• 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
    WWW.LINKEDIN.COM
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  • MY BUS DRIVER CLIENT ARRESTED BY IGNORANT COPS | CHARGES DROPPED, LAWSUIT FILED

    https://old.bitchute.com/video/mbVTSR7DT6c/
    MY BUS DRIVER CLIENT ARRESTED BY IGNORANT COPS | CHARGES DROPPED, LAWSUIT FILED https://old.bitchute.com/video/mbVTSR7DT6c/
    OLD.BITCHUTE.COM
    My Bus Driver Client Arrested by Ignorant Cops | Charges Dropped, Lawsuit Filed
    Video to submit? https://forms.gle/HmwnDQKvwvYPxe967 Blog: https://thecivilrightslawyer.com/ Donate to the Institute for Justice: https://ij.org/support/give-now/thecivilrightslawyer/ Freedom is Scary STEAK RUB! https://quiggysbbq.square.site/produc…
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  • As Bayer and other companies work to limit their financial exposure to pesticide injury lawsuits, they are shifting more of their focus to statehouses, where they can shape the legislative landscape and reduce the legal risks associated with their products. Pesticide companies are pushing for laws that would limit damages in pesticide-related injury cases. Bayer has backed the Agricultural Labeling Uniformity Act, a federal bill that seeks to standardize pesticide labeling and prevent states from enacting stricter requirements. While Bayer maintains that glyphosate – Roundup's active ingredient – is safe when used as directed, the company has faced thousands of lawsuits, and the financial toll is steep – Bayer set aside $6.3 billion for glyphosate litigation in 2023.
    https://www.newstarget.com/2024-11-08-pesticide-companies-increasing-state-level-political-contributions.html
    As Bayer and other companies work to limit their financial exposure to pesticide injury lawsuits, they are shifting more of their focus to statehouses, where they can shape the legislative landscape and reduce the legal risks associated with their products. Pesticide companies are pushing for laws that would limit damages in pesticide-related injury cases. Bayer has backed the Agricultural Labeling Uniformity Act, a federal bill that seeks to standardize pesticide labeling and prevent states from enacting stricter requirements. While Bayer maintains that glyphosate – Roundup's active ingredient – is safe when used as directed, the company has faced thousands of lawsuits, and the financial toll is steep – Bayer set aside $6.3 billion for glyphosate litigation in 2023. https://www.newstarget.com/2024-11-08-pesticide-companies-increasing-state-level-political-contributions.html
    WWW.NEWSTARGET.COM
    Pesticide giants ramp up state-level political contributions to seek total legal immunity from lawsuits
    Pesticide companies have significantly increased their political contributions at the state level as they grapple with rising legal liabilities linked to Roundup and other products. Political action committees (PACs) associated with major pesticide manufacturers like Bayer and Corteva have poured hundreds of thousands of dollars into state politics in recent years. This marks a stark […]
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  • https://www.thegatewaypundit.com/2024/11/cpac-files-lawsuit-after-wisconsin-man-is-pictured/
    https://www.thegatewaypundit.com/2024/11/cpac-files-lawsuit-after-wisconsin-man-is-pictured/
    WWW.THEGATEWAYPUNDIT.COM
    CPAC Files Lawsuit After Wisconsin Man Is Pictured Dumping Bag of Ballots into Ballot Drop Box | The Gateway Pundit | by Jim Hoft
    The Conservative Political Action Committee (CPAC) announced this week that they are holding photographic evidence of illegal ballot harvesting at a drop box outside of the Milwaukee City Hall.
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  • Actually, The Democratic Party Is Hitler.
    Along about now, you’re probably wondering what sort of mayhem the Party of Chaos is set to unleash on our democracy after their mighty ballot fraud operation fails to overcome the yet more powerful instinct of the voters to expel them from the seats of power they seized by fraud in 2020 and 2022. You can be sure they’ve gamed-out a playbook aimed at paralyzing the nation one way or another if the effort to install Kamala Harris in the White House face-plants, as it appears to be doing in these final days before the reckoning. More likely, the Party will hijack the nation’s legal machinery to cancel the election ex post facto. They’ve done a swell job in advance setting up conditions that make it difficult if not impossible to sort out legal ballots cast from the frauds. So, expect the Party’s chief lawfare ninja Marc Elias, and his zillion-dollar-funded cadre of pettifoggers, to contest the swing-state precincts where their ballot-harvest somehow fell short a few bushels. They’ll file enough lawsuits to gum up the courts until the sun becomes a red dwarf.
