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    Footage from last night’s Russian Ballistic Missile Attack on the City of Dnipro, shows that the Multiple Independently Targetable Reentry-Vehicle (MIRV) used, equipped to either an Intermediate-Range or Intercontinental Ballistic Missile, contained at least 6 Conventionally-Armed Warheads.
    HEY BIDEN F"K AROUND AND FIND OUT... Footage from last night’s Russian Ballistic Missile Attack on the City of Dnipro, shows that the Multiple Independently Targetable Reentry-Vehicle (MIRV) used, equipped to either an Intermediate-Range or Intercontinental Ballistic Missile, contained at least 6 Conventionally-Armed Warheads.
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    WWW.FOX5DC.COM
    Honduran migrant accused of rape was arrested for sex crimes, released multiple times
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  • Appear for a Scheduled EUO or Lose

    Failure to Honor Conditions Precedent Voids Coverage in New York

    Post 4937

    Read the full article at https://www.linkedin.com/pulse/appear-scheduled-euo-lose-barry-zalma-esq-cfe-gvkec/, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.

    State Farm contended that it is entitled to summary judgment because of the failure to appear for examination under oath (EUO) by multiple defendants. State Farm contended that timely notices were properly mailed to the Claimants who failed to appear.

    In State Farm Mutual Automobile Insurance Company v. Alford A. Smith, M.D., et al, 2024 NY Slip Op 33802(U), Index No. 155607/2020, Motion Seq. No. 003, Supreme Court, New York County, Appellate Division (October 24, 2024) court ruled in favor of State Farm.

    The Supreme Court of New York County ORDERED that the plaintiff, State Farm Mutual Automobile Insurance Company’s (“State Farm/Plaintiff’), motion for summary judgment was GRANTED against defendants, Alford A. Smith, M.D., P.C., and the multiple other defendants who are doctors, chiropractors and other health services, (hereinafter collectively (“The Defendants”).

    FACTS

    The Supreme Court found that the EUO scheduling letters were timely requested and claimants failed to appear at that EUO. The documentary evidence showed that plaintiff sent the EUO scheduling letters to the claimants within 15 business days of receiving the prescribed verification forms as required by New York statute.

    FRAUD, FAILURE TO APPEAR FOR EUO & FAILURE TO SIGN TRANSCRIPT ARE BREACHES OF MATERIAL CONDITION PRECEDENT

    The Appellate Division upheld the Supreme Court’s ruling that the failure to appear for an EUO that was requested in a timely fashion by the insurer is a breach of a condition precedent to coverage and voids the policy ab initio. In addition, although claimant Griselda Torres unlike the other defendants, appeared for her EUO, Torres failed to return a subscribed copy of her EUO transcript.

    State Farm properly and effectively argued that appearing for and testifying at EUO and returning the transcripts of the EUO are conditions precedent to coverage and failure to sign and return the transcript warranted a denial of the claims.

    State Farm demonstrated in its motion and supporting evidence that multiple claimants breached a condition precedent to coverage by failing to appear for properly noticed EUOs on two separate occasions. Furthermore, claimant Griselda Torres’ failure to subscribe and return the transcript of her EUOsviolated a condition precedent to coverage and warranted denial of the claims.

    Moreover, there was nothing on the Court’s record to suggest that the scheduled EUOs were not justified, nor held at a place and time that was not reasonably convenient to the defendants.

    CONCLUSION

    State Farm’s motion seeking summary judgment in its favor was GRANTED as to THE multiple defendants and it was further ORDERED that any requested relief sought not expressly addressed herein has nonetheless been considered; and it was further ORDERED that the case shall continue against the remaining defendants; and it was further ORDERED that within 30 days of entry, plaintiff shall serve a copy of this decision/order upon the defendants with notice of entry.

    ZALMA OPINION

    The defendants in this case were doctors, physicians, chiropractors and other health care providers who billed State Farm for services provided to people who were injured in automobile accidents and assigned their rights to the providers who tried to collect their billings without complying with the EUO condition. They all lost their claims because they refused to appear except one defendant who appeared but failed to sign the transcript of the EUO and return it to State Farm. They all lost their claims and State Farm will continue its actions against many more defendants not subject to the motion.

