Courts Must Never Speculate About Facts Not in Evidence
Post 5192
See the full video at https://rumble.com/v6z2r2s-duty-to-defend-is-not-without-limit.html and at https://youtu.be/3hhYFmKmGmA, and at https://zalma.com/blog plus more than 5,150 posts.
Injuries to Others at McDonald’s Do Not Provide Duty to Defend Suit by Employee Who Did Not Incur Bodily Injury
in McdDonald’s Corporation, et al v. Homeland Insurance Company Of New York, No. 23 C 16297, United States District Court, N.D. Illinois, Eastern Division (September 10, 2025) McDonald’s Corporation and McDonald’s USA LLC (collectively, “McDonald’s”) sued Defendant Homeland Insurance Company of New York (“Homeland”) challenging Homeland’s denial of coverage under a commercial general liability insurance policy.
BACKGROUND
A McDonald’s franchisee operated the McDonald’s restaurant (“Restaurant”) located in Chicago, Illinois. (hereinafter, “PRSOF”). From March 1, 2015 through March 1, 2018, the franchisee maintained a commercial general liability policy (“Policy”) issued by Homeland.
Section I of the Policy provides: “We will pay those sums that the insured becomes legally obligated to pay as damages because of ‘bodily injury’ or ‘property damage’ to which this insurance applies.” Importantly, the Policy dictates that a bodily injury is covered only if takes place during the policy period, i.e., March 1, 2015, through March 1, 2018.
McDonald’s attempted to utilize the Policy after being sued by a Restaurant employee in the Circuit Court of Cook County, Sonia Acuna, et al. v. McDonalds, et al., No. 2019 CH 13477 (“Underlying Action”). Ultimately, Acuna was a party to four different complaints in the Underlying Action; her participation culminated with the filing of the third amended complaint on July 19, 2021. Since Acuna was the sole plaintiff in the Underlying Action who worked at the Restaurant, only her specific claims are relevant to this dispute.
After evaluating the lawsuit and the Policy, Homeland denied coverage because Acuna did not allege any “bodily injury” during the policy period.
DISCUSSION
The factual allegations in the amended complaint state a vicarious liability claim that falls within the coverage of the insurance policy, and therefore, plaintiff’s amended complaint was not an improper or unsupported attempt to plead into coverage.
The Operative Complaint includes allegations of specific incidents involving Acuna, which McDonald’s concedes cannot trigger Homeland’s duty to defend because they occurred outside the policy period, and more generalized allegations of harm.
An insurer has a duty to defend when the complaint’s allegations fall within or potentially fall within the coverage provisions of the policy. Because a complaint need not allege or use language affirmatively bringing the claims within the scope of the policy, the duty to defend is broader than the duty to indemnify.
The duty to defend depends on the facts underlying a complaint, not the specific legal theory on which the plaintiffs base their claims. Illinois courts follow the so-called “eight-corners rule” where courts determine the duty to defend by looking only within the four corners of the insurance policy and the four corners of the complaint for which defense is sought.
The insurer’s duty to defend, while broad, is not without limits. Notwithstanding the breadth of the duty, the claim against the insured must still contain explicit factual allegations that potentially fall within policy coverage. While the Court must examine the underlying claims with care, it cannot read into the complaint facts that are not there.
Generalized allegations are not enough
The gist of Acuna’s claims is that witnessing bodily injury inflicted on others resulted in psychological harm to her. The Operative Complaint, and all preceding complaints for that matter, were devoid of facts establishing that Acuna sought damages for a covered bodily injury that occurred during the policy period.
A Court may not find a duty to defend based on conjecture. The duty to defend may be broad, but Illinois law does not permit the court to speculate about possible factual scenarios that are absent from the claim itself. Even if it could, second-hand injuries such as fear and emotional distress caused by viewing other persons’ bodily injuries are simply not covered by the Policy.
Therefore the Court found no duty to defend and granted summary judgment in favor of Homeland.
