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Little things mean a lot in an insurance coverage dispute

Mon Jan 20th, 2014 on     Insurance Claims,    

Questions about insurance coverage often turn on small details. A decision from the 5th U.S. Circuit Court of Appeals — Florida is in the 11th Circuit — illustrates the point and offers insight into just how complicated insurance litigation can be.

At the center of this dispute is a woman who relied on an ambulance service to take her to a dialysis center for treatment. To transport her to and from the vehicle, the emergency medical technicians used a gurney.

According to court documents, in July 2006, EMTs arrived at the clinic to take the woman home. They placed her on a gurney and began to roll the gurney out of the clinic to the ambulance. The unthinkable happened: One of the wheels caught on something, the gurney tipped over, and the woman fell to the ground.

The fall left her with a fractured shoulder; the fracture meant that the dialysis port had to be moved from her arm to her neck. She passed away a few days later, and her daughter filed a wrongful death claim against the ambulance company.

The ambulance company had two insurance policies written by two different companies: a commercial auto policy from Company A and a commercial general liability policy from Company B. The general liability policy included professional liability coverage for ambulance services as well.

The litigation with the woman’s daughter was complicated, but the parties finally settled. Each insurer paid $100,000 toward the settlement. With that matter cleared up, the insurance companies set about trying to recoup their losses — by suing one another.

The trial court decided that the incident should be covered by Company B. According to the opinion, the woman’s injuries were not the result of the use of an automobile, so the auto insurer had no duty to indemnify. The full $200,000 was Company B’s responsibility.

The appellate panel disagreed, and this is the tiny detail that we were talking about. The court said that the EMT was touching both the gurney and the ambulance at the time of the accident; the EMTs were clearly in the process of putting the woman into the ambulance. Therefore, the injury resulted from the use of an auto, and the auto insurer, Company A, should bear the full responsibility and pay the entire $200,000.

That one touch made the difference.

Source: Business Insurance, “Ruling in Scottsdale Insurance’s favor in ambulance death overturned,” Judy Greenwald, Jan. 16, 2014

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