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Developmentally Disabled Man With Personal Care Assistant is “Patient” Under Insurance Policy Exclusion


A developmentally disabled man required a personal care assistant. While supervised by an assistant from an in-home care provider company he was blinded in his left eye by a BB gun given to him by the assistant.

 

At the time of the injury, the care provider had insurance coverage for both general liability and professional liability. The policy was in effect until the insurer ceased operations, about seven months after the man was blinded. The man reported his claim to the care provider's last president and then to the insurer.

 

The insurer denied coverage, determining that the professional liability coverage covered only claims made before the policy's termination. The insurer also denied general liability coverage, citing the exclusion for: “Any loss, cost or expense arising out of ‘bodily injury’ to your patients.” The term “patient” was not defined in the policy. Only the general liability coverage was at issue, as the man no longer sought recovery for professional liability.

 

The man sued the care provider in Minnesota state court. The parties entered a Miller–Shugart settlement, in which an insured who has been denied coverage for a claim agrees with the claimant on a judgment for an amount collectible from the insurance policy. The claimant then releases the insured from personal liability and the claimant's recovery is limited to the amount obtained from the insurers. He received a judgment for $2,695,758.27. He then sued the insurer in state court. The insurer removed the case to federal court.

 

After removal, the United States District Court for the District of Minnesota entered summary judgment in insurer's favor, finding the man's claim excluded from the policy's general-liability coverage. On appeal, the man argued that “patient” meant someone receiving licensed medical care and the assistant supervising the man was not licensed and (for purposes of summary judgment) did not provide medical care or medication.

 

The Eighth Circuit United States Court of Appeals affirmed holding that the man was a “patient” for the purposes of the patient exclusion in the provider's general liability insurance policy.

 

The court found that the district court did not err in finding that, under Minnesota law, the word “patient” was unambiguous. Minnesota courts rely on dictionaries for the plain and ordinary meaning of an undefined term. According to Webster's Third New Int'l Dictionary, the definition of “patient” is “the recipient of any of various personal services.” The court reasoned that the man was the recipient of personal care services from the in-home care provider; thus, he was a patient of the company.

 

The Eighth Circuit United States Court of Appeals affirmed the trial court’s grant of the insurer’s motion for summary judgment on the basis that the man under the supervision of a personal care assistant was a “patient” for the purposes of the patient exclusion in the in-home care provider's general liability insurance policy.

 

See: Volk v. Ace American Ins. Co., 2014 WL 1388797 (C.A.8 (Minn.), April 10, 2014) (not designated for publication).

 

 

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