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Health Care Services Exclusion Applied to Paramedic Negligent Hiring, Training


An insurer issued an umbrella policy to a company that employed paramedics. The policy provided two types of coverage: professional liability and general liability. The professional liability policy was a “claims-made” policy, which afforded coverage for damages arising from “medical professional injury” that resulted “from acts or omissions in the providing of or failure to provide ‘health care professional services' by or for an insured.” The general liability policy covered damages for bodily injury and property damage caused by an “occurrence” during the coverage period, but it specifically excluded damages resulting from “the performance of or failure to perform ‘health care professional services.’ ” The term “health care professional services” included , “[m]edical, surgical, dental, x-ray, nursing, mental, or other similar health care professional services or treatments.”

 

A man sustained injuries in a car crash, and paramedics responded. The man died shortly thereafter. His wrongful death beneficiaries filed suit against the company that employed the paramedics and various employees. The wrongful death beneficiaries claimed that the man was alive when the paramedics arrived and that he remained alive for one hour while improperly being attended to, treated, and cared for. They alleged that the company was negligent in rendering medical care to the man, resulting in his death. They also alleged negligent hiring, negligent training, and failure to implement appropriate triage protocols. The defendants did not answer the complaint.

 

The attorney for the wrongful death beneficiaries notified the company’s insurer and advised that the policy that the insurer had issued to the company could be implicated. The insurer investigated the claim and informed the company the policy did not provide coverage. The wrongful death beneficiaries filed an entry of default. The trial court entered a default judgment against the company for $1,251,822.

 

The wrongful death beneficiaries filed a writ of garnishment against the insurer in an attempt to collect under the insurance policy. The insurer denied that the wrongful death beneficiaries were entitled to collect and filed a motion for summary judgment because the professional liability policy did not provide coverage as it was a “claims made” policy, which covered only claims made during the policy period, and the wrongful death beneficiaries did not make a claim during the policy period. The insurer asserted that there was no coverage under the general liability policy because the man’s death was the result of the failure to perform medical services, so the “health care professional services” exclusion applied. The Monroe County Circuit Court granted the insurer’s motion for summary judgment. The trial court found that the policy did not provide coverage. On appeal, the wrongful death beneficiaries sought payment under the general liability policy only.

 

The Supreme Court of Mississippi affirmed. The court held that the general liability policy’s “health care professional services” exclusion precluded coverage for claims for negligent hiring, negligent training, and failure to implement appropriate protocols.

 

The general liability policy’s “health care professional services” exclusion precluded coverage for claims of negligent hiring, negligent training, and failure to implement appropriate protocols. The court found that the paramedics were providing medical services or treatment to the man, which fell under the “health care professional services” exclusion. Under Texas law, if a claim would not exist but for conduct explicitly excluded by a liability insurance policy, the dependent claims are also not covered under the policy. The wrongful death beneficiaries’ claims for negligent hiring, negligent training, and failure to implement appropriate protocols are dependent because the wrongful death beneficiaries would not have been injured but for the paramedics' failure to provide medical attention. Failure to provide medical attention is an excluded service under the insurance policy. The exclusion applied to damages arising from the failure to provide medical services regardless of the theories of liability asserted.

 

The Supreme Court of Mississippi affirmed the trial court's grant of summary judgment in favor of the insurer.

 

See: Gray v. Arch Specialty Ins. Co., 2014 WL 5376981 (Miss., October 23, 2014) (not designated for publication).

 

See also Medical Law Perspectives, February 2013 Report: Emergency Medical Services: Liability and Immunity for Medical Rescue

 

 

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