قالب وردپرس درنا توس
Home / Insurance / New books on insurance issues from Barry Zalma

New books on insurance issues from Barry Zalma



“Insurance Fraud – Volume I and Volume II Second Edition”

Insurance Fraud Volume In Second Edition: How Lawyers and Compensators Defeat Insurance Fraud

Insurance fraud constantly takes more money each year than it did last year from insurance buyers. No one knows the actual amount with any 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-subsidized pseudo-insurers can only estimate the extent to which they are losing out on fraudulent claims. Lack of adequate investigation and prosecution of insurance offenders is endemic. Most criminals in insurance fraud 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 put an exact figure on the amount lost due to insurance fraud. Anyone who has looked at the issue knows – whether it is based on their heart, gut feeling or empirical facts established from convictions for the crime of insurance fraud – that the number is huge. When insurance companies and governments make a serious effort to reduce the amount of insurance fraud, the number of claims presented to insurers and pseudo-state-based or funded insurance companies drops logarithmically. Efforts to stop insurance fraud against Medicare and Medicaid have increased in recent years. Insurance Fraud Volume II Second Edition: A Handbook on How Lawyers and Claims Can Defeat Insurance FraudThis book contains appeal decisions regarding insurance fraud from federal and state appellate courts across the country and the full text of many insurance fraud statutes. It is available as both a legal research tool and a product to help insurers, insurance company staff, independent insurance adjusters, investigators of special investigative units, state fraud investigators and insurance lawyers to become effective individuals involved in trying to defeat or reduce the impact of insurance fraud.

Volume I of Insurance fraud includes the following:

  • Insurance fraud is an epidemic.
  • Measurement of insurance fraud
  • What is insurance fraud?
  • Arson for profit.
  • Soft fraud
  • Hard fraud
  • Insurance against the risk of loss of real estate or personal property
  • Liability insurance
  • Interpretation of insurance contracts
  • Ethics & Insurance Fraud Investigation
  • Fraud by professionals
  • First party property fraud
  • Health insurance fraud
  • Insurance fraud is a crime
  • Fraud created by legal experts
  • Fraud in acquiring insurance
  • Fraud in presenting a claim
  • Investigation of a requirement for chance
  • Investigating fraud
  • Fire foundation for profit investigation
  • Examination methods
  • Evaluation of records

Available as Kindle Book; Available as hardcover; Available as paperback

Volume II av Insurance fraud provides coverage of the issues not covered by Volume I and, together with Volume I, becomes a complete manual for how lawyers and tortfeasors can work effectively to deter or defeat insurance fraud.
INSURANCE FRAUD IS EPIDEMIC
The following is addressed in this volume, including:

  • Federal Crime of Insurance Fraud
  • Insurance fraud as a state crime
  • Insurance fraud by insurers
  • California’s SIU Regulations
  • Investigates insurance fraud
  • The examination under ed
  • Graduation under oath
  • The variability of memory
  • Termination
  • Insurance fraud statutes
  • Tort of Bad Faith and Insurance Fraud
  • Examples of resignation letters from California
  • Examples of complaints for declaratory relief
  • Form of mutual termination agreement
  • Fom Explanation of guarantor in support of termination
  • Insurance fraud statutes
  • Overview of training for integrated anti-fraud staff
  • Form of EUO Demand Letter
  • EUO testimony acknowledging fraud.

Available as Kindle Book; Available as hardcover; Available as paperback

How the union of good faith and fair business requires insurance staff to act ethically and with the utmost good faith and fair handling

by Barry Zalma

Ethics are essential for insurance staff

Insurance is by definition an activity of the utmost good faith. This means that both parties to the insurance contract must act fairly and in good faith towards each other and not do anything that will deprive the other of the benefits promised by the insurance contract.

In essence, the agreement requires that each party to the insurance contract treats the other ethically, fairly and in good faith.

Without the union of good faith and fair business and without the people working in the insurance industry applying and fulfilling the union ethically, insurance is impossible. You can not act fairly and in good faith without being a person with a well-formed ethical compass.

IN Carter v. Boehm SC 1 Bl. Burr 1906, May 11, 1766. 593, 3 Lord Mansfield in the British House of Lords stated: “Good faith forbids either party by concealing what he privately knows, to draw the other to a finding, from his ignorance of this fact, and his believe the opposite. “

Insurers, when deciding whether or not to insure a risk, rely on the information provided to them by the insured. As instructed by Lord Mansfield, the insured must provide the information requested honestly and in good faith. Failure to do so is unethical and violates the union of good faith.

The implied union declares that no party to an insurance contract should do anything to deprive the other of the benefits of the contract. By doing so, an insurer must keep all promises made by the police fairly, quickly and completely in accordance with promises made by the police. In the same way, an insured must treat the insurer ethically, fairly and in good faith when applying for the insurance.

The implied association of good faith and fair handling imposes obligations not only with respect to claims from third parties but also with respect to claims made by the insured. When the insurer unreasonably and in bad faith refrains from paying its insured’s claim, it is subject to liability for damages. In order for the insurer to be able to fulfill its obligation not to impair the insured’s right to receive benefits under the agreement, it must again take at least as much into account its interests as its own.

Therefore, the insurance business, at least in 1766, is a business of the utmost good faith. Each party to an insurance contract must treat each other ethically. The general duty of good faith and fair business incorporated by reference in any insurance policy requires a complete understanding of ethics and ethical conduct.

In every insurance contract, there is an implied union of good faith and fair settlement that neither party will do anything that harms the other’s right to enjoy the benefits of the contract. That was the decision of the California Supreme Court in Gruenberg v. Aetna Insurance Co., 9 Kal.3d. 566, 108 Cal. Rptr. 480 (1973) which first stated that damages in bad faith will apply to first party insurance in the state of California. Gruenberg was adopted in a majority of US states, which made the breach of an insurance contract unethical and in bad faith an indemnity.

The union is mutual and the principles of good faith and fair handling impose on the insured a positive obligation to cooperate as much as it requires the insurer to treat the insured fairly with regard to every claim made.

About Barry Zalma

An author, consultant and expert witness for insurance coverage and claims management with more than 48 years of practical experience and experience in the courtroom.


Source link