When an ill Texan was allegedly secured negligently on a gurney and loaded into an ambulance by emergency medical technicians, then fatally injured when the gurney came loose, a question of coverage for the resulting tort action arose. Did the claim fall under the ambulance’s auto liability coverage (for loading and unloading), which included a “professional services” exclusion, or under the EMT’s general liability coverage, which excluded loss arising from a motor vehicle? The Fifth Circuit, applying Texas law, found that the injury had two causes and that neither policy was excess.
The deceased suffered a medical incident that brought the EMTs and an ambulance. Negligence was alleged, but the issue before the court was coverage, not liability. Both the ambulance’s insurer and the general liability insurer disputed coverage. The auto insurer agreed to defend the suit, but sought declaratory relief that its “professional services” exclusion applied, and that the EMT’s insurer was obligated to defend the suit. The general liability insurer argued however, that the claim arose out of the loading of a motor vehicle and was thus excluded in its policy. The federal district court found that the decision to transport the patient did not involve a “professional service,” therefore both insurers were obligated to defend the lawsuit, and the Fifth Circuit concurred.
Insurance claims often involve issues of who did what and whose insurance is primary, whose is excess, or whether both or none apply. Only through proper investigation, evaluation and negotiation can correct decisions be made.