Bodily Injury to an Insured

Our insured's daughter had her ears pierced, and an infection ensued. She had to have surgery and reconstruction of part of her ear. The infection was traced back to water-borne bacteria at the piercing service's premises, as well as to unsanitary equipment. The insured sued the piercing service.

But now the service has counter-claimed against our insured, alleging that the daughter was responsible for her own infection. The service says if they have to pay any damages they should be entitled to recover that amount from our insured.

We presented this claim to their homeowners carrier, and the carrier denied based on the exclusion for bodily injury to an insured.

Can this be correct? The daughter is not suing her father—our insured—a third party is suing. We think the carrier should at the very least be required to defend based on the insuring agreement's promise to defend any lawsuit, even if it is groundless, false, or fraudulent.

Please review this situation and give us your opinion.

Illinois Subscriber

In Illinois, the homeowners exclusion for bodily injury to an insured—which is really what the piecing service is basing its suit on—has been upheld except when a motor vehicle that would be covered by the policy is involved. In that case, such as when a golf cart or riding mower is involved, Illinois statutes barring application of the exclusion have been upheld.

In the case of West American insurance Co. v. Bedwell, 715 N.E.2d 759 (3 App. Ill. 1999), the court ruled that the insurer had to defend its insured when a boy, riding in his father's golf cart, was hit by a golf ball. The father sued the golfer, who in turn counterclaimed for contribution based on negligence of the father. The courts based this finding on an Illinois statute that essentially says public policy allows an insured to sue another for bodily injury when a motor vehicle is involved, but in other instances, such as in the homeowners exclusion for bodily injury to an insured, the exclusionary language is acceptable.

So, if no covered motor vehicle is involved, the homeowners insurer is generally under no obligation to defend against a claim for bodily injury to its insured.

By Illinois law, as the court in Cincinnati Insurance Co. v. Allen, 347 F.Supp.2d 586 (C.D. Ill. 2004) stated, “the insurer has an obligation to defend if any part of the underlying lawsuit could require it to indemnify the insured, even if the complaint alleges several causes of action and only one of those may be covered. But, if it is clear from the face of the underlying complaint that the allegations fail to bring the case within, or potentially within the policy's coverage, the insurer has no obligation to defend.”

Thus, if the complaint against the insured clearly focuses on the daughter's injury, there is no coverage unless some other cause of action is alleged.

 

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