Bradley DeWall v. Medical Protective Company, No. 22-1952 (8th Cir. 2023)
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Medical Protective Company (“MedPro”) issued Professional Liability policies to Dr. Bradley DeWall and Wound Management Consultants, P.C. (collectively, “WMC”). Coverage Paragraph A insured WMC against “claim[s] for damages . . . based on professional services rendered or which should have been rendered . . . by the insured . . . in the practice of the insured’s profession.” In this coverage action, the parties dispute whether Paragraph A covers a third party’s claim to recover Medicare reimbursements it had to repay because of deficiencies in WMC’s documentation of the professional services it provided. Applying Iowa law, the district court1 ruled, consistent with other courts that have considered the issue, that the third party’s “Medicare recoupment” claim is not “based upon professional services” and, therefore coverage is limited to the $50,000 of defense costs provided in the policies’ separate Medicare Endorsement. WMC appealed this summary judgment ruling, raising numerous issues.
The Eighth Circuit affirmed. The court concluded that MedPro had no duty to defend WMC from Genesis’s Medicare recoupment claim under the policies’ Paragraph A coverage. The court also agreed with the district court that there is no duty to defend the other claims Genesis asserted in its arbitration complaint because those claims are not “based upon professional services rendered . . . in the practice of [WMC’s] profession.”
Court Description: [Loken, Author, with Gruender and Grasz, Circuit Judges] Civil case - Contracts. Medical services provider sought declaratory judgment that insurance provider had a duty to defend and indemnify it in an arbitration action involving recoupment of Medicare overpayments made to the provider. Held: The reimbursed payments were not based on any professional services that were or should have been rendered by provider, and insurer had no duty to defend or indemnify provider from Medicare recoupment claim under insurance policy's professional services liability coverage provision.
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