United States Court of Appeals
For the First Circuit
No. 13-1809
METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY,
Plaintiff, Appellant,
v.
SUSAN MCCARTHY; GLYNIS DIXON MCCORMACK,
Defendants, Appellees.
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MAINE
[Hon. Nancy Torresen, U.S. District Judge]
Before
Lynch, Chief Judge,
Souter,* Associate Justice,
and Lipez, Circuit Judge.
Jeffrey T. Edwards, with whom Preti Flaherty Beliveau &
Pachios, LLP was on brief, for appellant.
Michael J. Donlan, with whom Verrill Dana, LLP was on brief,
for appellee Susan McCarthy.
Christopher C. Dinan and Monaghan Leahy, LLP on brief for
appellee Glynis Dixon McCormack.
June 5, 2014
*
Hon. David H. Souter, Associate Justice (Ret.) of the Supreme
Court of the United States, sitting by designation.
LIPEZ, Circuit Judge. In this declaratory judgment
action, the district court ruled that Metropolitan Property and
Casualty Insurance Company has a duty to defend its insured, Glynis
Dixon McCormack, in a lawsuit alleging that McCormack's ward
sexually and physically abused a younger boy. The court rejected
Metropolitan's assertion that the governing policy excludes
coverage for such abuse, concluding that the facts alleged in the
underlying complaint leave open the possibility that some of the
alleged conduct fell outside the policy's exclusions. Having
reviewed the complaint and policy with care, we agree.1
On appeal, Metropolitan offers three primary arguments in
support of its claim that the district court erred. First, the
insurer maintains that the only abuse alleged in the underlying
complaint was either sexual in nature or intended to conceal sexual
abuse and, hence, the alleged harmful conduct is excluded from
coverage by the policy's definition of bodily injury.2 Second, the
1
Before oral argument, we raised a question about our
appellate jurisdiction because Metropolitan originally had sought
a declaration that it had no duty to defend or indemnify McCormack,
and the district court's order, consistently with McCormack's
motion for summary judgment, addressed only the duty to defend.
The district court subsequently clarified that the lawsuit as
litigated did not encompass the issue of Metropolitan's duty to
indemnify. Accordingly, there is no bar to our review of the
judgment on the duty to defend.
2
After defining "Bodily injury," in part, as "any physical
harm to the body," the policy states:
Bodily injury does not include:
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insurer argues that the abuse exclusion disallows coverage for even
non-sexual physical abuse committed by any person. Finally,
Metropolitan insists that the policy at least excludes coverage for
non-sexual physical abuse committed by an insured, as well as harm
resulting from intentional acts of an insured, and it reads the
complaint to identify the perpetrator as an insured member of
McCormack's household.
None of these theories is persuasive for the reasons
given by the district court in its thoughtful opinion. We briefly
review the court's rulings explaining Metropolitan's potential
obligation to pay under the policy, thereby establishing its duty
to defend. See Bucci v. Essex Ins. Co., 393 F.3d 285, 290 (1st
Cir. 2005) ("[T]he insurer has a duty to defend if the underlying
complaint discloses a 'potential or a possibility' for liability
within the policy's coverage." (quoting Elliott v. Hanover Ins.
Co., 711 A.2d 1310, 1312 (Me. 1998)); see also Mitchell v. Allstate
Ins. Co., 36 A.3d 876, 879 (Me. 2011) (same). The district court's
conclusion on the duty to defend is reviewed de novo. Bucci, 393
F.3d at 290.
1. As noted above, Metropolitan asserts that the
complaint alleges only sexual abuse or "other" physical abuse
. . .
3. the actual, alleged or threatened sexual molestation
of a person; . . . .
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related to sexual abuse, which is excluded from coverage by the
policy's definition of "bodily injury." Under the comparison test,
in which the allegations in the complaint are compared with the
policy provisions, "an insurer must provide a defense if there is
any potential that facts ultimately proved could result in
coverage." Mitchell, 36 A.3d at 879. Here, the complaint directly
alleges that some of the perpetrator's acts are within the
definition of "bodily injury" because the complaint includes
allegations of physical abuse that are not on their face limited to
physical contact related to sexual abuse. See, e.g., Compl. ¶ 9
(stating that the victim was "repeatedly sexually and otherwise
physically abused" (emphasis added)), ¶ 14 (referring to "the
sexual and other physical abuse and exploitation" (emphasis
added)), ¶ 19 (alleging "McCormack's negligent failure to prevent
this sexual and other physical and psychological abuse" (emphasis
added)); ¶ 21 (alleging that on one occasion, the victim was
"violently and forcefully struck" in the abdomen).
2. Metropolitan argues that, even if the bodily injury
definition does not preclude coverage for all of the abuse alleged
in the complaint, the policy elsewhere excludes coverage for any
type of abuse inflicted by any person. However, the provision on
which Metropolitan relies -- the abuse exclusion -- reasonably may
be read to preclude coverage only for abuse inflicted or directed
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by an insured rather than by any individual.3 Although the first
sentence of the provision is written in general terms, the second
sentence may be understood to limit the exclusion to such
individuals. See Jipson v. Liberty Mut. Fire Ins. Co., 942 A.2d
1213, 1216 (Me. 2008) ("All parts and clauses of an insurance
policy must be considered together that it may be seen if and how
far one clause is explained, modified, limited or controlled by the
others." (brackets omitted) (internal quotation marks omitted));
see also Peerless Ins. Co. v. Wood, 685 A.2d 1173, 1174 (Me. 1996)
(stating that the language of an insurance policy is viewed "from
the perspective of an average person, untrained in either the law
3
The abuse provision states as follows (with bold text as it
appears in the original):
Abuse. We do not cover bodily injury caused by or
resulting from the actual, alleged or threatened sexual
molestation or contact, corporal punishment, physical
abuse, mental abuse or emotional abuse of a person. This
exclusion applies whether the bodily injury is inflicted
by you or directed by you for another person to inflict
sexual molestation or contact, corporal punishment,
physical abuse, mental abuse or emotional abuse upon a
person.
The policy identifies "you" as "the policyowner," and states that
the policy "insures you and your property." The definition of
"you" and "your," in relevant part, is as follows:
"You" and "your" mean:
1. the person or persons named in the Declarations and if
a resident of the same household:
A. the spouse of such person or persons;
B. the relatives of either; or
C. any other person under the age of twenty-one in the care of
any of the above . . . .
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or the insurance field, in light of what a more than casual reading
of the policy would reveal to an ordinarily intelligent insured").
At best for appellant the provision is ambiguous. See
Cox v. Commonwealth Land Title Ins. Co., 59 A.3d 1280, 1283 (Me.
2013) ("Policy language is ambiguous if it is reasonably
susceptible of different interpretations or if any ordinary person
in the shoes of the insured would not understand that the policy
did not cover claims such as those brought." (internal quotation
marks omitted)). Given that ambiguity, we are obliged to adopt the
reading most favorable to the insured. Mitchell, 36 A.3d at 879
("Because the duty to defend is broad, any ambiguity in the policy
regarding the insurer's duty to defend is resolved against the
insurer, and policy exclusions are construed strictly against the
insurer." (citations omitted)); see also Foremost Ins. Co. v.
Levesque, 868 A.2d 244, 246 (Me. 2005) (stating that "[e]xclusions
and exceptions in insurance policies are disfavored" and thus
construed narrowly).4 Hence, for purposes of the duty to defend,
we treat the conduct of a non-insured individual as outside the
scope of the abuse exclusion.
3. Having concluded that the abuse exclusion should be
applied only to an insured -- i.e., anyone who qualifies as "you"
4
Defendants urge us to conclude that Metropolitan has made
inconsistent alternative arguments about the meaning of the abuse
exclusion and to take those arguments as evidence of ambiguity.
Because we conclude that the abuse exclusion is ambiguous for the
reasons already stated, we need not reach this issue.
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under the policy, see supra note 3 -- we must consider whether the
allegations in the complaint allow the possibility that the
perpetrator is a non-insured. "You" is defined as a person who is
"a resident of the same household" and a spouse, relative, or
person under age 21 in the care of an insured. See id. The
complaint establishes that the alleged abuser was a minor ward of
McCormack, but it does not state that he resided with her. Rather,
the allegations permit the inference that he, like the victim,
stayed only temporarily, though repeatedly, at McCormack's home.
See, e.g., Compl. ¶ 21 (stating that the older boy was "at
Plaintiff's home," allowing inference that it was not also his home
(emphasis added)). Given that inference, the youth would be a non-
insured whose conduct would be outside the abuse exclusion under
the reading of the policy we have described above. The same
rationale -- i.e., that the perpetrator might not be a covered
individual under the policy -- also potentially places his conduct
outside the policy exclusion for intentional acts. That provision
also applies only to an insured.5
In sum, the complaint allows inferences that McCormack's
ward was not a resident of her household and alleges that he
5
The intentional loss provision states, in pertinent part
(again, with bold text as it appears in the original):
Intentional loss. We do not cover bodily injury or
property damage which is reasonably expected or intended
by you or which is the result of your intentional and
criminal acts or omissions.
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inflicted physical, non-sexual abuse on the younger boy. Under
those facts, her policy would cover the resulting harm.
Accordingly, Metropolitan has a duty to defend McCormack in the
underlying action. We therefore affirm the district court's
judgment denying summary judgment for Metropolitan and granting
summary judgment for McCormack.
So ordered.
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