By There are a variety of situations where disputes about insurance coverage may arise, including cases involving injuries that occurred because of a person’s actions. In these situations, insurance companies may deny claims for numerous reasons, claiming that exceptions to coverage apply or that injuries were not accidental. This can put people in a difficult situation as they seek compensation in personal injury cases or similar matters, and they may need to take legal action to fight against the denial of claims. Fortunately for people in these types of cases, the Wisconsin Supreme Court has ruled that cases involving reckless conduct may not necessarily be excluded from insurance coverage.
Dostal v. Strand
In a recent case, the Wisconsin Supreme Court considered the denial of an insurance claim made by a woman based on the wrongful death of her child. The woman had left the three-month-old child in the care of its father. While he was providing care, he dropped the child on the floor, resulting in a skull fracture. Rather than contacting emergency services, he put the child to bed. The child later died from the injuries suffered in the fall, and the father was convicted of second-degree reckless homicide.
The mother brought a wrongful death lawsuit against the father, seeking compensation for loss of society and companionship, as well as other damages. While the mother believed the incident should have been covered by the father’s homeowner’s insurance policy, his insurer, State Farm, claimed that the incident was not covered under the policy. State Farm claimed that because the father was convicted of reckless homicide, the incident was not considered an accident and was not covered under the policy. In addition, State Farm claimed that even if the incident was considered an accident, a “resident relative” exclusion applied because the victim was the man’s child, and an “intentional acts” exclusion applied because the criminal conviction showed that he engaged in behavior that created a substantial risk of injury.
In reviewing the case, the Wisconsin Supreme Court ruled that a conviction for criminal recklessness does not necessarily mean that the incident was not accidental. The court’s decision stated that even if a person is engaging in behavior that involves a calculated risk, they may do so without expecting that someone else will be injured. In this case, the father who failed to take the proper care when holding and carrying the child may have behaved irresponsibly, but this does not mean that he acted intentionally or that he knew the child would be injured.
In addition, the court noted that while a jury found that the father was guilty of reckless homicide, it did not determine exactly what events occurred during the incident in question. The finding of recklessness may have been based on the father’s failure to contact emergency services after an accident occurred in which the child suffered a head injury, or other factors may have played a role in the jury’s decision. Because the criminal conviction did not demonstrate that the death was not accidental, this matter should be left up to the court to decide in the civil case related to insurance coverage.
The court also rejected State Farm’s claims that exclusions applied to the coverage. According to the facts of the case, the father rarely spent time with the child, and the couple did not have a formal physical placement schedule. Because of this, the child should not have been considered a “resident relative” who was excluded from homeowner’s insurance coverage. The court also found that the “intentional acts” exclusion did not apply, because even though the father was convicted of reckless homicide, this did not necessarily mean that he acted with intent to harm the child. If the incident in question was determined to be an accident, this would mean that he did not act intentionally.
Based on these findings, the Wisconsin Supreme Court reversed the lower court’s ruling and ordered the circuit court to hold a new trial. In this trial, the court will determine whether the incident could be considered an accident and whether the child’s wrongful death is covered under the insurance policy.
Contact Our Milwaukee, WI Insurance Dispute Lawyers
Disputes about insurance coverage in personal injury and wrongful death cases can be complicated. To overcome attempts by insurance companies to deny claims and avoid paying compensation to victims, it is crucial to work with an attorney who has experience in these types of cases. At [[title]], our Milwaukee insurance coverage litigation attorneys can provide effective representation for people who need to address the improper denial of claims or the refusal to pay compensation. To learn how we can assist with these matters, contact us at [[phone]] and schedule a consultation today.
Source:
https://www.wicourts.gov/sc/opinion/DisplayDocument.pdf?content=pdf&seqNo=615568