    (c) 2024 Barry Zalma & ClaimSchool, Inc.

    Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.

    Subscribe to my substack at https://barryzalma.substack.com/subscribe

    Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg

    Go to the Insurance Claims Library – https://lnkd.in/gwEYk
    Appear for a Scheduled EUO or Lose Failure to Honor Conditions Precedent Voids Coverage in New York Post 4937 Read the full article at https://www.linkedin.com/pulse/appear-scheduled-euo-lose-barry-zalma-esq-cfe-gvkec/, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. State Farm contended that it is entitled to summary judgment because of the failure to appear for examination under oath (EUO) by multiple defendants. State Farm contended that timely notices were properly mailed to the Claimants who failed to appear. In State Farm Mutual Automobile Insurance Company v. Alford A. Smith, M.D., et al, 2024 NY Slip Op 33802(U), Index No. 155607/2020, Motion Seq. No. 003, Supreme Court, New York County, Appellate Division (October 24, 2024) court ruled in favor of State Farm. The Supreme Court of New York County ORDERED that the plaintiff, State Farm Mutual Automobile Insurance Company’s (“State Farm/Plaintiff’), motion for summary judgment was GRANTED against defendants, Alford A. Smith, M.D., P.C., and the multiple other defendants who are doctors, chiropractors and other health services, (hereinafter collectively (“The Defendants”). FACTS The Supreme Court found that the EUO scheduling letters were timely requested and claimants failed to appear at that EUO. The documentary evidence showed that plaintiff sent the EUO scheduling letters to the claimants within 15 business days of receiving the prescribed verification forms as required by New York statute. FRAUD, FAILURE TO APPEAR FOR EUO & FAILURE TO SIGN TRANSCRIPT ARE BREACHES OF MATERIAL CONDITION PRECEDENT The Appellate Division upheld the Supreme Court’s ruling that the failure to appear for an EUO that was requested in a timely fashion by the insurer is a breach of a condition precedent to coverage and voids the policy ab initio. In addition, although claimant Griselda Torres unlike the other defendants, appeared for her EUO, Torres failed to return a subscribed copy of her EUO transcript. State Farm properly and effectively argued that appearing for and testifying at EUO and returning the transcripts of the EUO are conditions precedent to coverage and failure to sign and return the transcript warranted a denial of the claims. State Farm demonstrated in its motion and supporting evidence that multiple claimants breached a condition precedent to coverage by failing to appear for properly noticed EUOs on two separate occasions. Furthermore, claimant Griselda Torres’ failure to subscribe and return the transcript of her EUOsviolated a condition precedent to coverage and warranted denial of the claims. Moreover, there was nothing on the Court’s record to suggest that the scheduled EUOs were not justified, nor held at a place and time that was not reasonably convenient to the defendants. CONCLUSION State Farm’s motion seeking summary judgment in its favor was GRANTED as to THE multiple defendants and it was further ORDERED that any requested relief sought not expressly addressed herein has nonetheless been considered; and it was further ORDERED that the case shall continue against the remaining defendants; and it was further ORDERED that within 30 days of entry, plaintiff shall serve a copy of this decision/order upon the defendants with notice of entry. ZALMA OPINION The defendants in this case were doctors, physicians, chiropractors and other health care providers who billed State Farm for services provided to people who were injured in automobile accidents and assigned their rights to the providers who tried to collect their billings without complying with the EUO condition. They all lost their claims because they refused to appear except one defendant who appeared but failed to sign the transcript of the EUO and return it to State Farm. They all lost their claims and State Farm will continue its actions against many more defendants not subject to the motion. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk
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    https://medforth.biz/argentina-trans-identified-male-convicted-of-multiple-crimes-against-women-rapes-and-impregnates-female-inmate-after-being-housed-in-womens-prison/
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  • “Dismantling of America” by Cabal - MG Paul Vallely, Quo Warranto’s & JAG Letters w/Norman Traversy
    WestPoint Grad 1961, U.S. Army Ranger and VietNam Combat Veteran, Major General Paul E Vallely (ret.) is the co-founder and Chairman of Stand Up America Foundation. He is the author or co-author of multiple books, including “America’s End Game for the 21st Century: A Blueprint for Saving our Country” and his newest release the “Dismantling of America”
    https://rumble.com/v5bmo6i-dismantling-of-america-by-cabal-mg-paul-vallely-quo-warrantos-and-jag-lette.html
    “Dismantling of America” by Cabal - MG Paul Vallely, Quo Warranto’s & JAG Letters w/Norman Traversy WestPoint Grad 1961, U.S. Army Ranger and VietNam Combat Veteran, Major General Paul E Vallely (ret.) is the co-founder and Chairman of Stand Up America Foundation. He is the author or co-author of multiple books, including “America’s End Game for the 21st Century: A Blueprint for Saving our Country” and his newest release the “Dismantling of America” https://rumble.com/v5bmo6i-dismantling-of-america-by-cabal-mg-paul-vallely-quo-warrantos-and-jag-lette.html
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  • If You Eat an Avocado a Day For a Month, Here's What Will Happen to You
    What Will Happen to Your Body If You Eat Avocado Every Day. The avocado is a unique fruit with multiple nutritional and health benefits. How would your body respond if you ate just one avocado a day? In fact, it would transform your life as you’d get amazing results: your breath will be fresh at all times, your kidneys and liver will work more efficiently, your blood pressure will become lower, just to name a few.

