Health Care Professional Services Exclusion Applies Where Injury Would Not Exist But-For Failure to Provide Medical Attention

The Supreme Court of Mississippi held that a health care professional services exclusion applies where the damage alleged in an underlying claim would not exist but-for paramedics’ failure to provide medical attention under Mississippi law.  Gray v. Arch Spec. Ins. Co., No. 2013-CA-01124-SCT (Miss. Oct. 23, 2014). 

The underlying claimants filed a wrongful death suit against the insureds, alleging that the paramedics employed by the insureds were negligent in rendering medical care to an automobile accident victim, resulting in his death.  The underlying claim also alleged negligent hiring, negligent training, and failure to implement appropriate triage protocols.  After the insurer denied coverage, the underlying claimants procured a default judgment against the insureds.  The underlying claimants subsequently filed a writ of garnishment against the insurer.  The insurer’s policy excluded coverage for damages “result[ing] from the performance or failure to perform ‘health care professional services,’” defined in pertinent part as “[m]edical, surgical, dental, x-ray, nursing, mental, or other similar health care professional services or treatments.”

Accepting the underlying claimants’ allegations as true in light of the default judgment entered against the insureds, the Mississippi high court held that the health care professional exclusion barred coverage for the underlying claim given that “the [underlying claimants] would not have been damaged but for the paramedics’ failure to provide medical attention, which [wa]s an excluded service” under the exclusion.  According to the court, the “exclusion applie[d] to damages arising from the failure to provide medical services regardless of the theories of liability asserted.”  Accordingly, the court rejected the underlying claimants’ argument that the underlying claim’s allegations of negligent hiring, negligent training, and failure to implement appropriate protocols triggered coverage.