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 The Court rescinded its order permitting Plaintiff to proceed anonymously.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

So, the top Democrat on the House Ethics Committee is proven to be a documents leaker. How is that “ethical”? This is exactly what is wrong with politics — and especially Democrat politics — today. In any rational and reasonable world, leaking documents for purely political reasons would be considered an ethics violation. Today, it doesn’t even produce a raised eyebrow… #politics #democrats https://substack.com/@franksalvato/note/c-80935325

UNLIKE DONALD #TRUMP... I want #Police held accountable for their #Criminal actions! Trump says he wants to make Police even more "ABOVE THE LAW" than they are now! That is insane! Police should be REQUIRED BY LAW to have an active insurance policy for general liability, to pay out the lawsuits and police misconduct claims! And those cops should also be CRIMINALLY CHARGED under federal law, Title 18 U.S.C. § 241 and 18 U.S.C. § 242 every single time they violate the rights of Americans! I have been telling people this for YEARS! I install replacement windows for a living..... My job REQUIRES me to purchase a ONE MILLION DOLLAR general liability insurance policy. Without it I can't work! I DON'T carry a gun, shoot people, taze people, bust out people's car windows, imprison people with torture cuffs, or put people into a cage while I'm at work..... I simply install windows, and MUST HAVE liability insurance! Don't you think it's beyond reasonable to ask that #Police Officers be REQUIRED BY LAW to carry a general liability insurance policy, just like I have to have, since they DO all of the things listed above! They DO carry a gun, they DO commit violence against other Americans, they DO put people into shackles, they DO damage the property of Americans, and they DO harm Americans on a regular basis Is it REALLY necessary for ME to be forced to have general liability insurance in order to "Change a window" when we have MEN IN BODY ARMOR WITH GUNS AND TASERS who don't have insurance? You see..... Police definitely DON'T WANT to be required to purchase their own insurance policy! Do you know WHY??? I'll tell you... If these Police had their own liability insurance every time that an American citizen wins a case of police brutality or misconduct, and / or wrongful death when they kill the innocent.. THEIR INSURANCE WOULD HAVE TO PAY THE LAWSUIT! And that would make their premiums go up... And when it has happened several times (Like happens with bad cops) their policy would be CANCELLED leaving them unable to ever work as a police officer again! This is something that MUST HAPPEN! We can no longer tolerate a #Criminal gang of blue line thugs who are "Above the Law" and are NEVER HELD ACCOUNTABLE! And body cameras should be MANDATORY and activated throughout the shift of ALL POLICE OFFICERS! If they turn them off it should be an automatic 25 years in prison! The body cameras and dash cameras should be LIVE-STREAMED to servers controlled by CITIZEN OVERSIGHT COMMITTEES of regular Americans (Like myself and James Freeman) and to Police headquarters, after a 5 minute delay THE AMERICAN PEOPLE should NEVER get a redacted version of the body cameras, after all, THEY ARE THE BOSS! Every body camera in America should be viewable after a 5 minute delay, it should be released for ANYONE to look at it, at any time, and for any reason... and under NO CIRCUMSTANCES should it be edited whatsoever! STOP enabling criminal behavior by Police! STOP enabling criminals to walk free among us! DEMAND POLICE ACCOUNTABILITY WITH EVERY BREATHE YOU TAKE, RIGHT UP UNTIL THE VERY LAST ONE! Because if you should fail to do this.... Your children and grandchildren will live as #Slaves and under #Tyranny https://www.minds.com/newsfeed/1651406135372025867?referrer=conservativethinking