    There's a miraculous mineral to be found in avocados: potassium. It helps your system keep a healthy fluid balance through chemical channels for cells and organs. Avocados are also a great source of vitamins C and E. Vitamin C is known for its involvement in the creation of collagen and elastin, which help to maintain the skin's elasticity and firmness. Vitamin E takes it to a whole new level, reducing the damage of excessive sun exposure and counteracting aging.

    If You Eat an Avocado a Day For a Month, Here's What Will Happen to You What Will Happen to Your Body If You Eat Avocado Every Day. The avocado is a unique fruit with multiple nutritional and health benefits. How would your body respond if you ate just one avocado a day? In fact, it would transform your life as you’d get amazing results: your breath will be fresh at all times, your kidneys and liver will work more efficiently, your blood pressure will become lower, just to name a few. There's a miraculous mineral to be found in avocados: potassium. It helps your system keep a healthy fluid balance through chemical channels for cells and organs. Avocados are also a great source of vitamins C and E. Vitamin C is known for its involvement in the creation of collagen and elastin, which help to maintain the skin's elasticity and firmness. Vitamin E takes it to a whole new level, reducing the damage of excessive sun exposure and counteracting aging.
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  • Chutzpah – STOLI Fraudster Claims Hardship

    Felon Seeks Release from Home Confinement in Luxury Apartment in New York City

    Post 4931

    Read the full article at https://www.linkedin.com/pulse/chutzpah-stoli-fraudster-claims-hardship-barry-zalma-esq-cfe-8jbhc, see the full video at and at and https://zalma.com/blog plus more than 4900 posts.

    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.

    BACKGROUND

    Michael Binday was sentenced to 144 months’ imprisonment after being found guilty of conspiracy to commit mail and wire fraud, as well as actual mail and wire fraud. The evidence at trial established that Binday led his codefendants in a scheme designed to procure “stranger-originated life insurance” (or “STOLI”) policies-policies on the lives of seniors for the benefit of investors who were strangers to them- by means of fraudulent applications.

    Binday spent the first five years of his sentence at FCI Otisville. But in September 2021, during the height of the COVID-19 Pandemic, the Bureau of Prisons released Binday to serve his sentence on home confinement. Thus, Binday has spent the last three-plus years serving his sentence in his luxury apartment on the upper westside of Manhattan. His sentence is scheduled to end on September 20, 2025.

    Binday filed: (1) a motion for compassionate release and (2) a motion pursuant to Rule 60(b) of the Federal Rules of Civil Procedure seeking to vacate the judgement of this Court dated May 23, 2018, denying his first petition.

