What is an accident?
Whether or not a liability insurance policy will cover a claim often comes down to whether or not it is considered an accident. All general liability policies exclude coverage for injuries that are intentional. The public policy rationale is that as a society, we don’t want people to be able to intentionally cause injuries, knowing that they’ll never have to be personally financially responsible for these actions. Liability insurance is supposed to only cover “accidents.”
Whether something is an accident has been litigated throughout the country ad nauseum. This was summed up best by Justice Musmanno of the Pennsylvania Supreme Court in the famous case of Brenneman, Appellant, v. St. Paul Fire and Marine Insurance Company on July 2, 1963. He wrote “What is an accident? Everyone knows what an accident is until the word comes up in court. Then it becomes a mysterious phenomenon, and, in order to resolve the enigma, witnesses are summoned, experts testify, lawyers argue, treatises are consulted and even when a conclave of twelve world-knowledgeable individuals agree as to whether a certain set of facts made out an accident, the question may not yet be settled and it must be reheard in an appellate court.”
In order to get an insurance company to pay for something that may not resemble an accident, an attorney must know not only the laws regarding personal injury, but also insurance coverage. I was recently able to call upon my experience as a former Senior Analyst in AIG’s General Liability Insurance Coverage Department in order to settle a case with thorny coverage and liability issues.
My client got into a verbal altercation with another woman in a public place. This quickly escalated into a shoving match and concluded with the other woman striking my client in the face. This left a small scar, about the size of a pinky nail.
The Insurance Policy
Fortunately for all parties, the assailant had homeowners insurance. You may be thinking, “What does that matter? The home wasn’t damaged. And this didn’t even happen at the home.”
Homeowners insurance policies generally contain a provision for personal liability. This grew out of the need for banks to protect their investments. If a bank lends someone money to buy a house, and that person is sued for causing an injury, the bank could lose the house.
Homeowners policies cover losses that occur on or away from the premises, so long as the loss occurs in the designated coverage territory. For most policies, this means the United States and its territories, but some policies even cover international claims.
So, if your neighbor slips and falls on your icy driveway, or your dog bites someone while you are vacationing in Alaska, your homeowner’s policy would be triggered.
Litigate or Settle out of court?
Back to my case –The insurance company claims adjuster argued that the claim shouldn’t be covered under the policy because it was an intentional act, excluded by the policy. In my legal papers, I argued that this entire episode was an act of negligence, or an accident, and thus should be covered by the policy. The adjuster also felt that my client was the aggressor, and the scar was nearly invisible. I argued that if we litigated the case, the three main issues could be decided either way by the judge and jury.
- Was this an intentional act, and thus not covered by insurance? Or was it simply negligent, and thus covered?
- Was my client the aggressor and not entitled to money? Or was she the innocent victim of an accident gone awry?
- Was my client’s scar “barely noticeable?” Or would it in fact make her the object of pity and scorn, and have a significant impact on this single young woman’s ability to find a mate?
Instead of paying an attorney to litigate these issues for years, the insurance company offered to settle the case for $45,000.
While not one of the larger settlements of my career, it is one of my most proud as I was able to use my knowledge of insurance coverage law to get money on a case that had been turned down by other attorneys. My client will now be able to get a plastic surgery procedure to remove the scar so that she does not feel self conscious in public.
The Law Team
If you or a loved one has been assaulted and sustained an injury, I may be able to help you get compensation. Even if you were arrested and charged with a crime for your participation in the altercation, you may still have a case. I work with a team of excellent criminal defense attorneys, and together, we can fight for all of your rights. Call the Law Team today at 212-LAW-TEAM.