My Spouse Burned Down the House, Am I Covered? Part 1, New York

The intentional acts exclusion seems straightforward enough, but is it? I was recently referred a case where an insured’s spouse allegedly burned their house down. At first glance you might scream out FRAUD! But in some of these cases, the facts aren’t as clear cut as the insurance carrier would make them out to be.

Most homeowner policies have an exclusion for intentional or criminal acts. The clause may read like this:

We do not cover loss to the property described caused by the following:

- Intentional or criminal acts of or at the direction of any insured person, if the loss that occurs:
o May be reasonably expected to result from such acts; or
o Is the intended result of such acts.
- This exclusion applies regardless of whether or not the insured person is actually charged with, or convicted of, a crime
.

This clause got my criminal attorney brain working to answer one question:

What if the insured lacked the mental capacity to understand what he or she was doing?1

Courts generally have been all over the map with their interpretation of an insured’s mental illness as it applies to an intentional acts exclusion.

In New York, the general rule is that an insane person is responsible for his torts, except perhaps those in which malice and intention are necessary ingredients.2 However, not every intentional act falls within the parameters of an insurance policy’s intentional acts exclusion since “insurable ‘accident results’ may flow from ‘intentional causes’.”3 “In deciding whether a loss is the result of an accident, it must be determined, from the point of view of the insured whether the loss was unexpected, unusual and unforeseen.”4

Most cases where the intentional acts exclusion is cited revolve around criminal behavior such as murder, arson, assault, etc. During my days at the Hudson County Prosecutor’s Office, we often would plea cases out to a lesser charge that may not have included “intent” as an element of the crime. In New York, the fact that an assailant receives a favorable plea to a crime with a criminal intent element of recklessness does not necessarily foreclose finding that the underlying conduct falls within an insurance policy’s intentional acts exclusion.

These types of claims are very fact specific and would necessitate a mental health evaluation of the individual. Just because your insurance carrier denied your claim because of the intentional acts exclusion doesn’t mean your case is over. Consult with a lawyer to see what options you have.

I leave you with a quote from hall of famer Casey Stengel about pitchers’ intentions towards him, “I was such a dangerous hitter I even got intentional walks during batting practice.”


1 For this blog, I’m assuming the insurance policy didn’t have an extra clause disclaiming any damage resulting from mental incapacity.
2 Williams v. Hays, 143 N.Y. 442 (1894).
3 Slayko v. Security Mut. Ins. Co., 98 N.Y.2d 289, 293 (N.Y. 2002).
4 Agoado Realty Corp. v. United Intl. Ins. Co., 95 N.Y. 2d 141, 145 (N.Y. 2000).

 

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Insurance Veteran - February 3, 2016 10:22 AM

Actually handled a case where a person suffering from schizophrenia caused extensive damages and I was successful in getting the claim paid as there was no malicious intent formed during a psychotic episode. This was validated by a certified medical professional. See as independent adjusters we do actually work on behalf of the insured.

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