Zalma on Insurance
Education • Business
Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
Interested? Want to learn more about the community?
March 26, 2025
Fortuity Required for Defense

Tortious Interference Requires Intent to Harm

Defamation is a Covered Personal Injury Tortious Interference with Business Is Not

Post 5031

Read the full article at https://lnkd.in/g2MGe_8W, see the full video at https://lnkd.in/g3dDf3_9 and at https://lnkd.in/gRBCMG7b and at https://zalma.com/blog plus more than 5000 posts.

Robert Hole, M.D., appealed from the March 3, 2023 order granting plaintiff State Farm Fire and Casualty Company’s motion for summary judgment denying Dr. Hole coverage under the policy issued by State Farm.

In State Farm Fire And Casualty Company v. Dr. Robert Hole, M.D., and Dr. Michael Russonella, D.O., and North Jersey Orthopaedic And Sports Medicine Institute, LLC, No. A-2522-22, Superior Court of New Jersey, Appellate Division (March 21, 2025) a lawsuit filed against Dr. Hole by Michael Russonella, D.O. that alleged Dr. Hole made false statements regarding Dr. Russonella’s alleged misconduct at St. Mary’s Hospital in Passaic.

Dr. Hole sought coverage from his insurer, State Farm, to defend the action. The central question in this matter is whether State Farm was required to defend the action and indemnify Dr. Hole once the tortious interference count was the only remaining claim.

Initially Dr. Russonella sued Dr. Hole only alleging defamation. State Farm defended Dr. Hole under a reservation of rights. Because of the potential for an excess verdict and the punitive damages alleged, the letter also advised Dr. Hole of his right to obtain personal counsel and that State Farm’s “defense of this action by the attorney on your behalf is not to be considered a waiver of such policy defense or of any policy defenses which may be involved in this suit.”

In September 2017, the trial court dismissed Dr. Russonella’s defamation complaint as untimely under the statute of limitations. Dr. Russonella subsequently filed an amended complaint alleging tortious interference with business.

State Farm sued seeking declaratory relief claiming it had no duty to defend or indemnify Dr. Hole regarding the claims asserted by Dr. Russonella. It asserted Dr. Russonella alleged Dr. Hole “intentionally “interfered with his business relationships. State Farm further asserted that in allegedly making “untrue” and “malicious[]” statements “targeted to injure Dr…. Russonella” that Dr. Hole knew were “untrue,” “the policy exclusion for personal and advertising injury arising out of oral or written publication of material . . . with knowledge of its falsity precludes coverage.”

When the facts present a single, unavoidable resolution and the evidence is so one-sided that one party must prevail as a matter of law, then a trial court should grant summary judgment. Dr. Hole argued a tortious interference claim “does not require an intention to cause the injury alleged.” Rather, he asserts “the intent required in tortious interference claims is an intent to interfere.”

ANALYSIS

The interpretation of an insurance policy, like any contract, is a question of law.

Coverage provisions are to be read broadly, exclusions are to be read narrowly, potential ambiguities must be resolved in favor of the insured, and the policy is to be read in a manner that fulfills the insured’s reasonable expectations. By contrast, if the plain language of the policy is unambiguous, the court will not engage in a strained construction to support the imposition of liability or write a better policy for the insured than the one purchased.

A complaint based on tortious interference must allege facts claiming that the interference was done intentionally and with “malice”. Malice is defined to mean that the harm was inflicted intentionally and without justification or excuse.

A tortious interference cause of action is an excluded claim because not only does the tort require intentional interference, it also further requires malice or an intent that the harm was inflicted intentionally. That is, the tortious interference claim intrinsically includes an intent to harm.

The Appellate Division concluded that trial court did not err in concluding Dr. Hole was not entitled to coverage under the State Farm policy.

Even though State Farm initially provided a defense for the defamation claim, it was not required to also defend Dr. Hole because the amended complaint for tortious interference alleged similar facts but supported intentional conduct.

