I batter Islami called on the Supreme Court to remand the Court of Appeals and confirm the granting of a summary judgment in favor of the Kemper Independence Insurance Company (Kemper) which denied Ismet coverage for the loss of his home. I Kemper Independence Insurance Company v. Ismet Islami 2021 WI 53, no. 2019AP488, State of Wisconsin In the Supreme Court (June 8, 2021), the Supreme Court dismissed her argument over a rather strenuous disagreement.  FACTS
Ydbi Islami, from whom Ismet is legally separated, deliberately set fire to the home. All parties provided that Ydbi concealed facts from Kemper about his involvement in the fire with intent to deceive, and Kemper relied on Ydbi's concealment and fraud to its detriment (ie, the general legal definition of fraud). The district court ruled the condition of "concealment or fraud" in Kemperer's insurance that covers the home (the "policy") prohibited coverage for both Ydbi and Ismet. The Board of Appeal agreed.
ISMET & # 39; S ARGUMENT
Ismet addresses three arguments. First, Ismet claims that Ydbi, in view of her legal separation from Ydbi, is not her husband and therefore not an "insured" for the purpose of the policy. Second, Ismet argues that the "hidden or fraudulent" terms of the policy are ambiguous, run counter to the "intentional loss" of the policy and therefore do not prevent coverage. Third, Ismet claims she is innocent.
Ismet and Ydbi married in 1978. In 1988, Ydbi was convicted of a number of crimes, including persecution and sexual abuse of a minor, with victims other than Ismet. After these events, Ismet originally sought a divorce from Ydbi, but for religious reasons he was instead granted legal separation. As part of the separation, which took place in 1998, both parties entered into a marriage agreement, according to which Ismet was given sole ownership of his home in Oconomowoc, even though Ismet and Ydbi continued to live in the home together. Neither party continued with the divorce.
In 2012, Kemper issued a "Package Plus" home and car insurance that covered Ismet & # 39 ;s Oconomowoc homes and listed cars. According to the policy, Ismet is listed as "Name Insured." However, the introduction to the insurance reads: "Throughout the insurance, 'you' and 'your' refer to the person who is shown as the 'Name Insured' in the declarations. It also means the spouse of a resident of the same household. The policy further states that "insured" means "you and the residents of your household who are. . . [y] our relatives. In addition, both Ismet and Ydbi are listed in the vehicle coverage section as "Operator 1" and "Operator 2" respectively. Both parties also marked their marital status as "Married."
The policy also contains a condition for "concealment or fraud". As relevant to this dispute, the provision limits the coverage of "all insured" if "an insured" concealed or misrepresented an essential fact, with intent to deceive and as Kemper relied on. In its entirety, the provision reads:
Under section 1 – Property protection, with respect to all "insured" covered by this insurance, we provide coverage to no "insured" for loss under section 1 – Property protection if, either before or after a loss has an "insured":
1) Concealed or incorrect presentation of all facts that we trust, and that concealing or incorrect presentation is significant and made with the intent to deceive; or
2) Hidden or incorrectly presented fact and the incorrect presentation contributes to the loss.
In June 2013, a fire broke out in the Oconomowoc home which damaged the property and its contents and caused the home a total loss.
On the basis of "hidden or fraudulent" policy terms (among other provisions), Kemper denied coverage for the loss of the home. Kemper's declaration action sought a declaration that the "concealed or fraudulent" condition prevented coverage for both Ismet and Ydbi.
In the end, the district court granted Kemperer's proposal for a summary judgment and found that Ydbi was an "insured" according to the policy, and Ismet's and Ydbi's legal separation in 1998 did not change Ydbi's status. The district court further found that Ydbi was "insured", that "hidden or fraud" prevented recovery for Ismet.
Ismet claims that Ydbi is not her husband because they are legally separated; therefore, according to Ismet, Ydbi is not an "insured" according to the insurance. The insurance definitions answer this question: "Throughout the insurance, 'you' and 'your' means the person shown as" Name insured "in the declarations. It also means spouse about a resident in the same household." (Emphasis added
Insurances are agreements in which courts apply the same rules of law as apply to other agreements. By applying the simple language of the policy, the Supreme Court concluded that Ismet and Ydbi are "spouses" for the purposes of the contract. and Ydbi as "Married". Since the policy explicitly designates Ismet and Ydbi as spouses, Ydbi meets the definition of "you" under the policy, making Ydbi "insured".
In addition, both Ismet and Ydbi represented to Kemper that they were " insured "under the insurance contract. Ismet and Ydbi lived under the same roof in the Oconomowoc home; they are in a relationship recognized as marital under Wisconsin law, albeit legally separated; o ch they each considered their relationship when entering into a contract with Kemper, which is evident from the fact that they listed their status as "Married". Critically, both Ismet and Ydbi also stated in their "Sworn Statement in Proof of Loss" that they were each "insured" according to the contract. With this understanding, Kemper conducted an investigation under oath of both Ismet and Ydbi, during which Ismet repeatedly declared that Ydbi was her "husband". By giving effect to the parties' expectations and applying the clear language of the agreement, Ismet and Ydbi are "spouses" and therefore insured according to the policy.
"Concealment or fraud" terms Bars coverage for Ismet under the policy.
When the terms of an agreement are simple and unambiguous, the Supreme Court must interpret the agreement as it is. In this case, the insurance terms are simple and unambiguous, including the "hidden or fraud" condition. Since both Ismet and Ydbi are insured under the policy, either the individual can recover, either so concealed or misrepresented an essential fact that Kemper relied on.
As defined in the policy, "intentional loss" means "any act which an insured person" undertakes or conspires to commit with intent to cause a loss. "Ydbi's arson, which caused the loss of the Oconomowoc home, meets this definition. The conditions of "concealment or fraud" eliminate coverage not only for the insured who commits the intentional act causing the loss, but for all the insured.
Ydbi committed arson, lied to Kemper in his "Sworn Statement in Proof of Loss" and Examination Under Ed and made Kemper trust his lies. Under the "hidden or fraud" condition, the policy provides coverage for "no insured" – including Ismet.
The Supreme Court concluded that the district court granted Kemper's request for a summary judgment in the correct manner. Ydbi is an insured under the terms of the policy and because he "concealed or misrepresented" an essential fact, "with intent to deceive" and on which Kemper relied, the policy's "hidden or fraudulent" terms exclude coverage for Ismet.
The decision of the Court of Appeal was confirmed.
Although the court held that Ismet was innocent but was not entitled to recover under the policy due to fraud committed by her husband, Ydbi, she also signed the proof of loss under oath claiming the damage Ydbi knowingly caused. Her falsely sworn statement should have defeated her claim of innocence. This fact did not need to be established by Kemper because the clear language of the policy made it clear that no insured person could recover if a fraudulent claim was submitted to an insurance company and the insurer proves whether it was fraudulent.
© 2021 – Barry Zalma. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and email@example.com.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 53 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurance companies and their claims staff to become insurance claims staff.
Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Zalma on Twitter at https://twitter.com/bzalma ; Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the library for insurance claims – https://zalma.com/blog/insurance-claims-  bibliotek / Read posts from Barry Zalma at https://parler.com/profile / Hymn / post; and the last two issues of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/ podcast now available at https://podcasts.apple.com/us/podcast/zalma-on -insurance / id1509583809? uo = 4