Zalma's Insurance Fraud Letter - December 1, 2024 ZIFL Volume 28 No. 22 Post 4939 Read the full article at Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdfand at https://zalma.com/blog. Subscribe to ZIFL at https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D The Source for the Insurance Fraud Professional https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ This issue contains the following articles about insurance fraud: The EUO is a Material Condition Precedent A Key Tool in the Effort to Reduce Fraud Claim Properly Denied for Refusal to Testify at EUO I spoke recently at the Conference of the Southern California Fraud Investigators Association on the Examination Under Oath as a tool to help insureds prove their losses and what happens when an insured fails or refuses to testify. This case emphasizes the purpose of my talk. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Thanksgiving Wishes from the Zalma Family My family and I have much to be thankful for this year. My first born daughter, Stephanie Zalma, continues to care for my wife 24 hours a day 7 days a week with love and patience as Thea continues as Nana to our two grandchildren and the loving mother of our three children. After receiving a new Aortic Heart Valve I am personally in good health, walking about 25 miles a week. Exercising my, apparently unusual mode of retirement, I work only six to eight hours a day doing what I love the most, writing about insurance, insurance claims, insurance law and acting as an insurance claims consultant and expert witness. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf More McClenny Moseley & Associates Issues This is ZIFL’s thirty eighth 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 to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Ethical Behavior & Insurance Insurance, from the time of its first agreement to the present day has always been a business requiring ethical behavior between the insurer and the insured and between the insured and the insurer. The concept of ethical behavior refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues, all of which are essential to the lawyer. Ethics refers to those standards that impose the reasonable obligations to refrain from murder, rape, theft, assault, slander, and fraud. Ethical standards also include those that imply virtues of honesty, compassion, and loyalty. There are rights presumed to exist such as those described in the Declaration of Independence submitted to King George of England in 1776 that held: We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness. The unalienable rights also include the right to life, the right to freedom from injury, and the right to liberty. Such standards are adequate standards of ethics because they are supported by consistent and well-founded reasons. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Health Insurance Fraud Convictions Michigan Woman Convicted of $1.4M Health Care Kickback Scheme Mary Smettler-Bolton, 71, of Oakland County, Michigan was convicted November 22, 2024 for her role in a conspiracy to defraud the United States and receive illegal health care kickbacks. According to court documents and evidence presented at trial, Mary referred Medicare beneficiaries to several Metro Detroit home health companies in exchange for hundreds of thousands of dollars in kickbacks paid by the owners and operators of the home health companies. Over the course of four years, she and her co-conspirators caused over $1.4 million of loss to Medicare. Smettler-Bolton was convicted of one count of conspiracy to defraud the United States and receive illegal health care kickbacks and one count of violating the federal Anti-Kickback Statute. She is scheduled to be sentenced on March 3, 2025, and faces a maximum penalty of five years in prison on the conspiracy count and a maximum penalty of 10 years in prison on the kickback count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors. Read the full article about dozens more convictions at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Convictions of Other Than Health Insurance Fraud Creative Fraudster Guilty of $229K Insurance Fraud Schemes Justin Mack, a native of Buffalo, New York, and a resident of Cleveland, Ohio, was sentenced on November 25, 2024 in the Cuyahoga County Court of Common Pleas. Mack, an Ohio man was sentenced to five years in prison and ordered to pay restitution for filing 24 fraudulent claims with multiple insurance companies, totaling more than $229,000. An extensive investigation uncovered Mack’s pattern of submitting altered documentation, falsified claims, and using other people’s identities to fraudulently secure payouts from multiple insurance companies. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf The Examination Under Oath Is Not Part of a Judicial Process Although the EUO is a formal proceeding it is not part of a judicial process nor is it subject to the rules set out by codes of civil procedure. There is no right to object to questions and never a judge present to rule on the objections. The testimony at the EUO is required to be presented in accordance with the obligation imposed on an insured to deal fairly and in good faith with the insurer. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Barry Zalma 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. Write to Mr. Zalma at [email protected]; https://www.zalma.com; https://zalma.com/blog. He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling. Go to Zalma’s Insurance Fraud Letter at https://zalma.com/zalmas-insurance-fraud-letter-2/; Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ and GTTR at https://gettr.com/@zalma

