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Complying with the provisions on insurance fraud and how to defeat insurance fraud



For the past 52 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their claims staff to become professional in insurance claims.

Insurance Fraud – Volume I and Volume II

In Two Volumes

Insurance fraud continuously takes more money each year than it did from insurance buyers. No one knows the actual amount with certainty because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $ 87 billion to more than $ 300 billion each year.

Insurers and state-insured pseudo-insurers can only estimate the extent to which they lose for fraudulent claims. The lack of adequate investigation and prosecution of insurance offenders is endemic. Most insurance frauds are not detected. Those who are discovered do so

because they became greedy, careless and unprofessional so that the attempt at fraud becomes so obvious that it is impossible to ignore.

No one will ever be able to place an exact number on the amount lost to the insurance. fraud. Anyone who has looked at the question knows – whether they are based on their heart, their gut or empirical facts established on the basis of convictions for the crime of insurance fraud – that the number is huge.

When insurers and governments make serious efforts to reduce the amount of insurance fraud, the number of claims against insurers and pseudo-state or funded insurers decreases logarithmically. Since the appointment of Attorney General sessions, efforts to stop insurance fraud against Medicare and Medicaid have increased.

This book contains appeal decisions regarding insurance fraud from federal and state appellate courts across the country and full text for many insurances

It exists both as a legal research tool and as a product to help insurers, insurance company insurers, independent insurance insurers, investigators for special investigative units, state fraud investigators and insurance lawyers to become effective persons involved in the attempt to defeat or reduce the effect of insurance fraud.

Volume one available as a Kindle book and a paperback book.

Volume Two Available as a Kindle Book and a Pocket Book

The Compact Book of Adjusting Property Insurance Claims – Second Edition

A Manual for the First Party Property Insurance Adjuster

The insurance adjuster is not mentioned in a policy insurance. The obligation to investigate and prove the damages rests with the insured. First-party standard property insurance, based on New York Standard Fire Insurance, contains terms and conditions that require the insured, within sixty days of the loss, to submit hard evidence of loss to prove the insurer facts and amounts for the loss.

The insurance allows the insurer to then, and only then, respond to the insured's proof of loss. The insurer can then either accept or reject the insured's proof.

 The Compact Book of Adjusting Property Claims - Second Edition: A Primer For the First Party Property Claims Adjuster. Technically, if the wording of the policy literally followed the insurer could sit back, do nothing and wait for the proof. If the insured has delayed proof, the insurer can reject the claim. If the insured submits proof of loss in a timely manner, the insurer can either accept or reject the proof of loss. If the insurer rejected the proof of loss, the insured can either send a new one or give up and get nothing from the damage. The suit for the insurance would be difficult because the insurance contract limited the right to sue at times when the proof of loss conditions had been met. Insureds and insurers were not happy with that system. This made it too difficult for a layman to successfully present a claim. The system, as written in the standard fire policy, seemed to run counter to the union of good faith and fair trade that had been the basis of the insurance contract for centuries. Most insurers understood that their insured were mostly unable to comply with strict application of the insurance terms. In order to fulfill the union with good faith and fair insurance companies, the insurance adjuster created to fulfill his obligation to act fairly and in good faith with the insured.

The second edition adds new material from 2018 and 2019, is easier to use and more compact than the original.

Available as a Kindle book.

Available as a paperback book.

California SIU Regulations 2020 is designed to assist California insurance claims personnel, claims personnel, independent insurance adjusters, special investigators, private investigators working for the insurance industry, industry management, lawyers serving the industry, and all integrated anti-fraud law firms working with California law enforcement agencies. the requirements of the California SIU Claims Regulations which have been rewritten and put into operation October 1, 2020.

The State of California requires by law all admitted insurers to maintain a special investigation unit (a "SIU") that meets the requirements of the Special Investigative Unit Regulations (" The SIU Regulations ") and train all integrated anti-fraud staff to recognize insurance fraud indicators. It is therefore necessary for insurance personnel who are in any way working to present, process or negotiate insurance claims in California to be familiar with the SIU regulations.

The state has imposed on all responsible personnel the obligations to deal with insurance fraud if the insurance companies do business in the state. California Licensed Insurance Companies are liable under California Insurance Code Sections 1875.20-24 and California Code of Regulations, Section 10, Sections 2698.30 -.41 for establishing and maintaining special investigative units that identify and refer suspected insurance fraud to the California Department of Insurance (CDI) and directly to the local California County District Attorney & # 39 ;s Office for employee compensation only. The rules also require each insurer to submit an SIU annual report to the CDI that contains important information about the insurer's SIU fraud prevention, procedures and training materials. SIU's review program evaluates the report's accuracy, completeness and timeliness. The reports are used to carry out a risk assessment to determine which insurers are selected for review of SIU compliance. R

The appendices contain outlines to be used by an employee of the insurance company SIU, its trainers, teachers or lawyers to present a training class for all "integrated anti-fraud staff" of the insurers as defined in the SIU regulations. Insurers must understand that every employee on damages must be trained in accordance with the requirements of the SIU regulations no later than 30 days after the person is employed and thereafter annually. Because it is not economically reasonable to train a new employee, the California SIU Regulations 2020 camera provides the training needed at no extra cost to one or two people for a training class. California's SIU Regulations 2020 and its annexes will provide the insurer and its personnel with the information needed to comply with the SIU Regulations and will provide the training required for what the SIU Regulations describe as an insurer's "integrated fraud prevention staff."

Available as a Kindle book here.

Available as a paperback book here.


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