Will an insurer have to indemnify a company owner in wrongful death suit?
The insurer argues it has no duty to defend, as the policy's employer's liability and workers' compensation exclusions bar coverage.
An insurer may have to indemnify the owner of a plumbing company in a wrongful death lawsuit filed by the estate of a worker after a three-judge panel of 11th U.S. Circuit Court of Appeals reversed a district court’s decision that the company’s liability and workers’ compensation policy exclusions barred coverage of those claims.
Pedro Jose Sanchez worked for 3rd Generation, a plumbing contractor. While at work, Sanchez was injured when performing mechanical work on a tractor. He died from these injuries. Sanchez’s estate received workers’ compensation benefits. The personal representative of Sanchez’s estate sued James Massaro, the president, secretary, and sole director of 3rd Generation, for wrongful death based on a failure to follow the appropriate procedures. 3rd Generation was insured by Maxum Indemnity Company, which filed a federal declaratory action seeking a determination of whether, under the terms of 3rd Generation’s CGL policy, Maxim owed a duty to defend and indemnify Massaro in the wrongful death action. At summary judgment, the court ruled that no duty was owed.
On appeal, Maxum argued that it owed no duty to defend Massaro because the policy’s employer’s liability and workers’ compensation exclusions barred coverage. The court, looking to the allegations in the wrongful death complaint, disagreed. The complaint did not establish that the estate’s claims fell within either policy exclusion; therefore, Maxum had a duty to defend Massaro under the policy. The court reversed the judgment of the district court on the duty to defend. In addition, the court vacated the district court’s judgment that Maxum had no duty to indemnify Massaro under the policy — which was based on the district court’s conclusion that there was no duty to defend — and remand for the district court to look again at the duty to indemnify.
The case is Maxum Indem. Co. v. Massaro, No. 18-12988, 2020 U.S. App. LEXIS 19230 (11th Cir. June 19, 2020).
Editors Note: The insurer has the duty to prove that an exclusion applies, and bring forth facts and evidence of that exclusion application. The complaint in this case failed because it did not establish that the claims fell within either of the policy exclusions that were noted in the complaint.
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