    If the actual numbers add up to a Trump victory, the Democrats will re-brand that as the new “Big Lie” and commence a strenuous campaign in the old media to gaslight the public into believing the vote-count isn’t what it looks like. After all, numbers are math and math is racist. That will provide the rationale, and furnish the game-space, to stop Trump by other means.
    Anyway you cut it, the hysteria in the body politic is running at a pitch — as Mr. Trump himself might say — that has never been seen before, at least not since Fort Sumter. The Democrats complain that a Trump victory means the Department of Justice will be weaponized against them. Is that rich, or what? It actually tells the whole story since you know the Party always accuses its opponents of exactly what it is already doing.
    Speaking of which, we must look forward to Judge Juan Merchan’s November 26th sentencing of Mr. Trump in DA Alvin Bragg’s “Stormy Daniels hush money” case. It’s out there, looming, and it ain’t going away. Judge Merchan is going to have to do. . . something! The jury has pronounced Mr. Trump guilty of those 34 “felonies” (based on 34 book-keeping entries, originally misdemeanors, and beyond the applicable statute of limitations).
    I’d like to see the Judge stash the president-elect in the Rikers Island lockup for a few hours. It’ll be a better stunt than Mr. Trump’s shift serving fries at McDonald’s, or riding the garbage truck after “Joe Biden” called more than half the country that supports him “garbage.” Because a few hours after Mr. Trump settles into his Rikers cell and enjoys his first boloney sandwich, the SCOTUS is going to turn a flame thrower on Judge Merchan and Alvin Bragg and vacate the absurd case and every half-assed procedure that was used to arrive at it, and refer Merchan and Bragg for disbarment for professional misconduct, malicious prosecution, and failure to uphold the law.
    Actually, The Democratic Party Is Hitler. Along about now, you’re probably wondering what sort of mayhem the Party of Chaos is set to unleash on our democracy after their mighty ballot fraud operation fails to overcome the yet more powerful instinct of the voters to expel them from the seats of power they seized by fraud in 2020 and 2022. You can be sure they’ve gamed-out a playbook aimed at paralyzing the nation one way or another if the effort to install Kamala Harris in the White House face-plants, as it appears to be doing in these final days before the reckoning. More likely, the Party will hijack the nation’s legal machinery to cancel the election ex post facto. They’ve done a swell job in advance setting up conditions that make it difficult if not impossible to sort out legal ballots cast from the frauds. So, expect the Party’s chief lawfare ninja Marc Elias, and his zillion-dollar-funded cadre of pettifoggers, to contest the swing-state precincts where their ballot-harvest somehow fell short a few bushels. They’ll file enough lawsuits to gum up the courts until the sun becomes a red dwarf. If the actual numbers add up to a Trump victory, the Democrats will re-brand that as the new “Big Lie” and commence a strenuous campaign in the old media to gaslight the public into believing the vote-count isn’t what it looks like. After all, numbers are math and math is racist. That will provide the rationale, and furnish the game-space, to stop Trump by other means. Anyway you cut it, the hysteria in the body politic is running at a pitch — as Mr. Trump himself might say — that has never been seen before, at least not since Fort Sumter. The Democrats complain that a Trump victory means the Department of Justice will be weaponized against them. Is that rich, or what? It actually tells the whole story since you know the Party always accuses its opponents of exactly what it is already doing. Speaking of which, we must look forward to Judge Juan Merchan’s November 26th sentencing of Mr. Trump in DA Alvin Bragg’s “Stormy Daniels hush money” case. It’s out there, looming, and it ain’t going away. Judge Merchan is going to have to do. . . something! The jury has pronounced Mr. Trump guilty of those 34 “felonies” (based on 34 book-keeping entries, originally misdemeanors, and beyond the applicable statute of limitations). I’d like to see the Judge stash the president-elect in the Rikers Island lockup for a few hours. It’ll be a better stunt than Mr. Trump’s shift serving fries at McDonald’s, or riding the garbage truck after “Joe Biden” called more than half the country that supports him “garbage.” Because a few hours after Mr. Trump settles into his Rikers cell and enjoys his first boloney sandwich, the SCOTUS is going to turn a flame thrower on Judge Merchan and Alvin Bragg and vacate the absurd case and every half-assed procedure that was used to arrive at it, and refer Merchan and Bragg for disbarment for professional misconduct, malicious prosecution, and failure to uphold the law.
    0 Commentarii 0 Distribuiri 877 Views

