SW Legal Educational Publishing

Ambiguous Policy Terms Construed To Favor Insured
Description Medical expenses of live-in housekeeper injured in house fire denied by insurer. Court held that since the two conditions in the policy of live-in employees covered were inconsistent and ambiguous that, as usual, the policy would be interpreted so as to favor the insured.
Topic Insurance
Key Words Ambiguity, Coverage, Residence Employees
C A S E   S U M M A R Y
Facts When the Habers moved into a new house, their insurance agent visited and was told there would be a live-in housekeeper. The agent said he would take care of things. Three years later, the housekeeper suffered extensive injuries in a fire. She filed for worker's compensation benefits against the Habers. The insurance company denied the claim. District court held for the Habers; the insurance company appealed.
Decision Affirmed. The endorsement covers "residence employees" who are 1) "engaged in regular employment of less than 40 hours per week" and 2) are workers who, under New York law, must be provided workers' compensation benefits. These two conditions are inconsistent since New York does not require workers' compensation benefits be granted to residence employees of less than 40 hours per week. Since the Habers told the insurance agent they wanted coverage for their employee, and the policy terms are ambiguous, they will be interpreted in favor of the insured.
Citation Haber v. St. Paul Guardian Insurance Co., ---F.3d--- (1998 WL 61822, 2nd Cir.)
137 F.3d 691 (2d Cir., 1998)

Back to Insurance Listing

©1997  South-Western, All Rights Reserved