The incident that took place a couple of years from now, i.e.
in the month of February, 2011 forced the Ontario court to rethink on the
personal injury claims, when it was found that the insurance policy excludes
coverage for any kind of criminal acts. As a result, the Ontario court planned
to issue orders to the insurer to guard the personal injury claim of the
policyholder, when it was found that the policyholder, who was found guilty of
assaulting the man, who is now suing him.
Fausto Simone and Vincenzo Sgambelluri are the names of the
persons involved in the fight. It all happened when Sgambelluri supposedly ran
into the drive-through line. He has now sued Simone for all the alleged
personal injuries namely broken leg, depression and anxiety, which he had to
suffer because of Simone’s negligence.
Furthermore, the judge with the Ontario Superior court of
Justice found that the proceedings could be based on those negligent actions
that are not grouped under criminal actions. This caused the Ontario Court
issue orders to the insurance company to protect the lawsuit against the
policyholder for those personal injuries allegedly resulting from such an
action.
When Simone found that the insurance policy he had, offers no
coverage against the criminal acts, he applied to the court for a declaration
asking economical insurance for his defence. But the insurance company, on the
other hand, argued that the policy which Simone holds does not offer any kind
of compensation for personal injuries developed as a result of any intentional
criminal acts or failure to act.
After scrutinizing all the proofs and studying the entire
case, on May 31, 2013, Judge Glass ruled the decision in favour of Simone
saying that he "is entitled to declaratory relief" and ordered the
insurance company to support him "with the exception of a claim for
punitive or exemplary relief," since punitive and exemplary damages are
excluded from the insurance policy.
"There will be an order for a declaration that the
Respondent defends the action," Judge Glass wrote.
Looking
at the possibility that Simone could go for a negligence claim, Judge Glass in
his ruling also suggested, exclusions of Simone's policy with Economical
Insurance would not apply. However, "If there is a realistic possibility
that a claim in negligence might be advanced separate from a claim for damages
resulting from an assault, the insured is entitled to benefit of a defence
being carried by the insurer," Judge Glass wrote, noting that when
determining whether a carrier has a duty to defend, a court must look
"beyond labels used" by a plaintiff and "determine the substance
and true nature of the claims."