  • Zalma’s Insurance Fraud Letter – November 1, 2024

    ZIFL – Volume 28 Number 21

    Posted on November 1, 2024 by Barry Zalma

    Post 4924

    See the full video at and at

    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

    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:

    Pill Mill Doctor’s Conviction Affirmed

    HEALTH CARE FRAUD CONVICTION AFFIRMED

    ACTING AS A DR. FEEL GOOD IS A FEDERAL CRIME

    According to the Sixth Circuit Dr. David Jankowski’s medical clinics relied on several unusual billing and prescription practices, many of which were illegal and Jankowski fraudulently billed Medicare for services he did not provide and prescribed controlled substances to patients whose conditions did not call for such treatment, with some patients unlawfully trafficking their prescribed drugs.

    In United States Of America v. David Jankowski, M.D., No. 23-1404, United States Court of Appeals, Sixth Circuit (October 23, 2024) the Sixth Circuit disposed of the fraudsters claims on appeal.

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    More McClenny Moseley & Associates Issues

    This is ZIFL’s thirty sixth 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 indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

    10/24/2024

    MMA BANKRUPTCY HEARING TO DECIDE WHETHER TRUSTEE WILL BE APPOINTED

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    Injured While Drunk on the Job Gets Workers’ Compensation Benefits

    An appellate court in New York has upheld a decision of the Workers’ Compensation Board in favor of an injured employee of an electrical contractor company because intoxication was not the sole cause of the accident.

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    Man Bites Dog Story:

    Fraudsters Arbitration Attempts Stopped

    Arbitration Stayed for Suspected Chiropractors’ Fraudulent No Fault Medical Claims

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    In Government Employees Insurance Company, (“GEICO”) v. Didier Demesmin, M.D., et al, No. 23-CV-6191 (ARR) (MMH), United States District Court, E.D. New York (October 23, 2024) GEICO sought to enjoin defendants Manuel A. Mendoza, D.C. and Mendoza Chiropractic Office PC (collectively the “Mendoza Defendants”) from pursuing certain “no-fault” insurance collection arbitrations or initiating new collections proceedings during the pendency of this lawsuit.

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    Health Insurance Fraud Convictions

    Louisiana Nursing Home Owner to Pay $8.2M for Misusing Assets During Ida

    Bob Dean Jr a Louisiana nursing home owner and several companies he operated have agreed to an $8.2 million consent judgment to resolve allegations that they misappropriated and misused the assets and income of four nursing homes in Louisiana before and after Hurricane Ida’s landfall in August 2021.

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    Officer Caught Aiding Criminals for Cash

    Police Officer who took Bribes from Insurance Fraudster Convicted

    Demarkco Johnson (“Johnson”), appealed his convictions for taking bribes about insurance fraud.

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    Convictions of Other Than Health Insurance Fraud

    Former Lake Forest Agent Convicted On 90 Counts Of Insurance Fraud After Stealing Nearly $200,000 In Premium Payments

    Karen Marie Dondanville, 56, of Mission Viejo, California, a former Lake Forest insurance agent was convicted on 90 counts of insurance fraud after stealing nearly $200,000 in premium payments.

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    The Need to Understand the Mutability of Memory

    Investigators and lawyers believe what they are told by eye witnesses who describe what he or she says with conviction. However, every professional investigator or litigator must know that memory is not necessarily accurate because very few people have a perfect eidetic (photographic) memory. Memory is a fluid and often unreliable human function.

