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?
August 19, 2025
Shooting Someone to Death is not an Accident

Is Injury in the Course of Self-Defense an Occurrence?
Post 5171

Read the full article at https://lnkd.in/gAJnVny9, see the full video at https://lnkd.in/gUTs-w6E and at https://lnkd.in/gQPspzmB, and at https://zalma.com/blog plus more than 5150 posts.

When There is no Accident the Intentional Acts Exclusion is Irrelevant

The case involves a tragic incident where Kimberly Mollicone was killed during a gunfight between her husband, Matthew Mollicone, and Daniele Giannone. The central issue is whether Giannone’s actions, taken in self-defense, are covered under his State Farm homeowner’s insurance policy.

In State Farm Fire And Casualty Company v. Daniele Giuseppe Giannone; Heidi C. Aull, personal representative for the estate of Kimberly Ann Mollicone, Nos. 24-1264, 24-1265, United States Court of Appeals, Sixth Circuit (August 5, 2025) resolved the dispute.

THE INSURANCE COVERAGE

Although rare in insurance contracts the policy in question provides coverage for the insured’s liability to third parties who are injured in an accident, State Farm’s policy includes a self-defense exception to the intentional-acts exclusion. Sixth Circuit discussed various legal precedents and interpretations of the policy language, focusing on whether actions taken in self-defense can be considered “occurrences” under the policy.

Appellate courts have generally held that intentional actions taken in self-defense are not accidental and therefore do not constitute occurrences under the policy.

The decision explored the interplay between the personal liability coverage provision, the intended-acts exclusion, and the self-defense exception. It highlights the importance of interpreting the insurance contract as a whole to honor the intent of the parties involved.

Ultimately, the court affirmed the district court’s decision that Giannone’s actions did not qualify as an “accident,” and therefore, State Farm had no duty to indemnify or defend him in the state-court litigation.

ANALYSIS

The key issue before the Sixth Circuit whether Ms. Mollicone’s shooting constituted an “occurrence.” The policy defined an occurrence as “an accident” that results in “bodily injury” or “property damage.” Ms. Mollicone’s estate and Giannone argued that while Giannone intended to fire the gun, he did not intend to injure or aim at Ms. Mollicone, and her injuries are therefore a covered accident.

Michigan law defines an accident, for purposes of interpreting insurance contracts, as an undesigned contingency, a casualty, a happening by chance, something out of the usual course of things, unusual, fortuitous, not anticipated, and not naturally to be expected. Generally, an accident may include an unforeseen consequence of an intentional act.

But unforeseen consequences are not accidental when the intended act created a direct risk of harm from which the consequences should reasonably have been expected by the insured.

Unless the policy language specifies otherwise, Michigan uses a subjective standard, meaning the appellate court must look to whether the insured should have reasonably expected the consequences of his act. To prevail, then, Ms. Mollicone’s estate and Giannone must show that Ms. Mollicone’s death was not a foreseeable result of aiming and shooting a gun at the vehicle she occupied.

The Sixth Circuit concluded that they cannot make the needed showing.

Giannone aimed his loaded gun at Mr. Mollicone and fired, expecting a bullet to leave the chamber. The act took place as intended, even if Giannone desired a different result.

Giannone subjectively intended to cause harm, just not the harm that ultimately came about. Accordingly, Giannone’s conduct was not accidental and not a covered occurrence.

Ms. Mollicone’s estate and Giannone next argued that the analysis changes if Giannone was plausibly acting in self-defense. Along these lines, Giannone claims that he saw a gun poke out of the passenger window and, out of concern for his and his family’s safety, fired back. At the stage of the appeal the factual record is not developed enough to determine whether Giannone acted in self-defense. But the Sixth Circuit did not need to reach the question of self-defense, because such a determination would not affect State Farm’s liability.

The Sixth Circuit noted that the Michigan Supreme Court has held that actions taken in self-defense are “intentional.” [Auto-Owners Ins. Co. v. Harrington, 565 N.W.2d 839, 842-43 (Mich. 1997).] In Harrington, an insured man intentionally shoo an intruder who he had reason to believe was armed and intended harm. The court held that the insured’s actions were not covered under his insurance policy, because actions taken in self-defense were different from “those that are purely accidental” and excluded as intentional acts. Harrington‘s reasoning implies that, under Michigan law, intentional actions taken in self-defense are not accidental. They likely thus do not constitute an “occurrence.”

Ms. Mollicone’s estate and Giannone are wrong to suggest it matters if Giannone was acting in self-defense. Even if Giannone were validly acting in self-defense such that the events fall into the exception to his intentional-acts exclusion, his actions were not accidental. So, the occurrence provision still precludes coverage.

In sum, Ms. Mollicone’s death was a direct result of Giannone’s foreseeable actions. Therefore, Ms. Mollicone’s estate and Giannone cannot show that Giannone’s actions fall under the policy’s definition of an “occurrence”without which coverage cannot exist making the intentional act exclusion surplusage.

Because Kimberly Mollicone’s death was the direct and foreseeable result of Giannone’s actions, there is no coverage under the policy.

ZALMA OPINION

Occurrence, as defined, is the key to every liability insurance contract. If there is no occurrence, no accident, there can never be coverage and there is no need to consider exclusions.

(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 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 the Insurance Claims Library – https://lnkd.in/gwEYk.

Interested? Want to learn more about the community?
What else you may like…
Videos
Posts
December 30, 2025
Montana Lawyer Commits Insurance Fraud and Receives Minimal Punishment

Montana County Attorney Admits to Insurance Fraud & Is Only Suspended from Practice for 60 Days
Post 5251

Read the full article at https://lnkd.in/gnBaCjmv, see the video at https://lnkd.in/gfpVsyAd and at https://lnkd.in/gC73Nd8z, and at https://zalma.com/blog plus more than 5250 posts.

