A care home resident walked out and a vehicle struck him. His insurer now says two policy exclusions cut off coverage.
Hiscox Insurance Company Inc. went to federal court on August 24, 2026, asking a judge to settle a coverage fight before it goes any further. It wants a ruling that it does not have to defend or pay anything on a wrongful death suit brought against Pleasant Manor I AFC, LLC and two individual insureds. The case was filed in the US District Court for the Eastern District of Michigan.
According to the complaint, the man left the adult foster care facility on January 15, 2026 and a vehicle struck him. He died from his injuries. The complaint states he had become a legal resident of the facility on January 9, 2026.
The estate's personal representative filed the underlying suit on March 26, 2026 in the Circuit Court for the County of Jackson, Michigan. Hiscox describes that case as alleging the facility negligently monitored and supervised the resident, causing the injuries that resulted in his death.
Setting out those underlying claims, the Hiscox filing says the suit alleges the resident had “dementia and/or cognitive impairment and was known to wander,” and that the insureds had actual notice of those risks. It says the suit alleges the insureds represented they would provide “a safe, secure, and monitored environment appropriate for a resident with a risk of wandering,” and that the family relied on those assurances. It also says the suit alleges the insureds “failed to secure facility entrances and exits, and failed to implement alarms, surveillance, wander-guard systems, keypads, adequate staffing” and other measures against foreseeable wandering risks. The underlying claims are for general negligence and breach of contract.
Hiscox issued a commercial general liability policy - the standard business liability cover - numbered P100.144.500.6, running from March 9, 2025 to March 9, 2026. The complaint states limits of $1,000,000 per occurrence and $2,000,000 in the aggregate.
The carrier's case rests on two exclusions.
The first sits in Endorsement 4. Hiscox says this professional services exclusion means the policy does not apply to bodily injury, property damage or personal and advertising injury caused by the rendering or failure to render any professional service. On the carrier's account, it applies “even if the claims allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by an insured,” where the occurrence involved a professional service. The complaint notes the underlying suit describes the facility as licensed, and says the underlying allegations of failed supervision therefore fall inside the exclusion.
The second is a contractual liability exclusion at Section I.2.b. The complaint quotes it as removing coverage for bodily injury “for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement” - in plainer terms, harm the insured has to pay for because it took that responsibility on in a contract. The quoted wording carries exceptions, including for liability the insured would have had without the contract. Hiscox points to the underlying allegations that the resident and the insureds executed a Resident Agreement, that his service plan called for 24-hour supervision, and that the insureds did not provide the protection, safety, security, supervision, assistance or supervised personal care that agreement required.
The policy defines bodily injury to include death resulting from bodily injury, sickness or disease at any time. It defines occurrence as an accident, including continuous or repeated exposure to substantially the same general harmful conditions.
Hiscox says it is defending the insureds under a reservation of rights - paying for the defense while holding on to its argument that it owes nothing - and will continue to do so until the court decides the matter. It adds that other policy terms, conditions and exclusions may be relevant to the underlying suit but are not currently before the court, and that it reserves all coverage defenses.
The allegations in the complaint have not been tested in court. No defendant has filed a response, and no court has ruled on whether either exclusion applies or on whether Hiscox owes a defense or indemnity.