    Michael Binday and his two codefendants, James Kergil and Mark Resnick, were found guilty of conspiracy to commit mail and wire fraud; mail fraud; and wire fraud in connection with a scheme to defraud insurance companies which the defendants purported to serve as agents. Binday led his codefendants in a scheme designed to procure “stranger-originated life insurance” (or “STOLI”) policies-policies on the lives of seniors for the benefit of investors who were strangers to them- by means of fraudulent applications. Over the course of their scheme, the defendants submitted at least 92 fraudulent applications, resulting in the issuance of 74 policies with a total face value of over $100 million. These policies generated roughly $11.7 million in commissions to the defendants. Binday was sentenced to 144 months’ imprisonment.

    BINDAY SURRENDERS

    Binday surrendered on July 1,2016, to FCI Otisville to commence his term of imprisonment and immediately filed motions for compassionate release, reversal of his convictions, and multiple other motions.

    On July 1, 2024, Binday-who is serving his sentence in his Manhattan apartment- filed a renewed motion for compassionate release.

    Binday Failed to Demonstrate Extraordinary and Compelling Circumstances

    As a threshold matter, it is worth emphasizing that Binday is not asking to be released from prison, but rather, to be relieved of the inconveniences associated with the rules of home confinement. He has served the last 38 months in his apartment on the upper west side of Manhattan (not at all what the Court intended when he was sentenced). How much more inconvenient it would be if he were back at Otisville- where the Court intended that he would serve his sentence.

    Binday’s crimes were serious. As the court explained when he was sentenced to 144 months in prison: Venality, rampant mendacity, the creation of false documents, obstruction of efforts by the victims to ascertain the truth, obstruction of regulators and the government’s efforts to learn the truth, Binday’s actions were precisely the sort of criminality that has left large segments of our society convince that all businessmen are crooks.

    Insurance fraud may not qualify as a crime of violence within the meaning of the federal sentencing system and that, unfortunately, is why it is all too often punished not with the severity that it deserves. As it is, Binday’s home confinement means that he is subject to far less stringent conditions than he would be otherwise. In that regard, he got more of a break than he deserves.

    The motion for compassionate release was denied.

    ZALMA OPINION

    STOLI fraud is a type of fraud on insurers that effects the straw buyers, usually older men and women who have no need for life insurance, is a truly venal act that deserves serious punishment. Binday stole millions from insurers, owns a luxury apartment in the Upper West Side of New York, and wants to be released from the confinement when he should have stayed in federal prison. He has abused the courts with his multiple motions and appeals and will serve out the remainder of his sentence and the DOJ and FBI should look into his current conduct since there is, in my opinion, the possibility that he is funding his attorneys fees with more fraud.

