kings of the earth. Unto him that loved us, and washed us from our sins in his own blood, 6 And hath made us kings and priests unto God and his Father; to him be glory and dominion for ever and ever. Amen. 7 Behold, he cometh with clouds; and every eye shall see him, and they also which pierced him: and all kindreds of the earth shall wail because of him. Even so, Amen. 8 I am Alpha and Omega, the beginning and the ending, saith the Lord, which is, and which was, and which is to come, the Almighty. 9 I John, who also am your brother, and companion in tribulation, and in the kingdom and patience of Jesus Christ, was in the isle that is called Patmos, for the word of God, and for the testimony of Jesus Christ. 10 I was in the Spirit on the Lord's day, and heard behind me a great voice, as of a trumpet, 11 Saying, I am Alpha and Omega, the first and the last: and, What thou seest, write in a book, and send it unto the seven churches which are in Asia; unto Ephesus, and unto Smyrna, and unto Pergamos, and unto Thyatira, and unto Sardis, and unto Philadelphia, and unto Laodicea. 12 And I turned to see the voice that spake with me. And being turned, I saw seven golden candlesticks; 13 And in the midst of the seven candlesticks one like unto the Son of man, clothed with a garment down to the foot, and girt about the paps with a golden girdle. 14 His head and his hairs were white like wool, as white as snow; and his eyes were as a flame of fire; 15 And his feet like unto fine brass, as if they burned in a furnace; and his voice as the sound of many waters. 16 And he had in his right hand seven stars: and out of his mouth went a sharp twoedged sword: and his countenance was as the sun shineth in his strength. 17 And when I saw him, I fell at his feet as dead. And he laid his right hand upon me, saying unto me, Fear not; I am the first and the last: 18 I am he that liveth, and was dead; and, behold, I am alive for evermore, Amen; and have the keys of hell and of death. 19 Write the things which thou hast seen, and the things which are, and the things which shall be hereafter; 20 The mystery of the seven stars which thou sawest in my right hand, and the seven golden candlesticks. The seven stars are the angels of the seven churches: and the seven candlesticks which thou sawest are the seven churches.

Fraudulent Claims of Injury Defeated Respond to Motions for Summary Adjudication or Always Lose Posted on November 8, 2024 by Barry Zalma Post 4928 Read the full article at https://www.linkedin.com/pulse/fraudulent-claims-injury-defeated-barry-zalma-esq-cfe-kitgc, See the full video at and at and at https://zalma.com/blog IT PAYS DEFENDANTS TO INVESTIGATE INJURY CLAIMS Plaintiff appealed from two orders granting summary disposition in favor of defendants even though he failed to respond to either motion. 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. 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 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. ZALMA 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. (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

Declaring a Policy Void When a Policy Is Void For Subscribers to Excellence in Claims Handling You can Subscribe for only $5 a month to Excellence in Claims Handling at https://barryzalma.substack.com/subscribe A small portion of what was provided to subscribers. In almost every policy of insurance, there is a clause declaring the policy void if the insured misrepresents or conceals material facts or commits fraud. For example: We do not pay for bodily injury or property damage which is expected by, directed by, or intended by an insured. This exclusion does not apply to bodily injury that arises out of the use of reasonable force to protect people or property. (AAIS Form BP-200, (c) 1987 AAIS). or: This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other “insured,” at any time, intentionally conceal or misrepresent a material fact concerning: a. This Coverage Form; b. The covered “auto”; c. Your interest in the covered “auto”; or d. A claim under this Coverage Form. (Insurance Services Office form CA 00 01 01 87). The policy wording requires that the insurer prove, not only that the insured misrepresented or concealed a material fact but must also prove that the insured did so with the intent to deceive. Absent the rare confession it is often difficult to prove intentional deceit. The insured will usually claim that he or she was mistaken and had no intent to deceive. In more than 50 years of investigation of fraudulent insurance claims I only once received from an insured an under oath statement that the insured intentionally deceived the insurer and then, not in person, but by correcting false testimony in the transcript of an examination under oath. If fraud or mutual mistake is an issue, insurers and insureds doing business in Oklahoma must resort to courts of general jurisdiction for a determination of contractual rights.[1] In Oklahoma, the Workers’ Compensation court does not have the right to rescind or declare a policy of Workers’ Compensation insurance void. However, where there is a misrepresentation with intent to deceive and the putative insured recognized the materiality of the misrepresentation the insurance policy is void from its inception.[2] In Florida, Florida Statutes (2006), state in pertinent part: any insurance fraud shall void all coverage arising from the claim related to such fraud under the personal injury protection coverage of the insured person who committed the fraud. In harmony with this statutory provision, the fraud provision in an insurance policy set forth: “any insurance fraud shall void all personal injury protection coverage arising from the claim with respect to the insured who committed the fraud” is appropriate and enforceable. [Bosem v. Commerce & Indus. Ins. Co., 35 So.3d 944 (Fla. App., 2010)]

