The Eastern District Court of Pennsylvania recently ruled that a loss caused by the acts of a mentally ill insured were barred from coverage, as the loss was not accidental.

In Robinson v. Allstate, the husband, a co-insured set fire to his house resulting in various damage.  The insurer disclaimed coverage for the loss contending that the loss was not “accidental”, as required by the policy.  The wife, the other co-insured under the policy, argued that her husband’s actions were not intentional, as he was psychotic at the time of the occurrence.  The wife produced various medical documents evidencing her husband’s subsequent involuntary hospitalization and treatment after the incident.

In response to the wife’s argument, the insurer countered that neither of the insureds had proffered any expert medical evidence showing that the husband’s medical illness prevented him from performing an intentional act.  Rather, the only evidence regarding intent was the husband’s prior statements, which indicated that he had intended to destroy the house because he believed it was “demonic and need[ed] to be taken down”.  As such, the court concluded while the husband’s actions may have been irrational, it had no bearing in determining whether coverage was provided under the policy.  Thus, the only evidence before the court indicated that the husband’s intent was to burn the house down and, therefore, there was no coverage provided under the policy on this basis.

Consequently, this case illustrates if there is evidence suggesting that that an insured acted with intent, the insured will likely need to proffer additional evidence, in this instant case, medical expert testimony, establishing that the insured’s actions were not intentional –to defeat a claim that coverage is not provided under a policy because the loss was not “accidental”.

Thanks to Colleen Hayes for her contribution to this post.