Insurance Policy Intentional-Act Clause Could Cost You

A man sitting at a table presses his fingertips to his temples like he's a mind reader. — (Image credit: Getty Images)

“This past March, you wrote an article that insurance claims adjusters, like myself, have forwarded on to our colleagues all over the country: How to Deal with Property Insurance Claims After Storms. You and Los Angeles insurance broker Karl Susman made it clear that with proper documentation, claims adjusters ‘want to settle your claim, not reject it.’ The saying ‘one good turn deserves another’ came to mind, and I thought, ‘When the right moment arises, I am going to contact Dennis, and this is the moment,’” wrote “Paul.”

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At first, it seemed like a typical stop-sign-running accident, where “Mary,” Paul’s insured, was clearly at fault. “Charles” was the other driver, in a van making deliveries for his employer, a Midwest retailer of office supplies. While both vehicles were totaled and the van’s contents damaged, the drivers sustained only minor injuries.

“You would think this would be a simple case,” Paul wrote, “except that, as the facts developed, I became convinced this accident could be the basis for one of your articles — and something that your readers needed to be aware of. It also presented an ethical challenge for me.”

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I picked up the phone to find out why.

“There was something about Mary’s appearance,” Paul told me, “that Charles said alarmed him before and after the accident that removed this from the typical stop-sign-violation case adjusters routinely handle. He was convinced that she wanted to cause the accident by intentionally failing to stop. For that reason, he and his employer feel that they are entitled to a larger-than-normal settlement, because of Mary’s intentional conduct.”

And just what was the basis of his belief that Mary intended to cause the accident?

“I asked Charles the same question,” Paul replied, “and he said, ‘A second before the accident, I had a glimpse of an angry face, and then, while we were exchanging drivers’ information, I was looking at a woman whose facial expression (made her look furious).’ Luckily, the van had a dashcam that recorded them exchanging information. It was understandable why he would (think the woman looked so angry).”

Never say an auto accident was intentional!

You might be thinking, “What if Mary was over-the-top furious about something and intended to take it out on anybody — and chose that moment to run the stop sign?” Common sense says this should call for a much higher payment from the insurance company, as punishment for the wrongdoing. Right?

Wrong! Virtually all insurance policies have an intentional-act clause that states, No coverage will be provided in the event that harm or injury has been caused intentionally.

Paul explained this important policy language to Charles and “Derek,” the company’s owner. “I urged them to not persist in claiming this collision was an intentional act, as this would give my company an out to deny any payment. I was trying to help them, but I got hung up on!”

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“Mr. Beaver, I need your help. Maybe you can get them to understand why they must forget about claiming this was the plan of a very angry driver. I read your article about the employee with bad body odor” — How to Deal With Employees Who Stink (Literally) — “and how your phone call to the boss got the guy his job back. I’m betting that they will listen to you.”

A medical explanation for Mary’s appearance

I asked a physician friend to look at the video. “Mary has a goiter,” he immediately said, “that is caused by an enlarged thyroid gland resulting from a lack of iodine. Bulging eyes that give the patient a strange and very scary look are a classic symptom. With appropriate treatment, the condition will improve, … but it's a long process.”

I phoned Derek and began our conversation by telling him that Paul was one gutsy guy for doing the right thing. Then I said, “Charles didn’t cross paths with an angry driver who intended to run the stop sign. A physician saw the video and found that Mary has a goiter, which gives her that appearance. Paul has urged you to drop any claim that this was intentional, because insurance doesn’t pay for such claims. Please think it over, talk with your own attorney and get back to Paul.”

In the days that followed…

Derek and Charles dropped the intentional claim. Paul settled the matter and phoned my office.

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“Thank you so much! I had a duty to be fair to these people over and above anything I owed my employer who would have happily wiggled out of paying because the claimants thought they were mind readers.”

Dennis Beaver practices law in Bakersfield, Calif., and welcomes comments and questions from readers, which may be faxed to (661) 323-7993, or e-mailed to Lagombeaver1@gmail.com. And be sure to visit dennisbeaver.com.

Disclaimer

This article was written by and presents the views of our contributing adviser, not the Kiplinger editorial staff. You can check adviser records with the SEC or with FINRA.

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After attending Loyola University School of Law, H. Dennis Beaver joined California's Kern County District Attorney's Office, where he established a Consumer Fraud section. He is in the general practice of law and writes a syndicated newspaper column, You and the Law. Through his column, he offers readers in need of down-to-earth advice his help free of charge. "I know it sounds corny, but I just love to be able to use my education and experience to help, simply to help. When a reader contacts me, it is a gift."