Opinion ID: 1376031
Heading Depth: 1
Heading Rank: 2

Heading: general liability coverage

Text: A. Coverage Agreement The Fund agrees, subject to the limitations, terms, and conditions hereunder mentioned: 1. to pay on behalf of the Participant all sums which the Participant shall be obligated to pay by reason of the liability imposed upon the Participant by law or assumed by the Participant under contract or agreement for damages on account of Personal Injuries, including death at any time resulting therefrom, suffered or alleged to have been suffered by any person or persons (excepting employees of the Participant injured in the course of their employment)[.] Subsection H of section II defines the Covered Persons under the policy: 1. the Participantthe covered political subdivision named in the Contract Declarations[;] 2. any elected or appointed official of the Participant while acting within the scope of his authority, or apparent authority, expressed or implied, but only with respect to his liability while acting within the scope of his authority; 3. any employees of the Participant while acting within the scope of their duties, as such; and 4. any person or organization while acting as agent for the Participant, within the scope of his duties. Further, the policy contained certain enumerated exclusions in subsection E of section II, titled Exclusions Applicable to General Liability. Defendant contends that the exclusion in paragraph 18 of subsection E, titled Hospital and Health Clinic Professional Liability, removes the alleged negligent acts of the EMTs in question from coverage under the general liability section, and thus, sovereign immunity is not waived by virtue of the county's insurance policy. That exclusion provides as follows. 18. Hospital and Health Clinic Professional Liability To Personal Injury to any person arising out of the rendering of or failure to render any of the following professional services: a. medical, surgical, dental, or nursing treatment to such person or the person inflicting the injury including the furnishing of food or beverages in connection therewith; or b. furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; or c. handling of or performing post-mortem examinations on human bodies; or d. service by any person as a member of a formal accreditation or similar professional board or committee participant, or as a person charged with the duty of executing directives of any such board or committee.   However, this exclusion shall not apply to liability of county employed or county volunteer Emergency Medical Technicians. Plaintiff contends that the proviso at the bottom of subsection E, paragraph 18, removes EMTs from the exclusions and thus subjects Nash County to liability based upon its waiver of sovereign immunity. Defendant counters this argument by contending that this proviso applies to EMTs working in their individual capacity and not their official capacity and that sovereign immunity was therefore not waived. Defendant argues that the exclusions were written broadly and that the proviso was written narrowly. Therefore, defendant contends the policy's intent was to insure[] emergency medical technicians employed by Nash County for claims against them in their individual capacities alleging negligence in the performance of emergency ambulance services (to which sovereign immunity does not apply) without separately insuring Nash County for claims directly against it (since the County is protected from such claims by sovereign immunity). Defendant further argues that had the intent of the policy been to provide coverage for EMTs, then the proviso would have been written as follows: However, this exclusion shall not apply to any liability arising out of or in connection with the acts or omissions of county employed Emergency Medical Technicians. Defendant reasoned, and the Court of Appeals agreed, that the single use of the word liability in the proviso must refer only to the personal liability of EMTs, not to official liability, because [s]uits against governmental employees in their official capacity do not lead to `liability' against the individual governmental employee. Dawes v. Nash Cty., 148 N.C.App. 641, 648 n. 1, 559 S.E.2d 254, 259 n. 1 (2002). Our courts have long followed the traditional rules of contract construction when interpreting insurance policies. See Woods v. Nationwide Mut. Ins. Co., 295 N.C. 500, 505, 246 S.E.2d 773, 777 (1978); McDowell Motor Co. v. New York Underwriters Ins. Co., 233 N.C. 251, 253, 63 S.E.2d 538, 540 (1951). As our Court explained in Woods, [t]he various terms of the policy are to be harmoniously construed, and if possible, every word and every provision is to be given effect. If, however, the meaning of words or the effect of provisions is uncertain or capable of several reasonable interpretations, the doubts will be resolved against the insurance company and in favor of the policyholder. Whereas, if the meaning of the policy is clear and only one reasonable interpretation exists, the courts must enforce the contract as written; they may not, under the guise of construing an ambiguous term, rewrite the contract or impose liabilities on the parties not bargained for and found therein. 295 N.C. at 506, 246 S.E.2d at 777. The fallacy in defendant's argument, though innovative and persuasive, is contained in the specific terms of the policy setting forth the coverage agreement. Defendant Nash County contracted with North Carolina Counties Liability and Property Insurance Pool Fund (the Fund) to create the policy at issue. Nash County is the Participant or the party insured as stated on the declarations page. As we stated earlier, the policy specifically provides: The Fund agrees ... to pay on behalf of the Participant all sums which the Participant shall be obligated to pay by reason of the liability imposed upon the Participant ... under contract or agreement for damages on account of Personal Injuries, including death at any time resulting therefrom, suffered or alleged to have been suffered by any person or persons ... including but not limited to,... Incidental Malpractice.... (Emphasis added.) In subsection K of section II, incidental malpractice is defined as emergency professional medical services rendered or which should have been rendered to any person or persons ... by ... Technicians employed by or acting on behalf of the Participant. (Emphasis added.) Technician is defined in the policy as a certified first responder, certified emergency medical technician, certified intravenous technician, certified paramedic, or ambulance driver. Where a policy defines a term, that definition is to be used. Woods, 295 N.C. at 505-06, 246 S.E.2d at 777. Thus, the above portions of the policy plainly provide that the Fund will pay on behalf of the Participant damages incurred as the result of actions taken by the County's EMTs whether employed or voluntary. This coverage provision is consistent with the plain language of the proviso. The exclusions in paragraph 18 shall not apply to liability of county employed or county volunteer Emergency Medical Technicians. (Emphasis added.) Nothing in the coverage provision of the policy provides coverage for EMTs in their individual capacity. Coverage for liability to be paid by the Fund is available only when it is imposed against the participant (defendant Nash County) or selected covered persons (as defined in subsection H of section II) acting in an official capacity. In order for defendant's argument to prevail, the policy in question would need to provide coverage for, and agree for the Fund to pay for, liability incurred by EMTs in their individual capacities. Nothing in the coverage agreement provides for any other entity or personnel to be insured or covered other than the participant county and those county officials and employees named in section II, subsection H, titled Covered Persons. The argument by defendant interpreting the proviso at the bottom of section II, subsection E, paragraph 18 to cover EMTs in an individual capacity simply is not supported by the plain language of the policy. The insurer (the Fund) has in no way obligated itself to cover and pay for acts by individuals not a party to the insurance contract and for whose acts the participant is not responsible except in their official capacities. As we have concluded that the insurance policy in question does provide coverage for defendant County for the acts of its EMTs, the County's defense of sovereign immunity cannot prevail. Therefore, we reverse the decision of the Court of Appeals, which affirmed the trial court's grant of summary judgment for the County, and we remand this case to that court for further remand to the Superior Court, Nash County, for proceedings not inconsistent with this opinion. REVERSED AND REMANDED.