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

    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. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog. 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

    Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf
    Zalma’s Insurance Fraud Letter – November 1, 2024 ZIFL – Volume 28 Number 21 Posted on November 1, 2024 by Barry Zalma Post 4924 See the full video at and at 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 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: Pill Mill Doctor’s Conviction Affirmed HEALTH CARE FRAUD CONVICTION AFFIRMED ACTING AS A DR. FEEL GOOD IS A FEDERAL CRIME According to the Sixth Circuit Dr. David Jankowski’s medical clinics relied on several unusual billing and prescription practices, many of which were illegal and Jankowski fraudulently billed Medicare for services he did not provide and prescribed controlled substances to patients whose conditions did not call for such treatment, with some patients unlawfully trafficking their prescribed drugs. In United States Of America v. David Jankowski, M.D., No. 23-1404, United States Court of Appeals, Sixth Circuit (October 23, 2024) the Sixth Circuit disposed of the fraudsters claims on appeal. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf More McClenny Moseley & Associates Issues This is ZIFL’s thirty sixth 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 indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. 10/24/2024 MMA BANKRUPTCY HEARING TO DECIDE WHETHER TRUSTEE WILL BE APPOINTED Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Injured While Drunk on the Job Gets Workers’ Compensation Benefits An appellate court in New York has upheld a decision of the Workers’ Compensation Board in favor of an injured employee of an electrical contractor company because intoxication was not the sole cause of the accident. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Man Bites Dog Story: Fraudsters Arbitration Attempts Stopped Arbitration Stayed for Suspected Chiropractors’ Fraudulent No Fault Medical Claims Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf In Government Employees Insurance Company, (“GEICO”) v. Didier Demesmin, M.D., et al, No. 23-CV-6191 (ARR) (MMH), United States District Court, E.D. New York (October 23, 2024) GEICO sought to enjoin defendants Manuel A. Mendoza, D.C. and Mendoza Chiropractic Office PC (collectively the “Mendoza Defendants”) from pursuing certain “no-fault” insurance collection arbitrations or initiating new collections proceedings during the pendency of this lawsuit. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Health Insurance Fraud Convictions Louisiana Nursing Home Owner to Pay $8.2M for Misusing Assets During Ida Bob Dean Jr a Louisiana nursing home owner and several companies he operated have agreed to an $8.2 million consent judgment to resolve allegations that they misappropriated and misused the assets and income of four nursing homes in Louisiana before and after Hurricane Ida’s landfall in August 2021. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Officer Caught Aiding Criminals for Cash Police Officer who took Bribes from Insurance Fraudster Convicted Demarkco Johnson (“Johnson”), appealed his convictions for taking bribes about insurance fraud. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Convictions of Other Than Health Insurance Fraud Former Lake Forest Agent Convicted On 90 Counts Of Insurance Fraud After Stealing Nearly $200,000 In Premium Payments Karen Marie Dondanville, 56, of Mission Viejo, California, a former Lake Forest insurance agent was convicted on 90 counts of insurance fraud after stealing nearly $200,000 in premium payments. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf The Need to Understand the Mutability of Memory Investigators and lawyers believe what they are told by eye witnesses who describe what he or she says with conviction. However, every professional investigator or litigator must know that memory is not necessarily accurate because very few people have a perfect eidetic (photographic) memory. Memory is a fluid and often unreliable human function. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf 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. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog. 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 Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf
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  • Man Bites Dog Story: Fraudsters Arbitration Attempts Stopped

    Arbitration Stayed for Suspected Chiropractors’ Fraudulent No Fault Medical Claims

    Post 4921

    Read the full article at https://www.linkedin.com/pulse/man-bites-dog-story-fraudsters-arbitration-attempts-zalma-esq-cfe-5yw6c, see the full video at and at and at https://zalma.com/blog.

    In Government Employees Insurance Company, (“GEICO”) v. Didier Demesmin, M.D., et al, No. 23-CV-6191 (ARR) (MMH), United States District Court, E.D. New York (October 23, 2024) GEICO sought to enjoin defendants Manuel A. Mendoza, D.C. and Mendoza Chiropractic Office PC (collectively the “Mendoza Defendants”) from pursuing certain “no-fault” insurance collection arbitrations or initiating new collections proceedings during the pendency of this lawsuit.

    BACKGROUND

    GEICO provides personal injury protection benefits on a “no-fault” basis, which means that, after an accident, insured drivers and their passengers are entitled to certain benefits for medically necessary healthcare services regardless of who was at fault.