    (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
    Chutzpah – STOLI Fraudster Claims Hardship Felon Seeks Release from Home Confinement in Luxury Apartment in New York City Post 4931 Read the full article at https://www.linkedin.com/pulse/chutzpah-stoli-fraudster-claims-hardship-barry-zalma-esq-cfe-8jbhc, see the full video at and at and https://zalma.com/blog plus more than 4900 posts. 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. BACKGROUND Michael Binday was sentenced to 144 months’ imprisonment after being found guilty of conspiracy to commit mail and wire fraud, as well as actual mail and wire fraud. The evidence at trial established that Binday led his codefendants in a scheme designed to procure “stranger-originated life insurance” (or “STOLI”) policies-policies on the lives of seniors for the benefit of investors who were strangers to them- by means of fraudulent applications. Binday spent the first five years of his sentence at FCI Otisville. But in September 2021, during the height of the COVID-19 Pandemic, the Bureau of Prisons released Binday to serve his sentence on home confinement. Thus, Binday has spent the last three-plus years serving his sentence in his luxury apartment on the upper westside of Manhattan. His sentence is scheduled to end on September 20, 2025. Binday filed: (1) a motion for compassionate release and (2) a motion pursuant to Rule 60(b) of the Federal Rules of Civil Procedure seeking to vacate the judgement of this Court dated May 23, 2018, denying his first petition. Michael Binday and his two codefendants, James Kergil and Mark Resnick, were found guilty of conspiracy to commit mail and wire fraud; mail fraud; and wire fraud in connection with a scheme to defraud insurance companies which the defendants purported to serve as agents. Binday led his codefendants in a scheme designed to procure “stranger-originated life insurance” (or “STOLI”) policies-policies on the lives of seniors for the benefit of investors who were strangers to them- by means of fraudulent applications. Over the course of their scheme, the defendants submitted at least 92 fraudulent applications, resulting in the issuance of 74 policies with a total face value of over $100 million. These policies generated roughly $11.7 million in commissions to the defendants. Binday was sentenced to 144 months’ imprisonment. BINDAY SURRENDERS Binday surrendered on July 1,2016, to FCI Otisville to commence his term of imprisonment and immediately filed motions for compassionate release, reversal of his convictions, and multiple other motions. On July 1, 2024, Binday-who is serving his sentence in his Manhattan apartment- filed a renewed motion for compassionate release. Binday Failed to Demonstrate Extraordinary and Compelling Circumstances As a threshold matter, it is worth emphasizing that Binday is not asking to be released from prison, but rather, to be relieved of the inconveniences associated with the rules of home confinement. He has served the last 38 months in his apartment on the upper west side of Manhattan (not at all what the Court intended when he was sentenced). How much more inconvenient it would be if he were back at Otisville- where the Court intended that he would serve his sentence. Binday’s crimes were serious. As the court explained when he was sentenced to 144 months in prison: Venality, rampant mendacity, the creation of false documents, obstruction of efforts by the victims to ascertain the truth, obstruction of regulators and the government’s efforts to learn the truth, Binday’s actions were precisely the sort of criminality that has left large segments of our society convince that all businessmen are crooks. Insurance fraud may not qualify as a crime of violence within the meaning of the federal sentencing system and that, unfortunately, is why it is all too often punished not with the severity that it deserves. As it is, Binday’s home confinement means that he is subject to far less stringent conditions than he would be otherwise. In that regard, he got more of a break than he deserves. The motion for compassionate release was denied. ZALMA OPINION STOLI fraud is a type of fraud on insurers that effects the straw buyers, usually older men and women who have no need for life insurance, is a truly venal act that deserves serious punishment. Binday stole millions from insurers, owns a luxury apartment in the Upper West Side of New York, and wants to be released from the confinement when he should have stayed in federal prison. He has abused the courts with his multiple motions and appeals and will serve out the remainder of his sentence and the DOJ and FBI should look into his current conduct since there is, in my opinion, the possibility that he is funding his attorneys fees with more fraud. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk
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  • 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
    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
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  • In Italy a significant forgery network involving fake artworks attributed to renowned artists such as Banksy, Andy Warhol, and Amedeo Modigliani. Spanned multiple countries, underscoring the widespread nature of the network. This ring specialized in producing high-quality counterfeit pieces that were then sold to unsuspecting buyers, potentially fetching considerable sums due to the fame of these artists.

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

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

    Chiropractor Lies to Board and Loses Right to Practice

    Post 4930

    Read the full article at https://www.linkedin.com/pulse/chiropractor-disciplined-improper-billing-barry-zalma-esq-cfe-4qjdc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.

    This appeal arises from an attempt by the state of Illinois to impose discipline upon plaintiff Christopher D. Leone, D.C., due to certain improper activities performed as a licensed chiropractor in the state of Illinois.

    In Christopher D. Leone, D.C. v. The Department Of Financial And Professional Regulation, Division Of Professional Regulation; and Cecilia Abundis, in Her Official Capacity as Acting Director of the Department of Financial and Professional Regulation, No. 4-22-0753, 2024 IL App (4th) 220753-U, Court of Appeals of Illinois, Fourth District (November 6, 2024) the Court of Appeal resolved the multiple claims of the chiropractor.

    BACKGROUND

    Leone has practiced as a chiropractor since 1999 and initially practiced in the state of Washington. The matter was resolved pursuant to an informal disposition via stipulation.

    Leone began practicing in Illinois in 2004, and in 2010 and a consent order was issued pursuant to which Leone admitted to the allegations and was reprimanded with a $5000 fine and a requirement that he undertake 20 hours of continuing education; 10 of those hours were to focus on Medicare billing and insurance coding and another 10 on record keeping.

    In 2013, the United States alleged that Leone “knowingly and fraudulently” submitted Medicare claims of less than $1000 for one-on-one physical therapy services that were not provided. Following negotiation, the parties entered into a plea agreement, pursuant to which Leone pleaded guilty to the one-count information and stipulated to a factual basis for his plea.