Leviticus Chapter 24 1 And the LORD spake unto Moses, saying, 2 Command the children of Israel, that they bring unto thee pure oil olive beaten for the light, to cause the lamps to burn continually. 3 Without the vail of the testimony, in the tabernacle of the congregation, shall Aaron order it from the evening unto the morning before the LORD continually: it shall be a statute for ever in your generations. 4 He shall order the lamps upon the pure candlestick before the LORD continually. 5 And thou shalt take fine flour, and bake twelve cakes thereof: two tenth deals shall be in one cake. 6 And thou shalt set them in two rows, six on a row, upon the pure table before the LORD. 7 And thou shalt put pure frankincense upon each row, that it may be on the bread for a memorial, even an offering made by fire unto the LORD. 8 Every sabbath he shall set it in order before the LORD continually, being taken from the children of Israel by an everlasting covenant. 9 And it shall be Aaron's and his sons'; and they shall eat it in the holy place: for it is most holy unto him of the offerings of the LORD made by fire by a perpetual statute. 10 And the son of an Israelitish woman, whose father was an Egyptian, went out among the children of Israel: and this son of the Israelitish woman and a man of Israel strove together in the camp; 11 And the Israelitish woman's son blasphemed the name of the LORD, and cursed. And they brought him unto Moses: (and his mother's name was Shelomith, the daughter of Dibri, of the tribe of Dan:) 12 And they put him in ward, that the mind of the LORD might be shewed them. 13 And the LORD spake unto Moses, saying, 14 Bring forth him that hath cursed without the camp; and let all that heard him lay their hands upon his head, and let all the congregation stone him. 15 And thou shalt speak unto the children of Israel, saying, Whosoever curseth his God shall bear his sin. 16 And he that blasphemeth the name of the LORD, he shall surely be put to death, and all the congregation shall certainly stone him: as well the stranger, as he that is born in the land, when he blasphemeth the name of the LORD, shall be put to death. 17 And he that killeth any man shall surely be put to death. 18 And he that killeth a beast shall make it good; beast for beast. 19 And if a man cause a blemish in his neighbour; as he hath done, so shall it be done to him; 20 Breach for breach, eye for eye, tooth for tooth: as he hath caused a blemish in a man, so shall it be done to him again. 21 And he that killeth a beast, he shall restore it: and he that killeth a man, he shall be put to death. 22 Ye shall have one manner of law, as well for the stranger, as for one of your own country: for I am the LORD your God. 23 And Moses spake to the children of Israel, that they should bring forth him that had cursed out of the camp, and stone him with stones. And the children of Israel did as the LORD commanded Moses.

You can lead people to the #Truth.... But you cannot make them THINK! Most people will get angry with you when you break the delusion they reside in At one time #Halloween was my favorite holiday (Holy Day) THEN I FOUND OUT THE TRUE NATURE OF THE CELEBRATION! And how what MODERN SOCIETY DOES TODAY exactly mimics ancient, #Pagan (#Satanic) Rituals! And I'm sorry... But I DO NOT CHOOSE to pay homage to the devil or any of his traditions! It's plain scary how EVERYTHING we now do for "Halloween" from the PUMPKIN to the "wearing costumes" and everything in between is literally AN EXACT DUPLICATE OF THE SATANIC RITUALS IT IMITATES! It REALLY freaked me out when I learned the truth about it! So much so that I felt the need to beg forgiveness for ever taking part! People ALWAYS SAY "Yeah, but the Father knows my heart, and I don't mean it in that way." HOW DID THAT WORK OUT FOR THE ISRAELITES WHO FASHIONED THE GOLDEN CALF IN YAHUWAH'S HONOR??? Do you remember? EVERYTHING that I do, I do to honor the Father! I have enough sins under my belt, I shall NOT tempt the Father with more! Exodus Chapter 32 1 And when the people saw that Moses delayed to come down out of the mount, the people gathered themselves together unto Aaron, and said unto him, Up, make us gods, which shall go before us; for as for this Moses, the man that brought us up out of the land of Egypt, we wot not what is become of him. 2 And Aaron said unto them, Break off the golden earrings, which are in the ears of your wives, of your sons, and of your daughters, and bring them unto me. 3 And all the people brake off the golden earrings which were in their ears, and brought them unto Aaron. 