    GEICO sued a group of healthcare providers who allegedly carried out an insurance scheme to obtain fraudulent no-fault benefit payments from GEICO. The USDC granted the motion based on its conclusion that (1) GEICO would experience irreparable harm absent a stay, (2) GEICO raised a serious question going to the merits, and (3) the balance of hardships tipped in GEICO’s favor.

    Subsequently, GEICO requested leave to file a second amended complaint to add allegations concerning the Mendoza defendants which was granted.

    In total, GEICO seeks recovery of more than $5.9 million in wrongfully obtained benefits payments from the three groups of defendants, as well as a declaration that it is not obligated to reimburse defendants for outstanding no-fault claims.

    After filing the second amended complaint, GEICO filed the present motion seeking an order staying all pending no-fault benefits arbitrations between GEICO and the Mendoza defendants and enjoining the Mendoza defendants from commencing new collections proceedings during the pendency of this action.

    DISCUSSION

    GEICO Will Experience Irreparable Harm Absent A Stay.

    Irreparable harm is certain and imminent harm for which a monetary award does not adequately compensate. the risk of inconsistent judgments in no-fault insurance disputes can constitute irreparable harm separate and apart from the expenditure of time and money spent on parallel proceedings. As with the parallel proceedings brought by the Demesmin and Khanan defendants, the risk of inconsistent outcomes is great enough to establish irreparable harm.

    GEICO established irreparable harm because permitting arbitrations to proceed will subject it to a risk of judgments that may be inconsistent with future judicial rulings.

    GEICO Has Shown At Least Some Serious Questions Going To The Merits, And The Balance Of Hardships Tips In Its Favor.

    GEICO’s amended complaint details a complex scheme of fraudulent billing and referrals among a network of chiropractic providers. GEICO’s allegations concerning the Mendoza defendants’ role are well developed through numerous examples of charges billed without proper documentation or under suspicious circumstances and a table of more than 45,000 suspect claims.

    The balance of hardships also tips in GEICO’s favor because the Mendoza defendants have not established any hardship, beyond a delay in reimbursement. Because the defendants will presumably be entitled to collect interest on their pending claims if they prevail, the delay does not outweigh the risk of inconsistent outcomes faced by GEICO.

    A Stay Does Not Violate The Anti-Injunction Act.

    The Anti-Injunction Act (“AIA”) prohibits federal courts from enjoining proceedings in state court “except as expressly authorized by Act of Congress, or where necessary in aid of its jurisdiction, or to protect or effectuate its judgments.” 28 U.S.C. § 2283. The AIA does not, however, limit the court’s authority to enjoin ongoing private arbitration proceedings or the court’s authority to enjoin defendants from initiating future state court proceedings.

    GEICO’s motion was granted and a preliminary injunction was issued: staying all pending no-fault insurance collection arbitrations that have been Commenced against GEICO by or on behalf of the Mendoza defendants, pending the disposition of GEICO’s claims in this action, and enjoining the Mendoza defendants and anyone acting on their behalf from commencing new no-fault arbitrations and litigations against GEICO pending the disposition of GEICO’s claims in this action.

    ZALMA OPINION

    The USDC, and other courts dealing with No-Fault auto insurance claims, has acted to help insurers defeat attempted insurance fraud – a crime in each state like New Jersey – which became necessary because state prosecutors seemed to ignore the crimes reported to them by insurers like GEICO. It is essential that insurers be proactive against fraud to shame the insurance fraud investigators in each state to do their job and prosecute the fraud perpetrators. Every insurer, faced with such fraud, should emulate GEICO.

