Zalma's Insurance Fraud Letter - May 15, 2021

ZIFL - May 15, 2021

The May 15, 2021 issue of Zalma's Insurance Fraud Letter Includes articles on the following subjects:

EUO Is A Condition Precedent

People who commit insurance fraud tend to run from serious insurers who deny claims for fraud, misrepresentation, concealment or failure to fulfill conditions precedent. State Farm filed an unopposed motion for summary judgment against defendants All Med Merchandise and Trading, Inc., Haar Orthopedics & Sports Medicine, P.C., Park Avenue Orthopedics, P.C., and Anthony Vigorito, D.C., probably because the defendants knew they had no case and placed their efforts to collect from fraud by going against insurers who would rather pay than fight.

Insurance Fraud Statutes

Insurance fraud laws have been enacted in 47 of the 50 states, the District of Columbia and the United Kingdom. The statutes were not written to give an unfair advantage to insurers, as some members of the plaintiffs’ bar claim, but to protect the insurance buying public against the enormous disadvantage insurers meet when faced with a potentially fraudulent claim.

Unlike other victims of crimes, insurers are required by most of the statutes, to staff Special Investigative Units (SIU) to investigate and work to defeat insurance fraud attempts.

Ethics and the Public Insurance Adjuster

Some public insurers, acting alone or with the assistance of unscrupulous lawyers, violated the standards set by NAPIA and the covenant of good faith and fair dealing.

Health Insurance Fraud Convictions

Sentenced to Prison for Defrauding Medicaid Program Out of Hundreds of Thousands of Dollars - Folashade Adufe Horne, 52, of Laurel, Maryland, was sentenced May 12, 2021 to 13 months in prison for defrauding the D.C. Medicaid program out of more than $370,000. Plus many more convictions.

Other Insurance Fraud Convictions

Former Madera Insurance Agent Convicted for Felony Grand Theft Because she Embezzled over $20,000 of consumers’ insurance payments

Wendy Judd, 47, of Madera, a former insurance agent pleaded guilty to felony grand theft after embezzling over $20,000 of insurance premium payments from consumers. Plus many more convictions.

© 2021 – Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 53 years Barry Zalma has dedicated 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 make it possible for insurers and their claims staff to become insurance claims professionals.

Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma;  Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at 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/ Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts; and the last two issues of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/  podcast now available at https://podcasts.apple.com/us/podcast/zalma-on-insurance/id1509583809?uo=4