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

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

Valve / Steam Now Bans Based on Player Submitted Footage [TF2] - @TimeLierG #valve #Steam #Censorship #exposed #alttech #FreeSpeechMatters https://corder.tv/video/.6int

https://arthritistreatment.one/heal-n-soothe-arthritis/ Do You Hear Clicking in Your Joints when You Walk or Move Your Neck? Those are usually caused by bone spurs that damage joint tissues and cause fibrin and scar tissue to form in your joints. It causes inflammation and air pockets that click. Excess calcium deposits and acid deposits are what is causing it and the best thing you can do is use systemic enzymes to get rid of them and the pain and inflammation. It also heals your whole body from calcification (arteries, veins, heart valves) so you feel better all over, not just your joints! Heal N Soothe Systemic Enzymes do this and help your body dissolve impacted matter in your veins and digestive system! #arthritis #jointpain #enzymes #inflammation #mobility

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https://arthritistreatment.one/heal-n-soothe-arthritis/ Do You Hear Clicking in Your Joints when You Walk or Move Your Neck? Those are usually caused by bone spurs that damage joint tissues and cause fibrin and scar tissue to form in your joints. It causes inflammation and air pockets that click. Excess calcium deposits and acid deposits are what is causing it and the best thing you can do is use systemic enzymes to get rid of them and the pain and inflammation. It also heals your whole body from calcification (arteries, veins, heart valves) so you feel better all over, not just your joints! Heal N Soothe Systemic Enzymes do this and help your body dissolve impacted matter in your veins and digestive system! #arthritis #jointpain #enzymes #inflammation #mobility

https://arthritistreatment.one/heal-n-soothe-arthritis/ Do You Hear Clicking in Your Joints when You Walk or Move Your Neck? Those are usually caused by bone spurs that damage joint tissues and cause fibrin and scar tissue to form in your joints. It causes inflammation and air pockets that click. Excess calcium deposits and acid deposits are what is causing it and the best thing you can do is use systemic enzymes to get rid of them and the pain and inflammation. It also heals your whole body from calcification (arteries, veins, heart valves) so you feel better all over, not just your joints! Heal N Soothe Systemic Enzymes do this and help your body dissolve impacted matter in your veins and digestive system! #arthritis #jointpain #enzymes #inflammation #mobility

https://arthritistreatment.one/heal-n-soothe-arthritis/ Do You Hear Clicking in Your Joints when You Walk or Move Your Neck? Those are usually caused by bone spurs that damage joint tissues and cause fibrin and scar tissue to form in your joints. It causes inflammation and air pockets that click. Excess calcium deposits and acid deposits are what is causing it and the best thing you can do is use systemic enzymes to get rid of them and the pain and inflammation. It also heals your whole body from calcification (arteries, veins, heart valves) so you feel better all over, not just your joints! Heal N Soothe Systemic Enzymes do this and help your body dissolve impacted matter in your veins and digestive system! #arthritis #jointpain #enzymes #inflammation #mobility

Rotary Valves Make Normal Valves Look Silly - Why Aren't We Using Them? https://www.youtube.com/watch?v=DZU8tsNNxGA&list=TLPQMzEwMzIwMjQhQ1X6Mg9mqw&index=8