LAWSUIT INCOMING!! SGT CAN'T CONTROL HIMSELF DURING UNLAWFUL ARREST. #Police are apparently too f*cking dumb to tie their shoes! HOW are they supposed to have the intelligence required to ARTICULATE A #CRIME to someone? If the Police attempt to detain you absent reasonable, articulable, suspicion that you have committed a crime it's unlawful! Their "legal" standard is BS! Their "legal" (Against Yah's Law) standard claims that they need reasonable articulable suspicion that you HAVE COMMITTED, or "are about to commit a crime" Now how in the Sam Hill would a dumbass cop know "You are about to commit a crime?" Can you tell me that please??? Are these palm reading police??? Can they see into the future??? The reason your constitutional rights are trampled on a DAILY basis is because YOU ARE NOT A PARTY TO THE CONSTITUTION! As a "citizen" you have no constitutional protections! Instead, you are CHATTEL PROPERTY of the Corporation of the United States, and are under the #Jurisdiction of their "Maritime Admiralty Law" #Slave system! You should look into it! It's the #Truth! https://old.bitchute.com/video/Nm9DKfUSTlI/

EUO is a Material Condition Precedent Claim Properly Denied for Refusal to Testify at EUO Post 4936 Read the full article at https://www.linkedin.com/pulse/euo-material-condition-precedent-barry-zalma-esq-cfe-exccc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. See the full video at and at Erin Hughes appealed from the grant of summary judgment in favor of defendant and respondent Farmers Insurance Exchange (Farmers) on her causes of action for breach of contract and bad faith arising after Farmers’ denial of Hughes’s property insurance claim because she refused to testify at a second examination under oath (EUO). In Erin Hughes v. Farmers Insurance Exchange, B331168, California Court of Appeals (November 8, 2024) the condition precedent was enforced. FACTUAL BACKGROUND Hughes is the owner of real property in Malibu (the property). In December 2020, Hughes obtained an insurance policy to cover the property for fire loss through the California FAIR Plan Association (FAIR Plan). Also in December 2020, Hughes obtained a homeowner’s insurance policy from Farmers to cover perils other than fire, including losses due to theft (the policy). One month later, in January 2021, the property sustained significant fire damage. Hughes contacted Farmers, which advised her that fire loss was not covered by her Farmers policy, and she would have to pursue any such claim through her FAIR Plan policy. Unhappy, on January 21, 2021, Hughes tendered a theft claim under the Farmers policy, asserting in excess of $2 million worth of personal property was stolen from the property. Farmers ultimately denied the claim on January 5, 2022, on the ground that Hughes failed to cooperate with Farmers’ investigation, including by failing to participate in a second examination under oath as required by the policy. Hughes’s Complaint Against Farmers One week after the denial of her claim, Hughes sued Farmers and alleged Farmers demanded “duplicative, onerous and/or unnecessary” documentation of stolen items. Further, she alleged Farmers subjected her to “two confrontational, accusatory and grueling examinations under oath.” Hughes alleged her second examination under oath had been “suspended due to [her] medical condition,” but Farmers disregarded her condition and demanded a third examination. Farmers’ Motion for Summary Judgment Farmers moved for summary judgment contending it properly denied Hughes’s theft claim based on her failure to cooperate with Farmers’ investigation of her claim as well as her material misrepresentations in obtaining the Farmers policy. In May 2021, as part of Farmers’ theft claim investigation, Hughes participated in an examination under oath. During the examination, Hughes’s counsel informed the Farmers attorney he had just sent more than 40 additional receipts that the attorney would be receiving shortly. Recognizing they would not have time to go through the new items that day and the examination would need to continue on a future date, the Farmers attorney proposed “continu[ing] to work with one another to identify what’s missing.” In response, Hughes and her counsel agreed, with Hughes stating she would be happy to get “every single thing that you need and I’ll send it to my attorney right away.” In October 2021, a second session of the examination under oath was held regarding documentation Hughes had produced during and after the first session. Hughes appeared remotely with counsel and before any questions were asked of her, she objected to a further examination. Hughes accused the Farmers attorney of interrogating her “like a fucking criminal” and stated, “if you want to take my deposition . . . you are going to take a second deposition in court, and that’s going to be a formal deposition.” Hughes’s remote connection then cut out, and her counsel indicated she would not proceed with the examination. Farmers informed Hughes that it was denying coverage based on her failure to cooperate with Farmers’ investigation and particularly her refusal to proceed with the second examination under oath. Trial Court’s Grant of Summary Judgment and Denial of Hughes’s Continuance Request and Motion for New Trial The trial court granted summary judgment in favor of Farmers. Noting an insurer has “an absolute right” to require the insured to submit to an examination under oath “as long as the insurer exercises the right reasonably,” the court determined Hughes had not shown Farmers acted unreasonably. The court concluded summary judgment was appropriate “based solely on failure to cooperate.” DISCUSSION The trial court properly concluded there was no genuine dispute that Hughes’s failure to participate in an examination under oath constituted a material breach of the policy; accordingly, Farmers was excused from having to pay on Hughes’s claim. The right to require the insured to submit to an examination under oath concerning all proper subjects of inquiry is reasonable as a matter of law. An insured’s compliance with a policy requirement to submit to an examination under oath is a prerequisite to the right to receive benefits under the policy. Because Hughes refused to cooperate with Farmers’ investigation by participating in and completing her examination under oath, she cannot establish her own performance under the policy. Breach of Implied Covenant Claim The implied covenant of good faith and fair dealing is based on general contract law and the long-standing rule that neither party will do anything which will injure the right of the other to receive the benefits of the agreement. Hughes’s claim for bad faith fails as a matter of law. ZALMA OPINION Wildfires tend to destroy everything. That is why insurers are unwilling to write fire insurance in Malibu and other areas prone to wildfires and obtain fire insurance from the Fair Plan, an organization designed to cover uninsurable risks. Because of the destruction done by a wildfire or a dwelling fire a $2 million dollar theft loss after a fire is questionable and a good reason to take a thorough EUO. Farmers tried to do so and Hughes refused without reason after admitting she left open much investigation elements at the agreed conclusion of the first session and an agreement to a second only to refuse. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg

