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Zalma on Insurance
SCOTUS & INSURANCE
How Insurance is Treated in Mass Tort Cases in Bankruptcy Court. Between 1999 and 2019, approximately 247,000 people in the United States died from prescription-opioid overdoses. Respondent Purdue Pharma sits at the center of that crisis. Owned and controlled by the Sackler family, Purdue began marketing OxyContin, an opioid prescription pain reliever, in the mid-1990s. After Purdue earned billions of dollars in sales on the drug, in 2007 one of its affiliates pleaded guilty to a federal felony for misbranding OxyContin as a less-addictive, less-abusable alternative to other pain medications. Thousands of lawsuits followed. Purdue Pharma filed for bankruptcy and attempted to protect the Sackler family from individual tort actions.
Concealment of Prior Act of Sexual Abuse Excluded
Never Lie or Conceal Potential Claims From Insurer. Plaintiff CMGK, LLC, doing business as Massage Envy, appealed from an order granting summary-judgment to defendant Certain Underwriters at Lloyd’s, London Subscribing to Policy Number ME10XXXX, and dismissing with prejudice plaintiff’s claims. Plaintiff sought coverage under a Sexual Acts Liability Endorsement of a claims-made-and-reported policy issued by Lloyd’s to plaintiff. The court found plaintiff was not entitled to coverage and granted the motion.
Insurers Act to Defeat Fraud
GEICO Continues it Proactive Actions Against Insurance Fraud. Insurers have found that states, like New York, will do little or nothing to deter insurance fraud. Determined to protect its assets and its insureds, many GEICO brand insurance companies have acted proactively against people and health care providers who are attempting to defraud them and their insureds. In Government Employees Insurance Company, et. al. v. Colin Clarke, M.D., Colin Clarke Md P.C., Svetlana Kovaleva a/k/a Melana Kay, Medical Evaluation Services & Billing, Inc., Medical Consultation Services & Billing, Inc., and John Doe Defendants, No. 1:23-CV-04605 (FB) (SJB), United States District Court, E.D. New York (June 20, 2024) the fraud perpetrators attempted to defeat GEICO’s RICO action by counterclaiming that GEICO committed fraud.
Contract Breach Excluded from D&O Policy
Actual Or Alleged Contractual Liability Or Obligation Of Directors is. Paraco Gas Corporation (“Paraco”), a closely-held family corporation that distributes propane fuel and equipment, appealed a June 22, 2023 judgment of the district court dismissing its breach of contract and declaratory judgment claims against Ironshore Indemnity, Inc. (“Ironshore”), an insurance company that issued Paraco the liability insurance policy at the heart of this dispute. Ironshore issued an insurance policy for Directors, Officers, and Private Company Liability coverage (the “D&O Policy” or “Policy”) to Paraco.
It is Unwise to be a Chameleonic Litigant
It is Inappropriate to Argue a Win Was Wrong and a New Result is Required. Defendant, Bankers Insurance Company (“Bankers Insurance”), moved to vacate the Panel Appraisal Award Amendment & Clarification (“Amended Award”) based on three alleged “significant errors” or “clear mistakes of fact” only to see an unfavorable response in St. Joseph Medical Clinic AMC v. Bankers Insurance Company, Civil Action No. 22-4521, United States District Court, E.D. Louisiana (June 17, 2024)
Arsonist Must Serve Full Sentence
Chutzpah: Serial Arsonist & Insurance Fraudster Requests Shortened Sentence. Arson-for-Profit is the most evil form of insurance fraud where people may be injured or die. Defendant Michael Thomas set fire to many properties in a mobile home park and then used the mail to collect insurance money. He was charged with four counts of mail fraud, went to trial and the jury convicted him on all counts. The Court sentenced him to a below-guidelines sentence of ninety months of imprisonment. His sentence is set to expire on February 11, 2025. Mr. Thomas is currently under home confinement under the CARES Act.
Auto Insurance only Available for Drivers Listed in Policy
Scheduled Driver Endorsement Eliminates Coverage for Accident. Brandyn Washington and Stephan Jomar Gonzalez were involved in a car accident in Davenport, Florida. Washington sued and asserted that Gonzalez was driving the truck involved in the accident.
Application Wrongfully Stated No Work on Recreational or Playground Equipment
Policy Does Not Cover Damages Caused by In-Ground Trampoline. United Casualty Insurance Company ("United" ) refused to defend James Snell, a landscaper, in a civil lawsuit alleging that Snell had negligently installed a ground-level trampoline in a client's backyard. Snell sued, contending that United had breached its insurance contract with him in bad faith and seeking a declaratory judgment that United had a duty to defend and indemnify Snell. The district court granted summary judgment for United, holding that the accident did not "arise from" Snell's "landscaping" work within the meaning of his commercial general liability policy.