    Shortly after the Medicare fraud charge was filed against Leone, the State filed a five-count complaint alleging multiple violations of the Medical Practices Act of 1987 (Act). During the litigation, Leone applied to renew his chiropractic license. One of the questions on the application asked whether he had been convicted of any criminal offense, state or federal, since July 2011; Leone answered, “No,” failing to document the Medicare fraud conviction.

    Attempting to explain his federal guilty plea, Leone said that he was unable to modify the language in the plea agreement, as “the time for negotiations had run out” and the plea was a “take-it-or-leave-it” proposition. Leone read the plea agreement line by line and, although he claimed it contained false information, he signed it.

    ALJ Report and Recommendation

    The Administrative Law Judge (ALJ) issued his report and recommendation, finding that, pursuant to the guilty plea in the federal case, Leone had admitted that his patients performed physical therapy on their own without supervision. Also, Leone admitted in his plea that entries in patient records indicating that they received hands-on or one-on-one physical therapy were false. Further, the guilty plea established that Leone knowingly submitted claims to Medicare for services that he did not provide. Leone had also billed private insurers numerous times under the same code as Medicare.

    The conviction also established that he engaged in false billing and false entries in patient records. The ALJ recommended an indefinite suspension of Leone’s license for a minimum of two years.

    An expert testified that chiropractors who engaged in Medicare fraud violated several tenets of chiropractic ethics.

    There was a pattern of overcharging for services that were not provided, false notations in patient records to support the false charges, and the submission of false claims to insurance that went on for at least five years. Leone obtained fees by fraud, deceit, or misrepresentation, and those actions fell below the professional and ethical standards required of chiropractors in Illinois. Leone’s conduct, along with his past disciplinary history, “demonstrate[d] a pattern of behavior that [was] not acceptable.”

    ANALYSIS

    It was undisputed that Leone submitted charges under billing code 97110. Leone pled guilty to submitting a false demand for payment upon the United States. In his plea, Leone admitted to billing for services that were not actually provided to his patients as claimed, “and the instruments containing the demands for payment of public money, therefore were false when they were submitted” and “were submitted to Medicare with the knowledge that he did not perform the service charged.”

    The guilty plea supports the conclusion that Leone knowingly and intentionally submitted claims for reimbursement for services provided under code 97110 where the services did not meet the requirements to be paid under that code. This pattern went on for approximately five years, resulting in 1324 false claims in the amount of $93,900.

    The Department established a violation of the Act where Leone failed to note the federal conviction on his renewal application.
    Discipline

    A review of the initial circuit court order in this matter reveals that it merely recommended that the Department consider probation as a punishment; it did not make a ruling to that effect.

    There was no abuse of discretion in the discipline imposed. For the reasons stated, the Court reversed the circuit court’s judgment and affirm the Director’s decision.

    ZALMA OPINION

    Leone successfully committed fraud on the United States, the state of Illinois, and the insurance industry by falsely billing services he did not provide. He pleaded guilty to one count of Federal Health Insurance fraud and then lied to the state of Illinois when he applied to renew his license. With lawyers and retained experts he delayed the sanction for years. The Court of Appeals finally resolved the multiple disputes and applied an appropriate sanction and suspension of his license. He should consider himself lucky that he was not prosecuted criminally by the state and the US Government accepted his plea.

