Patient Injury Is Ruled Accidental

Commercial Liability	Occurrence
Intentional Act	Expected and Intended Injury Exclusion

Leila Walker (Walker), an 80-year-old Alzheimer patient, lived at a personal care home named Magnolia Estates (Magnolia). After living at the facility for many months, she was struck by another resident at the home.

Two months after the initial incident, the same resident knocked her down, causing several bones to be broken. Walker’s guardians later discovered that this same patient had been involved in no less than 14 other incidents.

Through the guardians, Walker filed suit against Magnolia, claiming negligence, premises liability and breach of contract. Magnolia turned to their insurance company, Cincinnati Insurance Company (Cincinnati), for defense and indemnity. Cincinnati denied coverage because the action that caused the injury was not an accident.

Cincinnati denied coverage based on the insuring agreement wording that stated the policy applies to bodily injury only if the bodily injury was “caused by an occurrence.” Occurrence is defined in the policy as “an accident, including continuous and repeated exposure to substantially the same general harmful conditions.”  Cincinnati also cited the Expected and Intended Injury exclusion.

Magnolia and Cincinnati both requested summary judgement. The trial court found in favor of Magnolia. Cincinnati appealed.

The appeals court rejected Cincinnati’s first argument based on the definition of accident as “an event which takes place without one’s foresight or expectation or design.” The insured had no foresight regarding Walker's injury, so an accident did occur.

The court also rejected Cincinnati’s second argument by noting that the Expected and Intended Injury exclusion was limited to only such acts of the insured.

The appeal court affirmed the trial court's order and granted a summary judgement to Magnolia.

Court of Appeals of Georgia, The Cincinnati Insurance Company v. Magnolia Estates, Inc. etal al
No. A07A0103, June 27, 2007.