Mt. Hawley Insurance v. Lopez

215 Cal. App. 4th 1385, 156 Cal. Rptr. 3d 771, 2013 WL 1818627, 2013 Cal. App. LEXIS 346
CourtCalifornia Court of Appeal
DecidedMay 1, 2013
DocketB234082
StatusPublished
Cited by86 cases

This text of 215 Cal. App. 4th 1385 (Mt. Hawley Insurance v. Lopez) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mt. Hawley Insurance v. Lopez, 215 Cal. App. 4th 1385, 156 Cal. Rptr. 3d 771, 2013 WL 1818627, 2013 Cal. App. LEXIS 346 (Cal. Ct. App. 2013).

Opinion

Opinion

SEGAL, J. *

INTRODUCTION

Insurance Code section 533.5, subdivision (b), 1 precludes insurers from providing a defense for certain kinds of claims. The statute provides: “No policy of insurance shall provide, or be construed to provide, any duty to *1390 defend . . . any claim in any criminal action or proceeding or in any action or proceeding brought pursuant to” California’s unfair competition law under Business and Professions Code sections 17200 and 17500 “in which the recovery of a fine, penalty, or restitution is sought by the Attorney General, any district attorney, any city prosecutor, or any county counsel, notwithstanding whether the exclusion or exception regarding the duty to defend this type of claim is expressly stated in the policy.” In Bodell v. Walbrook Ins. Co. (9th Cir. 1997) 119 F.3d 1411 (BodellI), the Ninth Circuit held that section 533.5, subdivision (b), applies to criminal actions brought by the four listed state and local agencies but does not apply to criminal actions brought by federal prosecutors. The dissenting judge in Bodell and the trial court in this case concluded that section 533.5, subdivision (b), applies to any criminal action, including federal criminal actions. We agree with the Ninth Circuit and hold that section 533.5, subdivision (b), does not preclude an insurer from agreeing to provide a defense for criminal actions against its insured brought by federal prosecutors. Therefore, the insurer in this case, which had agreed to provide its insureds with a defense in “a criminal proceeding . . . commenced by the return of an indictment” “even if the allegations are groundless, false or fraudulent,” cannot avoid its contractual duty to defend an insured against federal criminal charges by relying on section 533.5, subdivision (b).

FACTUAL AND PROCEDURAL BACKGROUND

1. The Indictment

On January 6, 2010, the United States Attorney for the Central District of California filed a grand jury indictment charging Dr. Richard R. Lopez, Jr., with criminal conspiracy, false statements and concealment, and falsification of records. The indictment alleged that Lopez, who was the medical director of the St. Vincent Medical Center’s comprehensive liver disease center, conspired with another doctor and other hospital employees in the liver transplant program to transplant a liver into the wrong patient. 2

According to the indictment, Lopez diverted a liver designated for one patient to a different patient who was further down the list of patients waiting for a liver transplant, in violation of regulations promulgated by the United States Department of Health and Human Services under the National Organ Transplant Act (Pub.L. No. 98-507 (Oct. 19, 1984) 98 Stat. 2339), and then *1391 covered up his diversion. The indictment alleges that Lopez initially notified the United Network for Organ Sharing (UNOS) that the second patient had received the liver, but later falsely told UNOS that the first patient had received the liver. The indictment further alleges that as a result the first patient never received a liver, “was removed from the liver transplant wait list,” was “thereafter deprived of the opportunity to have this life-saving operation,” and subsequently died. The indictment alleges that Lopez engaged in a coverup by directing his coconspirators to restore the second patient’s name to the transplant waiting list (even though the second patient had received the liver designated for the first patient), create a false pathology report for the first patient based on data in the second patient’s pathology report, and alter medical reports to support a claim “that the transplant program had made an honest mistake confiising the names.” The eight-count indictment included alleged violations of title 18 United States Code sections 371 (conspiracy), 1001 (making false statements), and 1519 (destruction, alteration, or falsification of evidence in federal investigations).

2. The Policy

Daughters of Charity Health Systems (DCHS), which owns St. Vincent’s, purchased a “Not For Profit Organization and Executive Liability Policy” pursuant to which Mt. Hawley agreed to “pay on behalf of the Insureds, Loss which the Insureds are legally obligated to pay as a result of Claims . . . against the Insured for Wrongful Acts . . . .” The policy defines “Loss” as “monetary damages, judgments, settlements, including but not limited to punitive, exemplary, multiple or non-contractual liquidated damages where insurable under applicable law, . . . and Defense Expenses which the Insureds are legally obligated to pay as a result of a covered Claim.” The policy further provides that Mt. Hawley “shall have the right and duty to defend any Claim covered by this Policy, even if any of the allegations are groundless, false or fraudulent . . . .” An endorsement defines “claim” to include “a criminal proceeding against any Insured commenced by the return of an indictment” or “a formal civil, criminal, administrative or regulatory investigation against any Insured . . . .” The policy’s definition of “insured” can include employees of St. Vincent’s like Lopez. 3

*1392 3. The Action

On March 3, 2010, Lopez tendered the defense to the charges to Mt. Hawley. On April 1, 2010, Mt. Hawley, through its attorneys, sent a letter to Lopez declining to defend or indemnify Lopez, and on the same date filed this action. Mt. Hawley’s first amended complaint alleged that a doctor at St. Vincent’s, with Lopez’s “knowledge and approval,” transplanted a liver designated for one patient “who was second in line on the regional waitlist” for a liver into another patient “who was fifty-second on the waiting list,” without prior approval. Mt. Hawley alleged that Lopez “engaged in an elaborate cover-up of the ‘switch,’ which included falsification of documents and encouragement of others to participate in the cover-up.” Mt. Hawley alleged that it had no duty to defend Lopez because of section 533.5, a “remuneration exclusion” or “personal profit exclusion,” and a “medical incident exclusion.” 4 Mt. Hawley sought a declaration that it did not owe Lopez a duty to defend or indemnify in connection with the indictment. Lopez filed a cross-complaint against Mt. Hawley for breach of contract, breach of the implied covenant of good faith and fair dealing, and declaratory relief.

4. The Demurrer and the Motion for Summary Judgment

Lopez filed a motion for judgment on the pleadings on Mt. Hawley’s original complaint and a demurrer to Mt. Hawley’s first amended complaint.

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Bluebook (online)
215 Cal. App. 4th 1385, 156 Cal. Rptr. 3d 771, 2013 WL 1818627, 2013 Cal. App. LEXIS 346, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mt-hawley-insurance-v-lopez-calctapp-2013.