Zalma on Insurance

Barry Zalma, CFE, is an insurance coverage attorney. He is the founder of Barry Zalma, Inc., a California law firm whose practice emphasizes the representation of insurers and those in the business of insurance.

Mr. Zalma is the author of Insurance Claims: A Comprehensive Guide, published by Specialty Technical Publishers, Vancouver, BC at http://www.stpub.com The Truth, The Whole Truth & Nothing But The Truth, Property Claims 2nd Edition and Liability Claims and all course books used by ClaimSchool, Inc. in its training programs. He is also the author of three books published by Thomas Investigative Publishing, and numerous articles for insurance trade publications and law journals.

Mr. Zalma writes the monthly Zalma's Insurance Fraud Letter which is available, FREE, from ClaimSchool, Inc. and over the internet at http://www.zalma.com

Specialty Technical Publishers has published "Mold: A Comprehensive Claims Guide" by Culver City lawyer Barry Zalma. The book is the only comprehensive guide to cover all issues relating to claims of damage by mold or fungal infestations. It is an essential tool for every person who owns real property, manages real property, for all risk managers, realtors, property inspection companies, insurance agents and brokers, insurance claims people, and lawyers who represent property owners or insurers. It is available at http://www.stpub.com or by calling 1800-251-0381

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MISCARRIAGE MANIPULATION FOR MONEY

The story that follows is based on fact but is fiction. The names, places and descriptions have been changed to protect the guilty. This story was written for the purpose of providing insurers, those in the insurance business and the insurance buying public sufficient information to recognize and join in the fight against insurance fraud.
Rita was five months' pregnant. Her entire family greeted her condition as an opportunity to make sufficient money for a happy Christmas in sunny Hawaii.
For four generations Rita's family has lived luxuriously on insurance claims. Their last names changed more often than their underwear.
Wherever they go, they carry a small plastic valve of soapy liquid and a small razor.
Depending on the size of the town they are visiting, they stay a week, a month or a year. One member of the family will claim to have slipped and fallen in a restaurant or grocery store. With the razor they will induce bleeding at their hairline or on an arm or leg. They will be pleasant
victims with no interest in profit. Grocers, and their insurers, rapidly and fairly settle their claims in fear that their injuries will increase.
Rita had been a professional claimant since she was eight. She fell in the most luxurious restaurants in Las Vegas, New York City, Baltimore, Washington, D.C., St. Louis, Missouri, and Beverly Hills, California.
Shortly after she began to walk, her family taught her how to slip and look like she was hurt without actually causing any physical damage. By the time she was five she could limp on either leg, hold one arm limp, wince with pain when touched and give all the symptoms of a severely injured person. By the time she was ten she had a clear knowledge of anatomy and knew all of the symptoms of soft tissue injury. Now, at 22, Rita is pregnant with the child of a sailor she met in San Diego whose name she does not know.
Rita is ready to move into major, profit making scams. Her brother Aaron would pose as her husband as they worked the major hotels and restaurants of Sacramento, California. At the Holiday Inn she fell in a puddle of water in the lobby restroom where two innocent women ran to her assistance.
"Oh, my God!" Rita moaned. "Did I hurt the baby."
"Don't worry," one of the ladies said, trying to soothe her. "My friend is going to the manager to have him call am ambulance so you can be checked out."
"But I'm not hurt."
"You can't take a chance with a baby coming. Let the doctors check you out." The innocent lady said, with honest concern and compassion.
"But I have no money. We are newly wed. We just stopped here for lunch.
I can't pay a doctor."
""Don't worry, dear, I saw what they left here in the bathroom. The hotel will take care of everything. You just lay here until the ambulance arrives." Rita did as she was told, smiling inwardly but showing sincere concern for her unborn child.
"This is my first baby," Rita told the paramedic when he arrived. "I'm so afraid. My big sister had three miscarriages before she gave birth to her first child. Can that happen to me?"
"I'm sure it won't," the paramedic said confidently. "Just relax. We are going to take you to the hospital so the doctor can check you and the baby out."
"But I don't have any money or insurance to pay the hospital."
"It's O.K., the Holiday Inn has already agreed to take care of your bill."
Rita rode to the hospital with her "husband" sitting in the ambulance beside her, wringing his hands. They left their name, a mail drop address and a telephone number which connected to the family cellular telephone, with the hotel. She and the baby were found healthy and allowed to leave, although the doctor, because of the family history of
miscarriage, noted on the hospital record that here condition was "guarded" and that she should cautiously watch for any spotting or other indication of a potential miscarriage. In the next four days Rita fell in five hotels, two department stores and three restaurants in greater Sacramento. She rode to the hospital in an ambulance twice and visited a local chiropractor known to her family four times.
The family lived, and traveled, in three sixty foot motor homes equipped with cellular telephones, a computer and all the comforts of a luxurious home. The family knew better than to be greedy. They never presented more than 10 claims each in any one city.
Rita stopped falling and spent the next three weeks mailing copies of the medical bills and the doctors' prognoses to various insurance adjusters representing each of the establishments in which she had fallen. The medical bills ranged in amounts from $1,400 to $2,300, all for an initial examination, x-rays, an occasional MRI, fetal monitoring
and ultra-sound examinations of the baby.
When the adjusters called either she or Aaron would negotiate with the adjusters, advising that they were just passing through Sacramento on their way to Seattle where they intended to settle. Aaron had a job in Sacramento that would keep him busy until after Christmas and then they
were to move on. They wanted to settle the claims, they told the adjusters, as soon as reasonably possible so that they could leave Sacramento without the claim outstanding.
Rita and Aaron were reasonable people. They told the adjusters they did not wish to hire a lawyer. Although they were afraid they might lose the baby, the doctors had assured them that the baby was unhurt by the fall.
The adjusters, sensing an ability to settle the claim quickly before the baby was born, with possible extra damage, worked quickly to gain the confidence of Rita and Aaron. They wanted a release that would protect their clients. They had no knowledge of Rita's family history. Liability was clear. Independent witnesses observed a slick, soapy substance on the floor and on Rita after she fell.
Rita and Aaron were professional claims presenters. They played upon the innocence and good faith of the insurance adjusters. They would tell the adjusters:
"We don't want money. We just can't afford to pay the doctors' bills. Please pay those for us and we'll be happy."
Of course, most of the doctors were in league with the family and had already agreed to return to the family fifty percent of every dollar received from the insurance company. Most of the billings were fake. The family created medical billing forms on the Gateway 2000 Pentium 133
they kept in the motor home. Eighty percent of the services billed by real doctors had never been performed since the doctors knew Rita was uninjured.
The adjusters, knowing the law and knowing that if litigation was filed Rita would be entitled to money for her pain and suffering, insisted that Rita take more money than the medical bills. Most of the claims were settled for between $6,000 and $25,000, depending on the generosity or gullibility of the individual adjusters. Rita's potential miscarriage brought her family over $100,000 for their stay in Sacramento. Her brothers, sisters, cousins and nephews falling all over the city generated another $100,000 in claims payments.
Their welcome in Sacramento worn thin, the family motor homes traveled east to San Francisco. The motor homes were parked in a long term secure parking lot and the entire family boarded airplanes for a three week holiday in Maui.

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