Westchester General Hospital, Inc. v. Evanston Insurance Company

48 F.4th 1298
CourtCourt of Appeals for the Eleventh Circuit
DecidedSeptember 16, 2022
Docket20-14814
StatusPublished
Cited by19 cases

This text of 48 F.4th 1298 (Westchester General Hospital, Inc. v. Evanston Insurance Company) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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

Opinion

USCA11 Case: 20-14814 Date Filed: 09/16/2022 Page: 1 of 21

[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 ____________________ USCA11 Case: 20-14814 Date Filed: 09/16/2022 Page: 2 of 21

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 insur- ance policy. The Defendant, Evanston Insurance Company (“Ev- anston”), appeals the district court’s grant of summary judgment in favor of Plaintiff Westchester General Hospital, Inc. (“Westches- ter”), 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 be- gins with a violent act. On December 31, 2018, Jane Doe was a USCA11 Case: 20-14814 Date Filed: 09/16/2022 Page: 3 of 21

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 in- cident. The Does sued Westchester and Ramos-Garcia in Miami- Dade County circuit court, claiming that Westchester was negli- gent for failing to adequately investigate, train, and supervise its staff. Westchester’s insurance policy, issued by Evanston, pro- vides 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 rele- vant to this case, and (2) the General Liability Insurance Policy (“GL Coverage Part”), which is. The GL Coverage Part is a wide- ranging policy that provides Westchester with the following cov- erage 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 Dec- larations, which the Insured shall become legally ob- ligated 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. USCA11 Case: 20-14814 Date Filed: 09/16/2022 Page: 4 of 21

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 Ser- vices 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 ser- vices 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 “Pro- fessional Services” is defined as encompassing ten broad categories, which are listed in the Hospital Amendatory Endorsement Aggre- gate Policy Limit (“Hospital Endorsement”). These are the cate- gories: 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 subpara- graph I.1. hereinabove; 3. The handling or performing of post-mortem USCA11 Case: 20-14814 Date Filed: 09/16/2022 Page: 5 of 21

20-14814 Opinion of the Court 5

examination or organ donation or harvesting on dead human bodies; 4. Health or therapeutic services, treatments, ad- vice or instructions; 5. Medical or mental health counseling services, social services or other such treatments; 6. Furnishing or dispensing of pharmacotherapeu- tic agents, including chemical and biological prod- ucts 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 In- sured’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 In- sured.

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 USCA11 Case: 20-14814 Date Filed: 09/16/2022 Page: 6 of 21

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 na- ture 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, ex- plaining 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 po- tential judgment entered against it. Westchester sued Evanston in the Eleventh Judicial Circuit in and for Miami-Dade County on May 29, 2019, seeking a declar- atory judgment that Evanston owed a duty to defend Westchester in the Does’ lawsuit under the GL Coverage Part of the policy. Ev- anston removed the action to federal court in the Southern District of Florida on July 10, 2019. Thereafter, the parties moved for sum- mary judgment, disputing whether the Professional Services Exclu- sion 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, USCA11 Case: 20-14814 Date Filed: 09/16/2022 Page: 7 of 21

20-14814 Opinion of the Court 7

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Bluebook (online)
48 F.4th 1298, Counsel Stack Legal Research, https://law.counselstack.com/opinion/westchester-general-hospital-inc-v-evanston-insurance-company-ca11-2022.