    (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
    Man Bites Dog Story: Fraudsters Arbitration Attempts Stopped Arbitration Stayed for Suspected Chiropractors’ Fraudulent No Fault Medical Claims Post 4921 Read the full article at https://www.linkedin.com/pulse/man-bites-dog-story-fraudsters-arbitration-attempts-zalma-esq-cfe-5yw6c, see the full video at and at and at https://zalma.com/blog. In Government Employees Insurance Company, (“GEICO”) v. Didier Demesmin, M.D., et al, No. 23-CV-6191 (ARR) (MMH), United States District Court, E.D. New York (October 23, 2024) GEICO sought to enjoin defendants Manuel A. Mendoza, D.C. and Mendoza Chiropractic Office PC (collectively the “Mendoza Defendants”) from pursuing certain “no-fault” insurance collection arbitrations or initiating new collections proceedings during the pendency of this lawsuit. BACKGROUND GEICO provides personal injury protection benefits on a “no-fault” basis, which means that, after an accident, insured drivers and their passengers are entitled to certain benefits for medically necessary healthcare services regardless of who was at fault. GEICO sued a group of healthcare providers who allegedly carried out an insurance scheme to obtain fraudulent no-fault benefit payments from GEICO. The USDC granted the motion based on its conclusion that (1) GEICO would experience irreparable harm absent a stay, (2) GEICO raised a serious question going to the merits, and (3) the balance of hardships tipped in GEICO’s favor. Subsequently, GEICO requested leave to file a second amended complaint to add allegations concerning the Mendoza defendants which was granted. In total, GEICO seeks recovery of more than $5.9 million in wrongfully obtained benefits payments from the three groups of defendants, as well as a declaration that it is not obligated to reimburse defendants for outstanding no-fault claims. After filing the second amended complaint, GEICO filed the present motion seeking an order staying all pending no-fault benefits arbitrations between GEICO and the Mendoza defendants and enjoining the Mendoza defendants from commencing new collections proceedings during the pendency of this action. DISCUSSION GEICO Will Experience Irreparable Harm Absent A Stay. Irreparable harm is certain and imminent harm for which a monetary award does not adequately compensate. the risk of inconsistent judgments in no-fault insurance disputes can constitute irreparable harm separate and apart from the expenditure of time and money spent on parallel proceedings. As with the parallel proceedings brought by the Demesmin and Khanan defendants, the risk of inconsistent outcomes is great enough to establish irreparable harm. GEICO established irreparable harm because permitting arbitrations to proceed will subject it to a risk of judgments that may be inconsistent with future judicial rulings. GEICO Has Shown At Least Some Serious Questions Going To The Merits, And The Balance Of Hardships Tips In Its Favor. GEICO’s amended complaint details a complex scheme of fraudulent billing and referrals among a network of chiropractic providers. GEICO’s allegations concerning the Mendoza defendants’ role are well developed through numerous examples of charges billed without proper documentation or under suspicious circumstances and a table of more than 45,000 suspect claims. The balance of hardships also tips in GEICO’s favor because the Mendoza defendants have not established any hardship, beyond a delay in reimbursement. Because the defendants will presumably be entitled to collect interest on their pending claims if they prevail, the delay does not outweigh the risk of inconsistent outcomes faced by GEICO. A Stay Does Not Violate The Anti-Injunction Act. The Anti-Injunction Act (“AIA”) prohibits federal courts from enjoining proceedings in state court “except as expressly authorized by Act of Congress, or where necessary in aid of its jurisdiction, or to protect or effectuate its judgments.” 28 U.S.C. § 2283. The AIA does not, however, limit the court’s authority to enjoin ongoing private arbitration proceedings or the court’s authority to enjoin defendants from initiating future state court proceedings. GEICO’s motion was granted and a preliminary injunction was issued: staying all pending no-fault insurance collection arbitrations that have been Commenced against GEICO by or on behalf of the Mendoza defendants, pending the disposition of GEICO’s claims in this action, and enjoining the Mendoza defendants and anyone acting on their behalf from commencing new no-fault arbitrations and litigations against GEICO pending the disposition of GEICO’s claims in this action. ZALMA OPINION The USDC, and other courts dealing with No-Fault auto insurance claims, has acted to help insurers defeat attempted insurance fraud – a crime in each state like New Jersey – which became necessary because state prosecutors seemed to ignore the crimes reported to them by insurers like GEICO. It is essential that insurers be proactive against fraud to shame the insurance fraud investigators in each state to do their job and prosecute the fraud perpetrators. Every insurer, faced with such fraud, should emulate GEICO. (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
    0 Commentarii 0 Distribuiri 1K Views 0
  • https://t.me/davidavocadowolfe/144250
    GOP chair Michael Watley announces at the Trump rally in Pennsylvania that they have filed a massive lawsuit against election officials in Delaware and Bucks County for stopping long lines of likely Republican workers from voting. (2 minutes)
    https://t.me/davidavocadowolfe/144250 GOP chair Michael Watley announces at the Trump rally in Pennsylvania that they have filed a massive lawsuit against election officials in Delaware and Bucks County for stopping long lines of likely Republican workers from voting. (2 minutes)
    0 Commentarii 0 Distribuiri 349 Views 0
  • Judicial Watch sues Oregon to force state to remove ineligible voters from voter rolls
    https://justthenews.com/nation/states/judicial-watch-sues-oregon-force-state-remove-ineligible-voters-voter-roll
    The lawsuit targets Oregon Secretary of State LaVonne Griffin-Valade, and claims the state has the "highest known inactive registration rate of any state in the nation," according to Judicial Watch.