ZALMA OPINION

Liability insurance provides defense and/or indemnity only for fortuitous conduct. Intentional acts are excluded by every liability insurance policy since providing such coverage would encourage wrongful or illegal conduct. The court concluded, properly, that although the defamation claim was a fortuitous loss the tortious interference claim required intentional conduct, was not fortuitous, and State Farm was entitled to a judgment it owed no defense or indemnity to Dr. Hole after it successfully protected him from the Defamation claim.

(c) 2025 Barry Zalma & ClaimSchool, Inc.

Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.

Subscribe to my substack at https://barryzalma.substack.com/subscribe

Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg

Go to X @bzalma; Go to the Insurance Claims Library – https://lnkd.in/gwEYk

00:07:57
Interested? Want to learn more about the community?
What else you may like…
Videos
Posts
20 hours ago
Zalma’s Insurance Fraud Letter – November 1, 2025

ZIFL – Volume 29, Issue 21

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL

Post 5220

Read the full article at https://lnkd.in/gRMJpi4s, see the video at https://lnkd.in/gwGSd6ZA & at https://lnkd.in/gbDiuFJy, and at https://zalma.com/blog plus more than 5200 posts.

See the video at & at https://rumble.com/v711hr0-zalmas-insurance-fraud-letter-november-1-2025.html

See the full 18 page issue of ZIFL at ZIFL-11-01-2025

Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/

Conviction for Health Insurance Fraud Upheld

Physician Conspired with Bonavilla to Effect Health Insurance Fraud

Dennis Davin Bonavilla was involved in an insurance fraud scheme as an executive of Free Choice Healthcare. The scheme targeted indigent patients, often on ...

00:10:22
October 31, 2025
The Zalma Philosophy of Claims Handling – Part 8

The Professional Claims Handler

Post 5218

Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-8-barry-zalma-esq-cfe-zdwsc, see the full video at https://rumble.com/v70zl4s-the-zalma-philosophy-of-claims-handling-part-8.html and at https://youtu.be/MIYcF71ffRQ, and at https://zalma.com/blog plus more than 5200 posts.

Claims Commandment X – Thou Shall Not Pretend to be a Lawyer

Some experienced and professional claims people know the law in their area of expertise better than most lawyers.

Adjusters should be adjusters and leave lawyering to lawyers. Similarly, lawyers should be lawyers and never try to be adjusters.

Claims Commandment XI – Thou Shall Empathize With the Claimant

Everyone presenting a claim is unhappy, disturbed, shocked, injured and needs help.

Empathy is identification with and understanding of another’s situation, feelings, and motives. It is the ability to understand another person’s circumstances, point of view, thoughts, and feelings....

00:11:08
October 28, 2025
The Zalma Philosophy of Claims Handling – Part 6

HOW TO CREATE AN EXCELLENCE IN CLAIMS HANDLING PROGRAM

See the full video at https://rumble.com/v70wb2i-the-zalma-philosophy-of-claims-handling-part-6.html and at https://youtu.be/tL5nDKPEs40 and at https://zalma.com/blog plus more than 5200 posts.

Post 5217

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry.

An Excellence in Claims Handling program begins with a statement in the insurer’s claims manual or statement of professionalism that it is dedicated to providing excellence in claims handling to every insured who presents a claim.

The excellence in claims handling program should include, at a minimum:

A series of lectures supported by text materials explaining:
A definition of insurance.
How to read and understand an insurance policy.
How to interview an insured, witness, or claimant.
How to assist an insured in the insured’s obligation to ...

00:08:40
October 31, 2025
The Zalma Philosophy of Claims Handling – Part 9

The Professional Claims Handler
Post 5219

Posted on October 31, 2025 by Barry Zalma

An Insurance claims professionals should be a person who:

Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.

How to Create Claims Professionals

To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...

post photo preview
October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

post photo preview
October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail

Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.

My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

post photo preview
See More
Available on mobile and TV devices
google store google store app store app store
google store google store app tv store app tv store amazon store amazon store roku store roku store
Powered by Locals