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Plaintiff v. Insurance Company

June 2009

Sedgwick obtained an appellate ruling in favor of our client, an insurance company, in a case arising out of an excess worker's compensation insurance policy. A national chain of supermarkets was self-insured for workers' compensation coverage. Our client issued an excess policy that did not provide coverage until, as to each "occurrence," the insured had exhausted its self-insured retention of $500,000. The policy defined an "occurrence" as an injury caused by an accident, or by a cumulative injury. The insurer learned that the supermarket chain was, for the purpose of satisfying the self-insured retention, considering several accidental injuries and/or cumulative injuries to the same employee to be one "occurrence" if the injury claims were resolved in one workers' compensation proceeding. The trial court granted summary adjudication in favor of the insurance company client. The Court of Appeal affirmed in a published opinion, holding that the insurance policy's definition of "occurrence" was clear and enforceable, and expressly provided that each injury due to accident and each cumulative injury was a separate "occurrence" subject to a separate self-insured retention.