Exclusion Denied for Use of the word “Included” in Declaration Page

Johnson v. Conn. Ins. Guar. Ass'n, 302 Conn. 639 (Conn. 2011)(November 8, 2011)

Plaintiff executor of decedent's estate sought a declaratory judgment to determine whether a policy issued to defendant medical group covered the estate's claims for medical malpractice. The policy contained an exclusion from corporate coverage liability based on injury arising solely out of acts or omissions in the rendering of professional services by any paramedical for which a premium charge was shown on the declarations page. 

The trial court rendered judgment in the estate’s favor, determining that the exclusion plainly did not apply focusing on the fact that the paramedical in questions was not a named insured, a dispositive fact in a question of coverage in Connecticut Medical Ins. Co. v. Kulikowski, 286 Conn. 1, 942 A.2d 334 (2008). The trial court further concluded that the exception did not apply because "the premium charge for paramedicals …was listed as 'included' and there were no paramedicals identified in or premium charges for paramedicals listed on [the] declaration pages.”

The insurer appealed, claiming that the insurance policy unambiguously indicated that the paramedical exclusion was applicable to the plaintiffs' claims. The insurer argued that the exclusion applies to paramedical employees as a class, as long as there is a premium shown for that class on the declarations page; and such a premium is shown on the declarations page in the word "included". The insurer asserted that the trial court improperly determined that the paramedical had to be named on the declarations page in order for the exclusion to apply. The association conceded that the policy was intended to cover the type of claim alleged in the underlying malpractice action but contended that, because that coverage existed only under the section for Paramedical Employee Liability, the plaintiffs' failure to name the paramedical as a defendant resulted in there being no coverage under the policy to shield the policyholder from liability.

The Connecticut Supreme Court concluded that the policy did not unambiguously manifest a clear intention to exclude coverage for the insured. Even if the exclusion referred to paramedicals as a class, the policy did not unambiguously show a premium charge for that class on the declarations page. Accordingly, the policy exclusion was inapplicable to the insured's coverage for claims brought against it predicated solely on liability that it may incur. Judgment was properly granted in favor of the estate.

For a copy of the decision click here

Matt Cabral and Anthony Golowski


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