Opinion ID: 2745270
Heading Depth: 2
Heading Rank: 1

Heading: The Arch Insurance Policies

Text: ¶5. Arch issued an umbrella policy to Emergystat and Southland for the period of November 9, 2002, to December 1, 2007. The umbrella 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” had the same definition in both policies. Thus, in Arch’s words, the General Liability Policy excluded what the Professional Liability Policy included. ¶6. Arch moved for summary judgment, claiming that the Grays were not entitled to payment under either policy. Arch maintained that the Professional Liability Policy did not provide coverage because it was a “claims made” policy, which covered only claims made 3 during the policy period, and the Grays did not make a claim during the policy period.1 Arch asserted that there was no coverage under the General Liability Policy because William’s death was the result of the failure to perform medical services, so the “healthcare professional services” exclusion applied. The circuit court agreed. On appeal, the Grays seek payment under the General Liability Policy only. ¶7. The allegations in the Grays’ complaint became fact when the Grays obtained the default judgment. Capital One Servs., Inc. v. Rawls, 904 So. 2d 1010, 1018-19 (¶ 30) (Miss. 2004) (quoting Journey v. Long, 585 So. 2d 1268, 1272 (Miss. 1991)). Thus, taking the facts in the complaint as true, it was the paramedics’ failure to provide proper medical care that resulted in William’s death. The General Liability Policy excludes from coverage “‘[b]odily injury’ or ‘property damage’ that result from the performance of or failure to perform ‘health care professional services.’” The policy defines “health care professional services” as follows: a. Medical, surgical, dental, x-ray, nursing, mental, or other similar health care professional services or treatments. b. Providing or dispensing of food, beverages, medications or medical supplies or appliances in connection with services described in Paragraph
c. Handling or treatment of dead bodies, including autopsies, organ donation or harvesting, or other procedures. 1 Claims brought under the Professional Liability Policy had to be filed during the policy period (November 9, 2002 – December 1, 2007) to be covered. The Grays filed their complaint on April 7, 2009. Thus, the claims were not covered. The Grays do not dispute the lack of coverage, and they seek payment under the General Liability Policy only. 4 d. The work of your formal accreditation, standards review or equivalent professional board or committee, done for any insured while: (1) Evaluating the professional qualifications or clinical performance of any provider of health care professional services; or (2) Promoting and maintaining the quality of health care professional services being provided. e. The execution, or failure to execute, a decision or directive of your formal accreditation, standards review or equivalent professional board or committee. The paramedics were providing medical services or treatment to William, and their conduct falls under section A of the “health care professional services” exclusion. The Grays do not dispute that section A excludes medical services, but they assert that their claims for negligent hiring and training are not excluded under that section.