ZALMA OPINION
The Illinois 8 corners rule made the decision of the Court obvious because the allegations of the complaint by Ms. Acuna did not fit the definitions of injury within the policy’s effective dates. Since there must be a bodily injury within the policy’s effective dates and no evidence existed the court properly refused to speculate and granted Homeland’s summary judgment.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Refusal to Provide Workers’ Compensation is Expensive
Post 5240
Read the full article at https://lnkd.in/guC9dnqA, see the video at https://lnkd.in/gVxz-qmk and at https://lnkd.in/gUTAnCZw, and at https://zalma.com/blog plus more than 5200 posts.
In Illinois Department of Insurance, Insurance Compliance Department v.USA Water And Fire Restoration, Inc., And Nicholas Pacella, Individually And As Officer, Nos. 23WC021808, 18INC00228, No. 25IWCC0467, the Illinois Department of Insurance (Petitioner) initiated an investigation after the Injured Workers’ Benefit Fund (IWBF) was added to a pending workers’ compensation claim. The claim alleged a work-related injury during employment with the Respondents who failed to maintain workers’ compensation Insurance.
Company Overview:
USA Water & Fire Restoration, Inc. was incorporated on January 17, 2014, and dissolved on June 14, 2019, for failure to file annual reports and pay franchise taxes. It then operated under assumed names including USA Board Up & Glass Co. and USA Plumbing and Sewer. The business ...
Arsonist Incompetently Moves Pro Se to Avoid Prison
Post 5239
Read the full article at https://lnkd.in/gRX8TfKn, see the video at https://lnkd.in/gY3Jvnqp and at https://lnkd.in/gRCaaf-3, and at https://zalma.com/blog plus more than 5200 posts.
In Christopher A. Barosh v. Morris Houser, et al., Civ. No. 22-0769, United States District Court, E.D. Pennsylvania (November 25, 2025) a convicted arsonist and insurance fraudster moved the USDC acting in Pro se filed Objections to Magistrate Judge Reid’s Recommendation that the US District Judge dismiss his § 2254 Petition to avoid jail.
BACKGROUND
In October 2005, Barosh set fire to his girlfriend’s Philadelphia home — some 25 hours before the cancellation of the property’s insurance policy. Several witnesses saw Barosh leaving the property shortly before the fire erupted. After the fire, Barosh made “two separate admissions of guilt.”
He attempted to pay an acquaintance to provide him with an alibi for the time of the arson. The eyewitnesses, brother, and ...
Conditional Release Allows Supplemental Claims
Post 5238
Read the full article at https://lnkd.in/ge2yNQby, see the video at https://lnkd.in/gcSF9KWj and at https://lnkd.in/gQfJqwiM, and at https://zalma.com/blog plus more than 5200 posts.
A Release Should Totally Resolve Dispute
In Harvey et al. v. Hall, No. A25A1774, Court of Appeals of Georgia, Fourth Division (December 3, 2025) Paul Harvey, an employee of Arthur J. Dovers (d/b/a 3D Mobile Home Services), drove a truck towing a trailer loaded with machinery and equipment. Harvey fell asleep, veered off the road, and crashed into a culvert, causing Lamar Hall serious injuries.
FACTS OF SETTLEMENT
On August 18, 2020, Hall signed a limited liability release under OCGA § 33-24-41.1, releasing Harvey, Dovers, and their insurer (Georgia Farm Bureau Insurance Company) from liability for the accident in exchange for $50,000, “except to the extent other insurance coverage is available which covers the claim.”
Dovers’s general liability insurer (Republic-Vanguard ...
The Professional Claims Handler
Post 5219
Posted on October 31, 2025 by Barry Zalma
An Insurance claims professionals should be a person who:
Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.
How to Create Claims Professionals
To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
The History Behind the Creation of a Claims Handling Expert
The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210
This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster
When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.
I was initially sat at a desk reading a text-book on insurance ...
