Watch the full video at https://rumble.com/v22yi88-zalmas-insurance-fraud-letter-january-1-2023.html and at https://youtu.be/MTvEb1uU8pE
The source for the insurance company
Starting with the 27th year of publication of Zalma’s Insurance Fraud Letter, ClaimSchool, Inc., Barry Zalma and the Zalma family wish you a Happy and Prosperous New Year.
Read the full pdf version of ZIFL at ZIFL-01-01-2023
Volume 27 Issue 1 contains articles including:
New Florida Statutes
The state of Florida has proposed a new statute to make insurance and insurance claims fairer. There are over 105 pages at https://www.flsenate.gov/Session/Bill/2022A/2A/BillText/er/PDF.
Florida lawmakers passed legislation to eliminate controversial awards of benefits on property claims, eliminate the one-way recovery of attorneys’ fees provision unique to Florida law, and require binding assessments included in a policy to be set forth in a separate endorsement and include a premium reduction. Also, bad faith claims for failure to settle a property claim may not be filed until after a court has determined that the insurer breached the contract and a final judgment has been entered against the insurer. Other provisions include shortening the time period for filing property claims from two years to one, and requiring insurers to reduce the period for paying or denying a claim from 90 days to 60. Anyone insured with the state’s Citizens Insurance must also have flood insurance. The provisions become law when they are signed by the governor, which is expected as early as today. For those who want more information about the new law, Coalition Against Insurance Fraud Law firm member Greenberg Traurig has provided a detailed summary.
Read the full pdf version of ZIFL at ZIFL-01-01-2023
California Department of Insurance Report on New Fraud Law
A press release from the California Department of Insurance edited to report only new laws related to insurance fraud:
Beginning January 1, 2023, Californians will benefit from newly created consumer protections when eleven new state laws sponsored by Insurance Commissioner Ricardo Lara this past legislative session go into effect. The new laws address climate change, expand health access and reproductive care, preserve health protections, protect against fraud, and ensure public safety.
“Protecting consumers is my number one priority,” said Commissioner Lara. “Partnering with the Legislature and Governor Newsom is critical to my department’s mission to create fairness for all in our oversight of the nation’s largest insurance marketplace. I look forward to putting these eleven new laws into effect while taking additional steps that benefit California consumers.”
Read the full pdf version of ZIFL at ZIFL-01-01-2023
How to increase the professionalism of professional insurance claims
Scot Strems disbarred & Public Adjuster facing loss of license
Florida Lawyer who used Cappers & Runners to build a practice failed to serve clients
On December 22, 2022, the Florida Supreme Court ousted attorney Scott Strems, whom it found guilty of professional misconduct. You can read the entire statement here. The court’s reasoning included:
Strems was the sole partner and owner of Strems Law Firm, PA (SLF), and the firm’s caseload increased significantly since its inception. In 2016, the firm had only three trial lawyers, each handling approximately 700 cases. SLF’s understaffing and lack of adequate office procedures resulted in client neglect, case dismissals, frustrated judges and costly sanctions on an almost weekly basis.
Read the full pdf version of ZIFL at ZIFL-01-01-2023
Health insurance fraud convictions
Woman sentenced to death by 86-year-old
Letticia Martinez, 28, pleaded guilty to negligence in the death of a resident at the Cappella Assisted Living and Memory Care facility in Grand Junction. She was sentenced to three years of probation, 100 hours of community service and 30 days in jail.
An investigation by the Medicaid Fraud Control Unit of the Colorado Department of Law and the Grand Junction Police Department found that Martinez, Jamie Johnston31 and Jenny Logan52, were responsible for the death of Hazel Place on June 14, 2021, after she was left alone in the heat for six hours.
Martinez pleaded guilty to one count of neglect of a caretaker, a Class 1 misdemeanor, and to a deferred adjudication charge of reckless homicide, a Class 5 felony. Johnston and Logan’s cases are pending.
This is followed by dozens more reports of convictions for health insurance fraud.
Read the full pdf version of ZIFL at ZIFL-01-01-2023
The genuine dispute and rather debatable doctrines
Defense to bad faith damages
Insurers in bad faith states (almost all states) deny fraudulent insurance claims with fear and trembling. The specter of punitive damages has worked to make multi-millionaires out of many insurance tortfeasors who convince insurance companies to settle rather than take the chance in a lawsuit against a lawsuit alleging that the insurer acted in bad faith. Any person dealing with a potentially fraudulent claim must understand this important defense against bad faith.
Read the full pdf version of ZIFL at ZIFL-01-01-2023
Other insurance fraud
Buffalo bus driver gets 5 years probation for compensation claim fraud
Antoinette Laney in Kenmore, New York, a former Niagara Frontier Transportation Authority (NFTA) bus driver was sentenced to five years of probation for fraudulently obtaining workers’ compensation benefits by misrepresenting her injuries. She must also pay full restitution to the NFTA for money she received through workers’ compensation.
Laney claimed she was unable to perform her work as a bus driver at NFTA and fraudulently obtained $30,212.69 in wages between September 2018 and February 2020 through workers’ compensation benefits. The defendant initially claimed that she was unable to work due to a right knee injury, but later changed the claim to a lower back and left knee injury.
The district attorney’s office said its investigation also revealed that Laney performed work through Instacart and Ebay while continuing to collect wages for workers.
Laney pleaded guilty to one count of grand larceny on September 26, 2022. She was sentenced this week before Judge Kenneth Case in Erie County Court.
Followed by many more other than health insurance fraud convictions.
Read the full pdf version of ZIFL at ZIFL-01-01-2023
It’s time to subscribe to Locals or Substack
For subscribers only, I have published special insurance videos
I have published on Locals.com more than 25 videos and two webinars for subscribers and more than 400 free videos. I aAlso posted on Substack.com are hundreds of free videos and webinars of the Excellence in Claims Handling Program available only to subscribers. Subscribers have access to all videos and a webinar on, among other things, “The Investigation Under Oath A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud.”
The videos begin with the history of insurance and work their way through different types of insurance and how to obtain and manage insurance claims.
Subscribe and receive videos limited to Excellence in Claims Handling subscribers at locals.com https://zalmaoninsurance.locals.com/subscribe.
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Read the full pdf version of ZIFL at ZIFL-01-01-2023
(c) 2023 Barry Zalma & ClaimSchool, Inc.
Barry Zalma, Esq., CFE, now limits his practice to serving as an insurance consultant specializing in insurance coverage, insurance claims management, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims attorney and more than 54 years in the insurance industry. He can be reached at http://www.zalma.com and zalma@zalma.com
Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published on https://zalma.substack.com. Go to the Zalma On Insurance podcast at https://anchor.fm/barry-zalma; Follow Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library; and @Zalma on Truth Social.
