709 F.3d 1259
8th Cir.2013Background
- Gear Automotive, L.L.C. lacked workers' compensation insurance for 2008.
- Robert Gear is the sole owner, manager, and initially the sole employee; Darrell Gear is a brother and employee.
- In Oct 2008, after a vandalism/theft incident, Robert and Darrell arranged a surveillance plan aided by Joe Posner.
- Robert was shot during the incident while monitoring Gear Automotive premises; Wilshire issued a commercial general liability policy to Gear.
- Robert sought policy limits; Wilshire denied coverage; Gear Automotive sued in state court, then federal court after removal; district court granted Wilshire summary judgment based on policy exclusions.
- The court on appeal addresses whether the Employee exclusion, Fellow Employee exclusion, or Workers' Compensation exclusion forecloses coverage; Gear Automotive argues against the Workers' Compensation exclusion and questions employee status and coverage.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the Employee exclusion applies to bar coverage | Gear Automotive argues Robert is not an employee for coverage purposes | Wilshire contends Robert is an employee and injury arose in course of employment | Employee exclusion applies to bar coverage |
| Whether Robert qualifies as an employee given his member status | Robert as a Gear member cannot be an employee | Missouri law allows a member to also be an employee; Robert served as manager and employee | Robert is an employee for purposes of the exclusion |
| Whether the Workers' Compensation exclusion applies | Gear Automotive argues act exemption applies due to fewer than five employees | District court correctly considered the exclusion; could bar coverage | Court did not need to decide Workers' Compensation exclusion to affirm; Employee exclusion suffices |
Key Cases Cited
- Baker v. DePew, 860 S.W.2d 318 (Mo. 1993) (interpretation of employee for insurance policy exclusions)
- Tickle, 99 S.W.3d 25 (Mo. Ct. App. 2003) (definition of employee for exclusion purposes; Workers' Comp interplay)
- Bevel, 663 S.W.2d 242 (Mo. 1984) (injury arising out of and in the course of employment; policy exclusion scope)
- Wieners, 791 S.W.2d 751 (Mo. Ct. App. 1990) (employee-status determination when facts are undisputed)
- Ward v. Allstate Ins. Co., 514 S.W.2d 576 (Mo. 1974) (statutory provisions as part of insurance contracts; definition guidance)
- Vassholz, 839 S.W.2d 23 (Mo. 1992) (interpretation of workers' compensation exclusion)