Plaintiffs — mother and child — suffered permanent injuries when their doctor negligently delayed an emergency c-section. They sued the doctor, who had a malpractice policy with an indemnity limit of $1 million per occurrence. The insurance company treated the malpractice as a single occurrence, limiting coverage to $1 million, but the doctor and the plaintiffs argued that the injuries to mother and child constituted 2 occurrences, making $2 million of coverage available under the policy. The trial court sided with the insurance company, observing that the allegations of negligence by the doctor all stemmed from the doctor’s treatment of the mother prior to delivery, while none referenced treatment rendered to the child. Thus, the trial court judge determined that the acts of malpractice arose from a single medical occurrence.
A Missouri appeals court reversed, reasoning that while the policy defines “medical occurrence” as an “act or occurrence . . . in the furnishing of professional medical services,” it also provides that “any such act or omission, together with all related acts or omissions in the furnishing of such services to any one person shall be considered one medical incident or occurrence”. So, in the court’s view, when two persons allege injury from the furnishing of medical services, there are two (2) separate medical occurrences and so two (2) separate limits under the policy. The appeals court stated that any ordinary person of average understanding buying this insurance would understand medical treatment provided to 2 different people to comprise 2 separate occurrences.
As a result, mother and child recovered $2 million from the doctor’s insurance company. Seems obvious, right? Not without a fight, however.
If you have to fight your insurance company, don’t hesitate to give us a call.
Patty v. Missouri Professionals Mutual Physicians Professional Indemnity Assoc. (Missouri Court of Appeals, Eastern District).
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack