Insurance Company Loses “Insurance Policy Exclusion” Battle. Plaintiff receives $400,000.00

Insurance policy exclusions and collection of damages from insurance policies.An injured woman settled for $400,000.00 after  she  was hit by a golf cart driven by  an intoxicted driver.  The plaintiff in this case was walking after leaving  an  outdoor  concert in  Peachtree  City.  She was then struck by  a golf  cart  driven  by a man  who was later arrested for  DUI.     The Defendant in  the case was  leaving the outdoor concert and had parked his golf cart  near the golf cart path.    As the defendant pulled  onto  the path, he  struck the plaintiff  and kept  going until a passersby stopped  him and  removed the key from the golf cart.   It was reported that the Defendant was not aware that he had hit the injured lady.  The Plaintiff’s injuries included two broken bones in her leg, and her medical bills totaled $75,000.00.

The Defendant’s insurance company fought to exclude liability coverage under the Defendant’s homeowner’s insurance policy.  The company argued that the golf cart was excluded from the Defendant’s liability coverage.  The insurance company then filed a complaint for declaratory judgment arguing “policy exclusion”.

The court; however, held that the  wording in  the insurance policy was  “unclear”.  The policy attempted to include an exclusion for golf carts based on the number of people the cart was designed to carry.  Further the court held that the language in the insurance policy was ambiguous  and coverage exclusions must be clearly defined.

Although  the policy limit in this case was $500,000, the reasoning for  settling at  $400,000 was to  persuade the insurance company  to  just settle the case and be done with it.

Though  this  case dealt with a homeowners  insurance policy, automobile insurance policies, health and  even  life  insurance policies are  often filled with exclusions.    For  example,  some life insurance  policies may exclude certain  behaviors they consider “risky”,  e.g., scuba diving,  sky  diving, etc.

Auto insurance  policies may have exclusions for injuries caused by  intentional acts, for  example,  attempting to hit someone with a car.   Also,  exclusions have been held valid where an individual has allowed  an  unlicensed driver to  operate  the vehicle.  There may be incidents where an  individually is  actually named as an  excluded driver,  for  example  where the person has a poor driving  history.

When  renting a vehicle,  the rental  car  company typically asks for the identity of all anticipated drivers who will  or may be operating the rental vehicle.   Any  other  drivers not listed may be excluded under the insurance policy in  the event of an  accident,  injury  or death.

Another  example in auto  insurance policies may be the “business  use “ exclusion.   The insurer may seek  to exclude coverage if an accident occurs while the  vehicle is in use for business  purposes  (under a personal auto  insurance  policy).  Although, this exclusion is not as widely pursued by insurance companies.

The bottom  line  is,  when signing up for  any  insurance,  read  the fine  print and  direct your intention to the section on  exclusions.  You may think you are insured when, in  fact, you may not be  when the accident,  injury  or loss occurs.   If you have questions or would like to discuss your legal matter, contact: Anthony Overton Van Johnson & Associates, P.C. at 678-882-7355, or e-mail: for a free consultation.