Insurer Not Covered for Medical Reimbursement Claims

Wellpoint, Inc. v. Nat’l Union Fire Ins. Co. (Ind. Ct. App., June 19, 2013)

Last month the Court of Appeals of Indiana affirmed summary judgment in favor of several reinsurers in a case seeking defense and settlement coverage for medical reimbursement claims, finding that the underlying claims did not stem solely from the plaintiff-insurer’s professional services. The plaintiff-insurer brought suit against certain reinsurers that denied it coverage for claims alleging that the insurer had inadequately reimbursed or improperly denied reimbursement to physicians for medical services. The policy provided coverage for claims alleging a wrongful act occurring “solely in the rendering of or failure to render professional services.” The appeals court affirmed the trial court’s determination that “professional services,” as referenced in the policy, included only those services rendered in the conduct of the insurer’s claims handling or adjusting and did not include medical reimbursement claims.