    Conservative watchdog Judicial Watch on Wednesday announced a lawsuit against the state of Oregon, that would force it to remove ineligible voters from its voter rolls, as mandated by the National Voter Registration Act.

    The voting act requires states to make a "reasonable effort" to remove voters who have either died or changed residences from their voter rolls. The voters are removed if they fail to respond to address confirmation notices, and do not vote in two consecutive federal general elections.

    The lawsuit targets Oregon Secretary of State LaVonne Griffin-Valade, and claims the state has the "highest known inactive registration rate of any state in the nation," according to a Judicial Watch news release. The lawsuit alleges that 29 of the state's 36 counties have removed few or no voter registrations, and that the state has registration rates exceeding 100%.

    “Dirty voter rolls can mean dirty elections,” Judicial Watch President Tom Fitton said in a statement. “Oregon has among the dirtiest voting rolls in America and needs to clean them up ASAP!”

    Judicial Watch has led other efforts to clean up voter rolls in New York, California, Pennsylvania, Colorado, North Carolina, Kentucky and Ohio. Altogether the efforts have resulted in the purging of up to four million ineligible voters, the group said.

    Misty Severi is an evening news reporter for Just The News. You can follow her on X for more coverage.
    Judicial Watch sues Oregon to force state to remove ineligible voters from voter rolls https://justthenews.com/nation/states/judicial-watch-sues-oregon-force-state-remove-ineligible-voters-voter-roll The lawsuit targets Oregon Secretary of State LaVonne Griffin-Valade, and claims the state has the "highest known inactive registration rate of any state in the nation," according to Judicial Watch. Conservative watchdog Judicial Watch on Wednesday announced a lawsuit against the state of Oregon, that would force it to remove ineligible voters from its voter rolls, as mandated by the National Voter Registration Act. The voting act requires states to make a "reasonable effort" to remove voters who have either died or changed residences from their voter rolls. The voters are removed if they fail to respond to address confirmation notices, and do not vote in two consecutive federal general elections. The lawsuit targets Oregon Secretary of State LaVonne Griffin-Valade, and claims the state has the "highest known inactive registration rate of any state in the nation," according to a Judicial Watch news release. The lawsuit alleges that 29 of the state's 36 counties have removed few or no voter registrations, and that the state has registration rates exceeding 100%. “Dirty voter rolls can mean dirty elections,” Judicial Watch President Tom Fitton said in a statement. “Oregon has among the dirtiest voting rolls in America and needs to clean them up ASAP!” Judicial Watch has led other efforts to clean up voter rolls in New York, California, Pennsylvania, Colorado, North Carolina, Kentucky and Ohio. Altogether the efforts have resulted in the purging of up to four million ineligible voters, the group said. Misty Severi is an evening news reporter for Just The News. You can follow her on X for more coverage.
    JUSTTHENEWS.COM
    Judicial Watch sues Oregon to force state to remove ineligible voters from voter rolls
    The lawsuit targets Oregon Secretary of State LaVonne Griffin-Valade, and claims the state has the "highest known inactive registration rate of any state in the nation," according to Judicial Watch.
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    0 Commentarii 0 Distribuiri 503 Views
  • (admin) Commielaw and Hitlery and laying it on thick about Trump
    Hillary is BACK! HUGE New Election Lawsuits! Plus, NEW Election Fraud Hotline
    https://youtu.be/gnEusWSNSIs
    (admin) Commielaw and Hitlery and laying it on thick about Trump Hillary is BACK! HUGE New Election Lawsuits! Plus, NEW Election Fraud Hotline https://youtu.be/gnEusWSNSIs
    Like
    1
    0 Commentarii 0 Distribuiri 237 Views
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