4 And he received them at their hand, and fashioned it with a graving tool, after he had made it a molten calf: and they said, These be thy gods, O Israel, which brought thee up out of the land of Egypt. 5 And when Aaron saw it, he built an altar before it; and Aaron made proclamation, and said, To morrow is a feast to the LORD. 6 And they rose up early on the morrow, and offered burnt offerings, and brought peace offerings; and the people sat down to eat and to drink, and rose up to play. 7 And the LORD said unto Moses, Go, get thee down; for thy people, which thou broughtest out of the land of Egypt, have corrupted themselves: 8 They have turned aside quickly out of the way which I commanded them: they have made them a molten calf, and have worshipped it, and have sacrificed thereunto, and said, These be thy gods, O Israel, which have brought thee up out of the land of Egypt. 9 And the LORD said unto Moses, I have seen this people, and, behold, it is a stiffnecked people: 10 Now therefore let me alone, that my wrath may wax hot against them, and that I may consume them: and I will make of thee a great nation. 11 And Moses besought the LORD his God, and said, LORD, why doth thy wrath wax hot against thy people, which thou hast brought forth out of the land of Egypt with great power, and with a mighty hand? 12 Wherefore should the Egyptians speak, and say, For mischief did he bring them out, to slay them in the mountains, and to consume them from the face of the earth? Turn from thy fierce wrath, and repent of this evil against thy people. 13 Remember Abraham, Isaac, and Israel, thy servants, to whom thou swarest by thine own self, and saidst unto them, I will multiply your seed as the stars of heaven, and all this land that I have spoken of will I give unto your seed, and they shall inherit it for ever. 14 And the LORD repented of the evil which he thought to do unto his people. 15 And Moses turned, and went down from the mount, and the two tables of the testimony were in his hand: the tables were written on both their sides; on the one side and on the other were they written. 16 And the tables were the work of God, and the writing was the writing of God, graven upon the tables. 17 And when Joshua heard the noise of the people as they shouted, he said unto Moses, There is a noise of war in the camp. 18 And he said, It is not the voice of them that shout for mastery, neither is it the voice of them that cry for being overcome: but the noise of them that sing do I hear. 19 And it came to pass, as soon as he came nigh unto the camp, that he saw the calf, and the dancing: and Moses' anger waxed hot, and he cast the tables out of his hands, and brake them beneath the mount. 20 And he took the calf which they had made, and burnt it in the fire, and ground it to powder, and strawed it upon the water, and made the children of Israel drink of it. 21 And Moses said unto Aaron, What did this people unto thee, that thou hast brought so great a sin upon them? 22 And Aaron said, Let not the anger of my lord wax hot: thou knowest the people, that they are set on mischief. 23 For they said unto me, Make us gods, which shall go before us: for as for this Moses, the man that brought us up out of the land of Egypt, we wot not what is become of him. 24 And I said unto them, Whosoever hath any gold, let them break it off. So they gave it me: then I cast it into the fire, and there came out this calf. 25 And when Moses saw that the people were naked; (for Aaron had made them naked unto their shame among their enemies:) 26 Then Moses stood in the gate of the camp, and said, Who is on the LORD'S side? let him come unto me. And all the sons of Levi gathered themselves together unto him. 27 And he said unto them, Thus saith the LORD God of Israel, Put every man his sword by his side, and go in and out from gate to gate throughout the camp, and slay every man his brother, and every man his companion, and every man his neighbour. 28 And the children of Levi did according to the word of Moses: and there fell of the people that day about three thousand men. 29 For Moses had said, Consecrate yourselves to day to the LORD, even every man upon his son, and upon his brother; that he may bestow upon you a blessing this day. 30 And it came to pass on the morrow, that Moses said unto the people, Ye have sinned a great sin: and now I will go up unto the LORD; peradventure I shall make an atonement for your sin. 31 And Moses returned unto the LORD, and said, Oh, this people have sinned a great sin, and have made them gods of gold. 32 Yet now, if thou wilt forgive their sin--; and if not, blot me, I pray thee, out of thy book which thou hast written. 33 And the LORD said unto Moses, Whosoever hath sinned against me, him will I blot out of my book. 34 Therefore now go, lead the people unto the place of which I have spoken unto thee: behold, mine Angel shall go before thee: nevertheless in the day when I visit I will visit their sin upon them. 35 And the LORD plagued the people, because they made the calf, which Aaron made.