Police should be REQUIRED BY LAW to have an active insurance policy for general liability, to pay out the lawsuits and police misconduct claims! And those cops should also be CRIMINALLY CHARGED under federal law, Title 18 U.S.C. § 241 and 18 U.S.C. § 242 every single time they violate the rights of Americans! I have been telling people this for YEARS! I install replacement windows for a living..... My job REQUIRES me to purchase a ONE MILLION DOLLAR general liability insurance policy. Without it I can't work! I DON'T carry a gun, shoot people, taze people, bust out people's car windows, imprison people with torture cuffs, or put people into a cage while I'm at work..... I simply install windows, and MUST HAVE liability insurance! Don't you think it's beyond reasonable to ask that #Police Officers be REQUIRED BY LAW to carry a general liability insurance policy, just like I have to have, since they DO all of the things listed above! They DO carry a gun, they DO commit violence against other Americans, they DO put people into shackles, they DO damage the property of Americans, and they DO harm Americans on a regular basis Is it REALLY necessary for ME to be forced to have general liability insurance in order to "Change a window" when we have MEN IN BODY ARMOR WITH GUNS AND TASERS who don't have insurance? You see..... Police definitely DON'T WANT to be required to purchase their own insurance policy! Do you know WHY??? I'll tell you... If these Police had their own liability insurance every time that an American citizen wins a case of police brutality or misconduct, and / or wrongful death when they kill the innocent.. THEIR INSURANCE WOULD HAVE TO PAY THE LAWSUIT! And that would make their premiums go up... And when it has happened several times (Like happens with bad cops) their policy would be CANCELLED leaving them unable to ever work as a police officer again! This is something that MUST HAPPEN! We can no longer tolerate a #Criminal gang of blue line thugs who are "Above the Law" and are NEVER HELD ACCOUNTABLE! And body cameras should be MANDATORY and activated throughout the shift of ALL POLICE OFFICERS! If they turn them off it should be an automatic 25 years in prison! The body cameras and dash cameras should be LIVE-STREAMED to servers controlled by CITIZEN OVERSIGHT COMMITTEES of regular Americans (Like myself and James Freeman) and to Police headquarters, after a 5 minute delay THE AMERICAN PEOPLE should NEVER get a redacted version of the body cameras, after all, THEY ARE THE BOSS! Every body camera in America should be viewable after a 5 minute delay, it should be released for ANYONE to look at it, at any time, and for any reason... and under NO CIRCUMSTANCES should it be edited whatsoever! STOP enabling criminal behavior by Police! STOP enabling criminals to walk free among us! DEMAND POLICE ACCOUNTABILITY WITH EVERY BREATHE YOU TAKE, RIGHT UP UNTIL THE VERY LAST ONE! Because if you should fail to do this.... Your children and grandchildren will live as #Slaves and under #Tyranny https://www.minds.com/newsfeed/1651406135372025867

