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No Insurance Coverage for Pathologist on Exonerated Criminal Defendant Claims


A forensic pathologist testified as a state’s witness in criminal trials. Exonerated criminal defendants against whom the pathologist had testified sued the pathologist for malicious prosecution, fraud, and negligent misrepresentation. The pathologist sought coverage under a medical malpractice insurance policy he had purchased from the insurer. The insurer declined to provide coverage, arguing that the exonerated criminal defendants were not “patients” under the pathologist's medical malpractice insurance policy, and that the company therefore was under no obligation to cover the pathologist in relation to the suit brought by the exonerated criminal defendants.

 

The language of the policy stated that the insurer would defend the pathologist for claims brought against him for incidents occurring during the coverage period. The policy defined “claim” as a suit alleging injury, disability, sickness, disease, or death to a patient arising from the pathologists rendering or failing to render professional services. The policy also had an exclusionary clause for work the pathologist performed as a governmental employee.

 

The pathologist filed suit against the insurer, arguing that the insurer knew when it issued the policy exactly what kind of medicine he practiced, and that the insurance policy covered him for the types of medical malpractice suits he might face, including the suit filed by the exonerated criminal defendants. The pathologist submitted into evidence a “policy booklet” which he claimed represented the policy that he had purchased. The policy booklet had a different definition of “claim” than that contained in the insurance policy. It defined a “claim” as a demand for payment of damages arising from a professional services incident.

 

The insurer moved for summary judgment, arguing that the policy language was clear and unambiguous in the kind of coverage provided, and that this lawsuit by an exonerated nonpatient regarding testimony that the pathologist had given as an expert witness did not fall within the policy's coverage. Moreover, the insurer argued that the exclusionary clause applied because the pathologist was a government employee when he testified for the State of Mississippi against the exonerated criminal defendant. The Circuit Court of the First Judicial District of Hinds County granted summary judgment in favor of the insurer.

 

The Supreme Court of Mississippi affirmed. The court held that the medical malpractice insurance policy did not provide coverage for suits brought by exonerated nonpatient criminal defendants against whom the pathologist had testified, who alleged injuries to themselves due to the pathologist's negligence. The court also held the policy booklet provided to the forensic pathologist, which defined a “claim” as a demand for payment of damages arising from a professional services incident, and contained different terms than the actual medical malpractice policy, did not create an ambiguity in what the language of the policy actually said with regard to what constituted a claim.

 

The medical malpractice insurance policy did not provide coverage for suits brought by exonerated nonpatient criminal defendants against whom the pathologist had testified, who alleged injuries to themselves due to the pathologist's negligence. The policy unambiguously provided coverage only for claims arising out of injury to patients. Even if someone had informed the forensic pathologist that his policy would cover him for the type of malpractice claims he was likely to face, the plain language of the policy unambiguously denied coverage when sued by a non-patient.

 

The policy booklet provided to the forensic pathologist, which defined a “claim” as a demand for payment of damages arising from a professional services incident, and contained different terms than the actual medical malpractice policy, did not create an ambiguity in what the language of the policy actually said with regard to what constituted a claim. The pathologist acknowledged that he received a copy of the policy. Knowledge of the terms of the policy was imputed to the pathologist. The policy unambiguously provided coverage only for claims arising from injury to patients.

 

The Supreme Court of Mississippi affirmed the trial court’s judgment in favor of the insurer.

 

See: Hayne v. Doctors Co., 2014 WL 4243766 (Miss., August 28, 2014) (not designated for publication).

 

See also Medical Law Perspectives, June 2013 Report: Independent Medical Evaluations: Legal Risks and Responsibilities

 

 

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