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Truck Insurance Exchange v. Pacificare Health Systems3/30/2005
essional liability." Both of these clauses require the insurers to indemnify PacifiCare for sums that it is obligated to pay because of "injury."
The policies define what constitutes an injury. The pertinent clause reads, "The terms injury, sickness, disease and death as used herein include, but are not limited to, bodily injury and injury, sickness, disease or death resulting from rendering or failing to render professional services, or from . . . discrimination, false arrest or imprisonment, malicious prosecution, libel, slander, defamation of character or invasion of privacy."
The policies state that the insurers will " efend any suit against the insured alleging such injury, sickness, disease, death, destruction, malpractice, error, or mistake and seeking damages on account thereof, even if such suit is groundless, false or fraudulent . . . ."
a. The Hospital and Professional Liability Insuring Clause
The hospital and professional liability clause of respondents' policy promises " o pay on behalf of the insured all sums which the insured shall become legally obligated to pay as damages because of injury to any person arising out of the rendering of or failure to render, while the policy is in force, the following Hospital and Professional services: [ ] (1) medical, surgical, dental, nursing or other health care services to such person . . . ." This coverage applies only to "occurrences." An "occurrence" "means the rendering of, or the failure to render, professional services during the policy period."
Per the policy's list of definitions, injuries "include but are not limited to, bodily injury and injury, sickness, disease or death resulting from rendering or failing to render professional services . . . ." (Italics added.) The term "bodily injury" is "unambiguous. It means physical injury and its consequences." (Aim Insurance Co. v. Culcasi (1991) 229 Cal.App.3d 209, 220.) Here, an injury described by the CHPL policy merely "includes" bodily injury. A "`definition of a thing as "including" certain things does not necessarily place thereon a meaning limited to the inclusions.'" (Flanagan v. Flanagan (2002) 27 Cal.4th 766, 774.)
We are left wondering what constitutes an "injury to any person" covered by the hospital and professional liability clause. The nature of the covered injury is ambiguous. Because contrary to respondents' position, covered injuries are not limited to bodily injury.
Respondents maintain that "injury to any person" means "personal injury," thereby transforming the broad concept of "injury" into a term of art. In insurance contracts, "personal injury" coverage, which is broader than bodily injury coverage, is triggered by the insured's wrongful acts (such as false arrest, malicious prosecution, defamation, and invasion of privacy), not by the nature of the injury or the type of damages demanded by the third party claimant, and it may cover intentional wrongdoing. (Atlantic Mutual Ins. Co. v. J. Lamb, Inc. (2002) 100 Cal.App.4th 1017, 1032; Martin Marietta Corp. v. Insurance Co. of North America (1995) 40 Cal.App.4th 1113, 1125; Croskey et al., Cal. Practice Guide, Insurance Litigation (The Rutter Group 2004) 7:127 to 7:128.)
In this CHPL policy, respondents agreed to pay for injuries to any person arising out of the rendering or the failure to render professional health care services. "Professional liability policies obligate the insurer to indemnify the insured against liability to third persons for loss or detriment caused by the insured." (Croskey, supra, Cal. Practice Guide, Insurance Litigation, 7:2475.) Injuries "arise out of" an insured's conduct even if there is only a minima
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