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

Another Jump in Astrophysics: Early Galaxies Challenging Dark Matter Models, The field of astrophysics has always been rife with surprising discoveries, and the latest findings from cutting-edge telescope data are no exception. Recent observations have cast doubt on some long-held assumptions about the formation of the early universe, leading scientists to question whether our current cosmological models, including the standard ΛCDM (Lambda Cold Dark Matter) model, truly represent the intricacies of cosmic evolution. A Glimpse into Early Galaxies Data from advanced telescopes, like the James Webb Space Telescope (JWST), has shown that early galaxies, formed less than a billion years after the Big Bang, were much larger and more luminous than previously believed possible. According to traditional models, galaxies were expected to grow more gradually, accruing mass and light over billions of years. The revelation that such massive and bright galaxies existed so early in the universe’s history has prompted a reevaluation of the ΛCDM model. The Standard ΛCDM Model: A Quick Overview The ΛCDM model is a mathematical framework that has long been the backbone of Big Bang cosmology. It consists of three main components: A cosmological constant (Λ): This represents dark energy, an enigmatic force driving the accelerated expansion of the universe. Cold dark matter (CDM): Hypothetical matter that does not emit or interact with electromagnetic radiation, explaining the unseen mass that affects gravitational forces on large scales. Ordinary matter: The familiar atoms and particles that make up stars, planets, and everything else visible in the universe. This model is referred to as the standard model of cosmology because it is the simplest and most comprehensive framework that has so far provided a reasonable explanation for a wide range of astronomical observations, from the cosmic microwave background to the distribution of galaxies. Early Challenges and New Theories However, the discovery of unexpectedly large and bright early galaxies implies that our models might be missing key details about the dynamics of the early universe. If galaxies formed so rapidly after the Big Bang, alternative explanations may be necessary. These might include modifications to our understanding of gravitational interactions on cosmic scales or the introduction of new interactions between particles that do not fit into the current ΛCDM framework. Some astrophysicists are exploring models that propose dark matter behaves differently in the presence of extreme conditions, while others suggest entirely new mechanisms that accelerate the process of galaxy formation. These theories challenge the conventional narrative by suggesting that dark matter might not be a universal constant, or that additional factors, such as modified gravity theories, might come into play. The Future of Cosmological Exploration As these observations continue to be studied and debated, it is clear that our current cosmological models may need to be updated or expanded to align with this unexpected data. The insights gained from the JWST and similar telescopes will undoubtedly continue to push the boundaries of our understanding, leading to new theories that could redefine our comprehension of the universe’s origins and its early development. The journey of discovery is far from over, and the universe, as always, holds more mysteries yet to be revealed. Whether these findings lead to small adjustments in the ΛCDM model or prompt the development of entirely new paradigms, one thing is certain: astrophysics is entering an exciting new chapter.

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)]