A Brutal, Senseless Physical Altercation is not an “Accident”

Battery, With Intent to Injure, is not an Insurable Event

Trinity Carr, with malicious intent, beat, kicked and slammed Amy Joyner-Francis to the ground causing her unexpected death. Carr sought indemnity from her homeowners insurer claiming her actions resulted in the accidental death of Amy because she suffered from a pre-existing heart condition.

In USAA Casualty Insurance Company v. Trinity Carr,  No. 273, 2019, Supreme Court Of The State Of Delaware (January 29, 2020) USAA Casualty Insurance Company (“USAA”) sought a declaratory judgment in the Superior Court that it was not obligated to defend, indemnify, or provide insurance coverage for claims made in two lawsuits against Trinity Carr, the daughter of a USAA homeowner’s-insurance policyholder. The plaintiffs in the underlying lawsuits sought money damages from Carr and others for personal injuries and wrongful death suffered by Amy Joyner-Francis the physical altercation—described in both complaints as a “brutal, senseless, forseeable [sic] and preventable attack”— between Joyner-Francis and Carr and her friends.

USAA argued that the incident—whether it be labeled an altercation, an attack, or otherwise—was not an “accident” and therefore not a covered occurrence under the policy and that, even if it were, the purported liability was excluded from coverage. The Superior Court disagreed and entered summary judgment in favor of Carr.

FACTS

Amy Joyner-Francis suffered sudden cardiac death after she was assaulted by Trinity Carr in their high school bathroom. Joyner-Francis’s autopsy revealed that she had a “large atrial septal defect and pulmonary hypertension,” which, in addition to the emotional and physical stress from the fight, caused her heart failure. The assault, which consisted mostly of “awkward punches . . . grappling[,] and kicking” on the floor, was a contributing cause of Joyner-Francis’s death even though her death was not a risk of which Carr should have been aware.

After Carr’s criminal prosecution, two civil lawsuits by Joyner-Francis’s estate and by her parents were filed. Carr demanded a defense and indemnification from USAA, which had a homeowner’s insurance policy (“Policy”) covering Carr’s mother and potentially Carr as a resident relative.

The Policy defines “Occurrence” as “an accident, including continuous or repeated exposure to substantially the same general harmful conditions, which results . . . in . . . bodily injury; or property damage.” The Policy also includes an exclusion of coverage for bodily injury “which is reasonably expected or intended by an insured even if the resulting bodily injury . . . is of a different kind, quality[,] or degree than initially expected or intended” (“Exclusion Clause”). [emphasis added]

ANALYSIS

The interpretation of an insurance policy is a question of law. The parties’ dispute concerns the meaning of the word “accident,” although they agree that the meaning incorporates some form of unforeseeability. The central questions are “what must be unforeseeable?” and “to whom?”

On appeal, USAA contended that whether an incident is an accident must be determined from the insured’s standpoint rather than the victim’s. According to USAA, because Carr intended for the fight, which unexpectedly caused Joyner-Francis’s death, to happen, the fight was not an accident.

The Coverage Clause provides that the bodily injury—in this case, Joyner-Francis’s death—must be caused by an accident, not that the nature or extent of the injury itself must be an accident. Even from Joyner-Francis’s viewpoint, the question is whether the events that caused her death were accidental, not whether the death itself was an accident.

The Supreme Court of Delaware determined that contrary to lower court rulings, whether an incident is an “accident” in the context of homeowners’ insurance policies must be determined from the viewpoint of the insured. It concluded that to hold otherwise would be to distort the ordinary meaning of the word “accident” and subvert the “well-established common law principle that an insured should not be allowed to profit, by way of indemnity, from the consequences of his own wrongdoing.”

Joyner-Francis’s death was caused by a combination of her medical conditions and the emotional and physical stress from the assault. The medical conditions were preexisting conditions. And the assault was not an “accident”—as noted evidence showed Carr “bragging that [she and her friends] intended to ‘get’ [Joyner-Francis],” and Carr was the aggressor in the fight.

The Supreme Court concluded that because, from Carr’s perspective, the fight that caused Joyner-Francis’s death was not an accident, the Policy does not provide coverage for her litigation expenses or legal liabilities.

Even if Joyner-Francis’s death was caused by an “accident,” coverage is excluded under the Exclusion Clause.

Separately, albeit unnecessarily, the Policy’s Exclusion Clause provides USAA relief even if the Coverage Clause does not. The Supreme Court noted that the intent of the Exclusion Clause is clear: USAA sought to exclude coverage where the insured intended to cause bodily injury, even if the resulting injury was more or less serious or of a different kind than intended.

The Exclusion Clause clearly excluded coverage. Carr intended some bodily injury; she initiated the assault on Joyner-Francis, beat and kicked her viciously.  That intention alone triggers the Exclusion Clause. That the resulting injury was not initially expected or intended is irrelevant.  It was just such a situation the Exclusion Clause is meant to exclude.

ZALMA OPINION

The Delaware Supreme Court set the interpretation of an insurance policy clearly and without ambiguity. To label an intentional assault an “accident” is to disregard the ordinary, everyday meaning of the term “accident.” Whether an assault is an “accident” is determined by the intent of the insured, and not by the viewpoint of the victim. Even though Carr may not have intended to cause Francis’s death, she certainly intended to cause injury to her.


© 2020 – Barry Zalma

This article, and all of the blog posts on this site, digest and summarize cases published by courts of the various states and the United States.  The court decisions have been modified from the actual language of the court decisions, were condensed for ease of reading, and convey the opinions of the author regarding each case.

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant  specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 50 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 51 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

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About Barry Zalma

An insurance coverage and claims handling author, consultant and expert witness with more than 48 years of practical and court room experience.
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