Westchester General Hospital, Inc. v. Evanston Insurance Company

48 F.4th 1298
Court of Appeals for the Eleventh Circuit·Decided September 16, 2022·No. 20-14814·Published·Cited by 19 cases

Opinion

[PUBLISH]

In the

United States Court of Appeals For the Eleventh Circuit

No. 20-14814

WESTCHESTER GENERAL HOSPITAL, INC., Plaintiff-Appellee,

versus EVANSTON INSURANCE COMPANY,

Defendant-Appellant.

Appeal from the United States District Court for the Southern District of Florida D.C. Docket No. 1:19-cv-22831-KMW

2 Opinion of the Court 20-14814

Before JORDAN, JILL PRYOR, and MARCUS, Circuit Judges. MARCUS, Circuit Judge:

This diversity case requires us to interpret a quirky insurance policy. The Defendant, Evanston Insurance Company (“Evanston ”), appeals the district court’s grant of summary judgment in favor of Plaintiff Westchester General Hospital, Inc. (“Westchester ”), challenging the district court’s holding that Evanston must defend Westchester in its ongoing litigation against Jane and John Doe (the “Does”). After the Does sued Westchester for negligence based on a violent incident that occurred at Westchester’s facility, Westchester sought coverage from Evanston, its insurer, under Westchester’s “Specified Medical Professions Insurance Policy” (“the Policy”). Evanston refused to provide complete coverage. So, Westchester sued Evanston, seeking a declaratory judgment that Evanston must defend it in its ongoing litigation against the Does. After the case was removed to federal court, a district court judge in the Southern District of Florida granted partial summary judgment in favor of Westchester, and Evanston appealed.

The district court’s grant of summary judgment in favor of Westchester was proper because none of the relevant exclusions invoked by Evanston bars coverage for the Does’ claims against Westchester. Accordingly, we affirm.

I.

The story of this seemingly mundane insurance dispute begins with a violent act. On December 31, 2018, Jane Doe was a 20-14814 Opinion of the Court 3

patient at Westchester’s mental health facility in Miami-Dade County. While asleep and medicated, Doe was allegedly sexually assaulted and raped by Fernando Felix Ramos-Garcia (“Ramos- Garcia”), who was employed by Westchester at the time of the incident . The Does sued Westchester and Ramos-Garcia in Miami- Dade County circuit court, claiming that Westchester was negligent for failing to adequately investigate, train, and supervise its staff.

Westchester’s insurance policy, issued by Evanston, provides insurance coverage for Westchester’s defense against a third party’s legal claims. The Policy has two parts: (1) the Professional Liability Insurance Policy (“PL Coverage Part”), which is not relevant to this case, and (2) the General Liability Insurance Policy (“GL Coverage Part”), which is. The GL Coverage Part is a wideranging policy that provides Westchester with the following coverage for bodily injury and property damage liability:

[Evanston] shall pay on behalf of the Insured all sums in excess of the Deductible amount stated in the Declarations , which the Insured shall become legally obligated to pay as Damages as a result of a Claim first made against the Insured during the Policy Period or during the Extended Reporting Period, if exercised, and reported to the Company . . . for Bodily Injury or Property Damage caused by an Occurrence[.]

DE 31-1 at 27.

4 Opinion of the Court 20-14814

The Policy also contains an Umbrella Policy, which provides excess indemnity coverage if either the PL Coverage Part or the GL Coverage Part applies.

The GL Coverage Part has several exclusions to coverage.

Two of them are relevant for our purposes: the Professional Services Exclusion and the Bodily Injury Exclusion. The Professional Services Exclusion excludes any claim:

[b]ased upon, arising out of, or in any way involving an act, error or omission in the performance of services of a professional nature rendered or that should have been rendered by the Insured or by any person or organization for whose acts, errors or omissions the Insured is legally responsible[.]

DE 31-1 at 33.

The critical phrase “services of a professional nature” is not defined anywhere else in the Policy, though the similar term “Professional Services” is defined as encompassing ten broad categories, which are listed in the Hospital Amendatory Endorsement Aggregate Policy Limit (“Hospital Endorsement”). These are the categories :

1. Medical, surgical, dental, x-ray, nursing, mental health services or treatments; 2. The furnishing of food, beverages, drugs or medical, dental or surgical supplies or appliances in connection with the services stated in subparagraph I.1. hereinabove; 3. The handling or performing of post-mortem 20-14814 Opinion of the Court 5

examination or organ donation or harvesting on dead human bodies; 4. Health or therapeutic services, treatments, advice or instructions; 5. Medical or mental health counseling services, social services or other such treatments; 6. Furnishing or dispensing of pharmacotherapeutic agents, including chemical and biological products or medical, dental or surgical appliances or equipment; 7. Services in connection with a Clinical Trial; 8. Supervising, teaching or proctoring services rendered by a natural person at the Named Insured ’s request; 9. Services rendered by an Insured as a member of a formal accreditation or similar professional board or committee of the Named Insured; or 10. The execution or failure to execute a decision or directive of a formal accreditation or similar professional board or committee of the Named Insured .

DE 31-1 at 83.

While the Professional Services Exclusion bars coverage for claims arising out of acts involving the performance of “services of a professional nature,” the Bodily Injury Exclusion bars coverage for claims that are:

[b]ased upon or arising out of Bodily Injury sustained by any patient, person or resident of a facility 6 Opinion of the Court 20-14814

receiving services of a professional nature or any such Claim brought by or on behalf of the spouse, child, parent, grandparent, brother, sister or partner of such patient, person or resident of a facility.

DE 31-1 at 36.

After the Does filed their complaint against Westchester, Westchester promptly notified Evanston of the existence and nature of the Does’ lawsuit. At the time of the alleged sexual assault, the Policy and the Umbrella Policy were in effect. Evanston issued a reservation of rights letter to Westchester on April 2, 2019, explaining that it would provide a defense to Westchester under the PL Coverage Part, but refusing to defend Westchester under any other parts of the Policy or to indemnify Westchester for any potential judgment entered against it.

Westchester sued Evanston in the Eleventh Judicial Circuit in and for Miami-Dade County on May 29, 2019, seeking a declaratory judgment that Evanston owed a duty to defend Westchester in the Does’ lawsuit under the GL Coverage Part of the policy. Evanston removed the action to federal court in the Southern District of Florida on July 10, 2019. Thereafter, the parties moved for summary judgment, disputing whether the Professional Services Exclusion and the Bodily Injury Exclusion of the GL Coverage Part barred coverage. In an Omnibus Report & Recommendation (“R&R”), the magistrate judge determined that Westchester was covered under the GL Coverage Part and the Umbrella Policy, 20-14814 Opinion of the Court 7

rejecting Evanston’s argument that the Professional Services Exclusion and the Bodily Injury Exclusion barred coverage.

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Westchester General Hospital, Inc. v. Evanston Insurance Company, 48 F.4th 1298 (11th Cir. 2022).

48 F.4th 1298 (Westchester General Hospital, Inc. v. Evanston Insurance Company) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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