Officer Caught Aiding Criminals for Cash Police Officer who took Bribes from Insurance Fraudster Convicted Post 4923 Read the full article at https://www.linkedin.com/pulse/officer-caught-aiding-criminals-cash-barry-zalma-esq-cfe-niboc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. Demarkco Johnson (“Johnson”), appealed his convictions and claims the following errors: 1 The trial court abused its discretion in denying appellant’s request for a jury instruction on entrapment. 2 The trial court erred in failing to admonish and/or instruct the witness to stop answering questions with a legal conclusion after defense counsel had objected. 3 Appellant’s convictions are against the manifest weight of the evidence; therefore, his convictions are in violation of the Ohio state constitution and the Sixth and Fourteenth Amendments to the United States Constitution. In State Of Ohio v. Demarkco Johnson, 2024-Ohio-5098, No. 113591, Court of Appeals of Ohio, Eighth District, Cuyahoga (October 24, 2024) resolved the issues on appeal. FACTS Defendants were charged with two counts of conspiracy, three counts of bribery, eight counts of forgery, one count of insurance fraud, one count of identity fraud, and one count of engaging in a pattern of corrupt activity. They engaged in a pattern of corrupt activity charge included a clause alleging that at least one of the incidents of corrupt activity was a felony of the third degree or higher. At trial George Michael Riley, Sr. (“Riley”), testified that he became a confidential source for the Federal Bureau of Investigation (“FBI”), which was investigating corruption in the East Cleveland Police Department. Special Agent Shaun Roth (“Roth”), an agent with the FBI working with the Cleveland Metropolitan Anti-Corruption Task Force, testified that the FBI executed a search warrant for one of Riley’s properties. Harris’s services included running Riley’s name in police databases to check for warrants and blocking off city roads so Riley could move his demolition equipment throughout the city. Two of Riley’s trucks were stolen from his business in East Cleveland. Riley told his contacts at the FBI, and FBI officials instructed him to file a police report with the East Cleveland police just as any other victim would do. Riley cooperated with the FBI. After hearing the evidence, the jury found Johnson guilty of two counts of bribery, as alleged in Counts 5 and 10 of the indictment. The jury acquitted him of all other charges. The court sentenced Johnson to 12 months in prison on both counts and ordered that the two prison terms be served concurrently. Johnson appealed the trial court’s judgment. Law and Analysis - Entrapment Instruction In the first assignment of error, Johnson argues the trial court erred in denying his request for a jury instruction on the defense of entrapment. Entrapment is a ‘confession and avoidance’ defense in which the defendant admits committing the acts charged but claims that the criminal design arose with the state’s agent. There is no entrapment when government officials merely afford opportunities or facilities for the commission of the offense to a criminal defendant who was predisposed to commit the offense. The video evidence showed Johnson handing Riley reports in exchange for money on multiple occasions. Johnson’s conduct demonstrated a ready acquiescence to the inducements offered by the government’s confidential source and a willingness to become involved in criminal activity in exchange for money. The evidence showed that Johnson not only had expert knowledge as to how to create the police reports in a way that could go undetected, but he also had access to the blank police forms that made the concealment of the reports possible. The Court of Appeals found that evidence did not support an entrapment defense. Testimony Pertaining to Bribery In the second assignment of error, Johnson argues the trial court erred by refusing to instruct Roth to refrain from using the word “bribe” or “bribery payment” in response to questions that were not specifically related to bribe payments. Even if Roth had avoided the words “bribe” or “bribery payment,” the outcome of the trial would not have been any different. The overwhelming evidence established that Johnson helped create fake police reports in exchange for money. Manifest Weight of the Evidence Johnson argued his convictions were against the manifest weight of the evidence. The Court of Appeals noted that Johnson’s convictions were not dependent on his knowledge of any insurance scheme or Harris’s separate dealings with Riley. His convictions were based solely on his position as a police officer in the East Cleveland Police Department and his acceptance of cash in exchange for police reports. Video evidence showed Johnson accepting cash from Riley in exchange for the reports on at least two occasions. And, despite Johnson’s argument to the contrary, Johnson played along when Harris introduced him to Riley as Nevels. CONCLUSION The Court of Appeals ordered that a special mandate issue out of the court directing the common pleas court to carry this judgment into execution. The defendant’s conviction having been affirmed, any bail pending appeal is terminated. Case remanded to the trial court for execution of sentence. ZALMA OPINION There can be no excuse for a police officer to sell information to an insurance criminal to ease the ability of the crime to succeed. Officer Johnson tried multiple arguments to set aside his conviction even though the evidence against him was overwhelming. The Court of Appeals disposed of his arguments quickly and intelligently. Fraud is a crime. Insurance fraud is a crime. Helping the criminal avoid prosecution is also a crime and establishes the officer had given up his honor for cash. (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