    (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
    Chiropractor Disciplined for Improper Billing Chiropractor Lies to Board and Loses Right to Practice Post 4930 Read the full article at https://www.linkedin.com/pulse/chiropractor-disciplined-improper-billing-barry-zalma-esq-cfe-4qjdc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. This appeal arises from an attempt by the state of Illinois to impose discipline upon plaintiff Christopher D. Leone, D.C., due to certain improper activities performed as a licensed chiropractor in the state of Illinois. In Christopher D. Leone, D.C. v. The Department Of Financial And Professional Regulation, Division Of Professional Regulation; and Cecilia Abundis, in Her Official Capacity as Acting Director of the Department of Financial and Professional Regulation, No. 4-22-0753, 2024 IL App (4th) 220753-U, Court of Appeals of Illinois, Fourth District (November 6, 2024) the Court of Appeal resolved the multiple claims of the chiropractor. BACKGROUND Leone has practiced as a chiropractor since 1999 and initially practiced in the state of Washington. The matter was resolved pursuant to an informal disposition via stipulation. Leone began practicing in Illinois in 2004, and in 2010 and a consent order was issued pursuant to which Leone admitted to the allegations and was reprimanded with a $5000 fine and a requirement that he undertake 20 hours of continuing education; 10 of those hours were to focus on Medicare billing and insurance coding and another 10 on record keeping. In 2013, the United States alleged that Leone “knowingly and fraudulently” submitted Medicare claims of less than $1000 for one-on-one physical therapy services that were not provided. Following negotiation, the parties entered into a plea agreement, pursuant to which Leone pleaded guilty to the one-count information and stipulated to a factual basis for his plea. Shortly after the Medicare fraud charge was filed against Leone, the State filed a five-count complaint alleging multiple violations of the Medical Practices Act of 1987 (Act). During the litigation, Leone applied to renew his chiropractic license. One of the questions on the application asked whether he had been convicted of any criminal offense, state or federal, since July 2011; Leone answered, “No,” failing to document the Medicare fraud conviction. Attempting to explain his federal guilty plea, Leone said that he was unable to modify the language in the plea agreement, as “the time for negotiations had run out” and the plea was a “take-it-or-leave-it” proposition. Leone read the plea agreement line by line and, although he claimed it contained false information, he signed it. ALJ Report and Recommendation The Administrative Law Judge (ALJ) issued his report and recommendation, finding that, pursuant to the guilty plea in the federal case, Leone had admitted that his patients performed physical therapy on their own without supervision. Also, Leone admitted in his plea that entries in patient records indicating that they received hands-on or one-on-one physical therapy were false. Further, the guilty plea established that Leone knowingly submitted claims to Medicare for services that he did not provide. Leone had also billed private insurers numerous times under the same code as Medicare. The conviction also established that he engaged in false billing and false entries in patient records. The ALJ recommended an indefinite suspension of Leone’s license for a minimum of two years. An expert testified that chiropractors who engaged in Medicare fraud violated several tenets of chiropractic ethics. There was a pattern of overcharging for services that were not provided, false notations in patient records to support the false charges, and the submission of false claims to insurance that went on for at least five years. Leone obtained fees by fraud, deceit, or misrepresentation, and those actions fell below the professional and ethical standards required of chiropractors in Illinois. Leone’s conduct, along with his past disciplinary history, “demonstrate[d] a pattern of behavior that [was] not acceptable.” ANALYSIS It was undisputed that Leone submitted charges under billing code 97110. Leone pled guilty to submitting a false demand for payment upon the United States. In his plea, Leone admitted to billing for services that were not actually provided to his patients as claimed, “and the instruments containing the demands for payment of public money, therefore were false when they were submitted” and “were submitted to Medicare with the knowledge that he did not perform the service charged.” The guilty plea supports the conclusion that Leone knowingly and intentionally submitted claims for reimbursement for services provided under code 97110 where the services did not meet the requirements to be paid under that code. This pattern went on for approximately five years, resulting in 1324 false claims in the amount of $93,900. The Department established a violation of the Act where Leone failed to note the federal conviction on his renewal application. Discipline A review of the initial circuit court order in this matter reveals that it merely recommended that the Department consider probation as a punishment; it did not make a ruling to that effect. There was no abuse of discretion in the discipline imposed. For the reasons stated, the Court reversed the circuit court’s judgment and affirm the Director’s decision. ZALMA OPINION Leone successfully committed fraud on the United States, the state of Illinois, and the insurance industry by falsely billing services he did not provide. He pleaded guilty to one count of Federal Health Insurance fraud and then lied to the state of Illinois when he applied to renew his license. With lawyers and retained experts he delayed the sanction for years. The Court of Appeals finally resolved the multiple disputes and applied an appropriate sanction and suspension of his license. He should consider himself lucky that he was not prosecuted criminally by the state and the US Government accepted his plea. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk
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    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.
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