A Lawyer Who Commits Insurance Fraud and Pleas to a Lower Charge Only Suspended

In The Matter Of: Naomi R. Leisz, Attorney at Law, No. PR 25-0150, Supreme Court of Montana (December 23, 2025) the Montana Office of Disciplinary Counsel (ODC) filed a formal disciplinary complaint with the Commission on Practice (Commission) against Montana attorney Naomi R. Leisz.

On September 25, 2025, Leisz tendered a conditional admission and affidavit of consent. Leisz acknowledged the material facts of the complaint were true and she had violated the Montana Rules of Professional Conduct as alleged by ODC.

ADMISSIONS

Leisz admitted that in April 2022, her minor son was involved in a car accident in which he hit a power pole. Leisz’s son ...

00:08:27
December 30, 2025
Montana Lawyer Commits Insurance Fraud and Receives Minimal Punishment

Montana County Attorney Admits to Insurance Fraud & Is Only Suspended from Practice for 60 Days
Post 5251

Read the full article at https://lnkd.in/gnBaCjmv, see the video at https://lnkd.in/gfpVsyAd and at https://lnkd.in/gC73Nd8z, and at https://zalma.com/blog plus more than 5250 posts.

A Lawyer Who Commits Insurance Fraud and Pleas to a Lower Charge Only Suspended

In The Matter Of: Naomi R. Leisz, Attorney at Law, No. PR 25-0150, Supreme Court of Montana (December 23, 2025) the Montana Office of Disciplinary Counsel (ODC) filed a formal disciplinary complaint with the Commission on Practice (Commission) against Montana attorney Naomi R. Leisz.

On September 25, 2025, Leisz tendered a conditional admission and affidavit of consent. Leisz acknowledged the material facts of the complaint were true and she had violated the Montana Rules of Professional Conduct as alleged by ODC.

ADMISSIONS

Leisz admitted that in April 2022, her minor son was involved in a car accident in which he hit a power pole. Leisz’s son ...

00:08:27
December 26, 2025
Liability Insurance only Responds to Fortuitous Acts

Insurer’s Exclusion for Claims of Assault & Battery is Effective
Post 5250

Read the full article at https://lnkd.in/gBzt2vw9, see the video at https://lnkd.in/gEBBE-e6 and at https://lnkd.in/gk7EcVn9, and at https://zalma.com/blog plus more than 5250 posts.

Bar Fight With Security is an Excluded Assault & Battery

In The Cincinnati Specialty Underwriters Insurance Company v. Mainline Private Security, LLC, et al., Civil Action No. 24-3871, United States District Court, E.D. Pennsylvania (December 16, 2025) two violent attacks occurred in Philadelphia involving young men, Eric Pope (who died) and Rishabh Abhyankar (who suffered catastrophic injuries). Both incidents involved security guards provided by Mainline Private Security, LLC (“Mainline”) at local bars. The estates of the victims sued the attackers, the bars, and Mainline for negligence and assault/battery. The insurer exhausted a special limit and then denied defense or indemnity to Mainline Private Security.

INSURANCE COVERAGE

Mainline had purchased a commercial ...

00:08:42
December 31, 2025
“Sudden” is the Opposite of “Gradual”

Court Must Follow Judicial Precedent
Post 5252

Read the full article at https://www.linkedin.com/pulse/sudden-opposite-gradual-barry-zalma-esq-cfe-h7qmc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.

Insurance Policy Interpretation Requires Application of the Judicial Construction Doctrine

In Montrose Chemical Corporation Of California v. The Superior Court Of Los Angeles County, Canadian Universal Insurance Company, Inc., et al., B335073, Court of Appeal, 337 Cal.Rptr.3d 222 (9/30/2025) the Court of Appeal refused to allow extrinsic evidence to interpret the word “sudden” in qualified pollution exclusions (QPEs) as including gradual but unexpected pollution. The court held that, under controlling California appellate precedent, the term “sudden” in these standard-form exclusions unambiguously includes a temporal element (abruptness) and cannot reasonably be construed to mean ...

post photo preview
placeholder
December 29, 2025
Doctor Accused of Insurance Fraud Sues Insurer Who Accused Him

Lack of Jurisdiction Defeats Suit for Defamation

Post 5250

Posted on December 29, 2025 by Barry Zalma

See the video at and at

He Who Represents Himself in a Lawsuit has a Fool for a Client

In Pankaj Merchia v. United Healthcare Services, Inc., Civil Action No. 24-2700 (RC), United States District Court, District of Columbia (December 22, 2025)

FACTUAL BACKGROUND
Parties & Claims:

The plaintiff, Pankaj Merchia, is a physician, scientist, engineer, and entrepreneur, proceeding pro se. Merchia sued United Healthcare Services, Inc., a Minnesota-based medical insurance company, for defamation and related claims. The core allegation is that United Healthcare falsely accused Merchia of healthcare fraud, which led to his indictment and arrest in Massachusetts, causing reputational and business harm in the District of Columbia and nationwide.

Underlying Events:

The alleged defamation occurred when United ...

post photo preview
placeholder
December 15, 2025
Zalma’s Insurance Fraud Letter – December 15, 2025

Zalma’s Insurance Fraud Letter

Read the full article at https://lnkd.in/dG829BF6; see the video at https://lnkd.in/dyCggZMZ and at https://lnkd.in/d6a9QdDd.

ZIFL Volume 29, Issue 24

Subscribe to the e-mail Version of ZIFL, it’s Free! https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D

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/

Zalma’s Insurance Fraud Letter

Merry Christmas & Happy Hannukah

Read the following Articles from the December 15, 2025 issue:

Read the full 19 page issue of ZIFL at ...

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