Zalma’s Insurance Fraud Letter – June 15, 2024
ZIFL – Volume 28 Issue 12. Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th year of publication dedicated to those involved in reducing the effect of insurance fraud. It is provided FREE to anyone. This issue contains the following articles:
Arbitration Clause in Policy Void in Louisiana
Right of Contracting Parties to Arbitrate Prohibited by Louisiana Statute. Plaintiff SKAV, L.L.C. owns a Best Western hotel in Abbeville, Louisiana. The hotel was damaged when Hurricane Laura, one of the strongest hurricanes in state history, made landfall in August 2020. SKAV submitted a claim on a surplus lines insurance policy it had purchased from Independent Specialty Insurance. The policy contained a broad arbitration clause, requiring “[a]ll matters in dispute” to be settled by arbitration. SKAV litigated the dispute and the insurer asked that arbitration – in accordance with the contract of insurance, be arbitrated.
Litigation Sloth Defeats S
The appellate courts of the state of New York are noted for their ability to resolve an appeal quickly and with brevity.The Supreme Court, the trial court, dismissed plaintiffs’ complaint against Allied World National Insurance Company as time-barred because plaintiffs commenced this action eight years after Allied’s disclaimer of insurance coverage.
Insurer Has the Right to Oppose Plan that Exposes it to Potential Fraud
SCOTUS Unanimously Gives Insurer Right as a “Party in Interest” to a Chapter 11 Bankruptcy. Read the full article at https://lnkd.in/gJPhuaZ3, see the full video at https://lnkd.in/ggC7g-Vt and at https://lnkd.in/g9c25N5Q and at https://zalma.com/blog plus more than 4800 posts.
RICO Suit Against Chiropractors
In Allstate Insurance Co. et al. v. Lint Chiropractic PC et al., No. 2:23-cv-10904, United States District Court, E.D. Michigan, Southern Division (May 30, 2024) Allstate brought a RICO case against chiropractors and conspiracies to defraud Allstate.
Chutzpah From Convicted Dentist
Sentenced to 20 Years in Prison for Medicaid Fraud Yet Demands Return of his License to Practice Dentistry. The Board of Dental Examiners revoked Seth Lookhart’s dental license after he was convicted of dozens of crimes perpetrated in furtherance of a fraudulent scheme of staggering proportions that jeopardized the health and safety of his patients. Lookhart appealed the Board’s revocation of his license, arguing that his punishment was inconsistent with past Board decisions. On appeal, the superior court concluded that the Board properly exercised its discretion by revoking Lookhart’s dental license.
No Coverage for Covid Caused Damage
California Supreme Court Finds no Coverage Under First Party Property Policy for Covid-19 Claims. In Another Planet Entertainment, LLC v. Vigilant Insurance Company, S277893, the Supreme Court of California (May 23, 2024) where Chief Justice Guerrero authored the opinion of the Court, in which Justices Corrigan, Liu, Kruger, Groban, Jenkins, and Evans concurred in a response to an inquiry from the Ninth Circuit Court of Appeals that posed the following question: “Can the actual or potential presence of the COVID-19 virus on an insured’s premises constitute ‘direct physical loss or damage to property’ for purposes of coverage under a commercial property insurance policy?”
Arsonist Must Pay Restitution to Insurer
In September 2019 Otho Harris visited a Boost Mobile store for assistance with his broken cellphone. He became enraged when he was told that it could not be repaired. He returned in the middle of the night and set fire to the store,
Liars Never Prosper
Failure to Tell the Truth on an Insurance Application Voids Entire Policy as if it Never Existed. Ms. Stephens demanded that Defendant Great American Assurance Company (“Great American”) provide legal representation for her under an insurance policy (the “Policy”) it issued related to a professional disciplinary hearing and Great American refused and asserted that she lied on the application for insurance causing the policy to be void.
Zalma’s Insurance Fraud Letter – June 1, 2024
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.
Appeal Dismissed Even With Fraud Allegation
Appeal Lost Due to Failure to Provide an Adequate Record. In an action to recover damages for personal injuries, the defendant Myrtle 6, LLC, appealed from an order of the Supreme Court, Kings County (Lawrence S. Knipel, J.). The order, insofar as appealed from, denied those branches of the motion of the defendant Myrtle 6, LLC to stay the trial ,to vacate the note of issue, and to compel discovery.
Duty to Defend Exists for Umbrella Policy
Many companies find that a single policy of liability insurance is inadequate and purchase multiple layers or insurance. Many times the policies follow each other’s terms and conditions, but not always. Thermoflex Waukegan obtained several lawyers of coverage but did not require the terms and conditions of each policy to be the same.
Zalma on Insurance
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Barry Zalma, Esq., CFE is a retired insurance coverage lawyer who blogs daily with digests of insurance cases and writes books and articles on insurance claims, insurance law, and insurance fraud.
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