American Family Mutual Insurance Co. v. Enright

Case Date: 11/01/2002
Court: 2nd District Appellate
Docket No: 2-01-0630, 2-01-0653 cons. Rel

Nos. 2--01--0630 & 2--01--0653 cons.


IN THE

APPELLATE COURT OF ILLINOIS

SECOND DISTRICT


AMERICAN FAMILY MUTUAL INSURANCE
COMPANY,

               Plaintiff-Appellant,

v.

ROBERTA ENRIGHT, Indiv. and as
Mother and Next Friend of
Jane Doe, a Minor; NORTH SHORE
ULTRASOUND, INC.; ACE PROPERTY
AND CASUALTY INSURANCE COMPANY,
f/k/a Cigna Insurance Company,

               Defendants-Appellees

(Matthew S. Burnett and
Midwestern Regional Medical
Center, Inc., Defendants).

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Appeal from the Circuit
Court of Lake County.



No. 00--MR--251










Honorable
John R. Goshgarian,
Judge, Presiding.

AMERICAN FAMILY MUTUAL
INSURANCE COMPANY,

               Plaintiff and
               Counterdefendant-Appellee,

v.

ACE AMERICAN INSURANCE COMPANY,
f/k/a Cigna Insurance Company,

              Defendant and
              Counterplaintiff-Appellant

(Roberta Enright, Indiv. and as
Mother and Next Friend of Jane
Doe, a Minor; and North Shore
Ultrasound, Inc., Defendants
and Counterdefendants-Appellees
(Midwestern Regional Medical
Center, Inc., and Matthew C.
Burnett, Defendants and
Counterdefendants)).

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Appeal from the Circuit
Court of Lake County.




No. 00--MR--251













Honorable
John R. Goshgarian,
Judge, Presiding.


JUSTICE BYRNE delivered the opinion of the court:

These consolidated appeals involve multiple declaratory judgment actionsarising from an underlying complaint in which Roberta Enright, as mother and nextfriend of the minor, Jane Doe, sued Matthew C. Burnett and his employer, NorthShore Ultrasound, Inc. (NSU), alleging that Burnett sexually assaulted Jane Doewhile performing an ultrasound procedure. The trial court found that bothAmerican Family Insurance Company (American) and Ace American Insurance Company(Ace) owe a duty to defend NSU, but American's policy is primary, and that Aceowes a duty to defend Burnett. Midwestern Regional Medical Center, Inc.(Midwestern), and Burnett are not parties to the appeals. We affirm in part andreverse in part.

FACTS

NSU provides technical support for the performance of ultrasound proceduresby furnishing agents and employees to facilities, including Midwestern. Burnettwas employed by NSU as a licensed ultrasound technician. On July 11, 1998, whileperforming ultrasound procedures on Jane Doe, Burnett sexually assaulted Jane Doeby placing his finger in her vagina against her will.

Enright filed a five-count complaint against NSU, Midwestern, and Burnetton December 2, 1999, for injuries incurred by Jane Doe. Count I alleges a causeof action for negligent hiring against NSU; counts II, III, and IV are directedagainst NSU and Midwestern and are not at issue on appeal; and count V allegesa cause of action for battery against Burnett. On June 30, 1999, Burnett pleadedguilty to aggravated criminal sexual abuse and thereafter was sentenced.

NSU tendered the defense of the lawsuit to its insurance companies. American issued to NSU a business owner's policy that provides general exposureliability coverage for business practices or activities of the firm. The Acepolicy essentially provides coverage for professional malpractice claims. Bothinsurers denied coverage and filed declaratory judgment actions seeking adetermination as to whether they owed a duty to defend NSU or Burnett. Theinsurers also filed several motions for summary judgment. Enright and NSU alsofiled motions for summary judgment.

After considering the summary judgment motions, the trial court found thatAmerican owes no duty to defend or indemnify Burnett; that American and Ace owea duty to defend NSU, but American's policy is primary and Ace's policy isexcess; and that Ace owes a duty to defend Burnett. Both American and Ace filedseparate appeals from the trial court's judgments against them. We consolidatedtheir appeals.

ANALYSIS

The standard of review on appeal from the entry of summary judgment is denovo. Crum & Forster Managers Corp. v. Resolution Trust Corp., 156 Ill. 2d 384,390 (1993). The construction of an insurance policy and a determination of therights and obligations thereunder are questions of law for the court andappropriate subjects for disposition by summary judgment. Crum & Forster, 156Ill. 2d at 391.

In determining whether an insurer has a duty to defend its insured in anunderlying lawsuit, the court must look to the allegations in the underlyingcomplaint and compare these allegations to the relevant coverage provisions ofthe insurance policy. Crum & Forster, 156 Ill. 2d at 393. If the facts allegedin the underlying complaint fall within, or potentially within, the policy'scoverage provisions, then the insurer has a duty to defend the insured in theunderlying action. Crum & Forster, 156 Ill. 2d at 393. If the insurer owes noduty to defend, then it owes no duty to indemnify because the duty to defend isbroader than the duty to indemnify. Crum & Forster, 156 Ill. 2d at 398. Wherethe language of an insurance policy is clear and unambiguous, it must be givenits plain and ordinary meaning. State Farm Fire & Casualty Co. v. Hatherly, 250Ill. App. 3d 333, 337 (1993).

I. American's Duty To Defend NSU

We first address American's contention that the trial court erred indetermining that American owes a duty to defend the underlying claim broughtagainst NSU for negligent hiring. The Enright complaint alleges that NSU has aduty to exercise reasonable care in the hiring and retention of Burnett. Itfurther alleges that NSU breached that duty in that it (1) failed to investigateand inquire about Burnett's prior criminal history; (2) knew or should have knownat the time of hiring Burnett that he had pleaded guilty to the offense ofdisorderly conduct and had an active warrant for his arrest; (3) knew or shouldhave known that Burnett was unfit for the position of sonographer because itallowed for unsupervised contact with minors; and (4) failed to adoptadministrative review and to conduct adequate preemployment screening andreference verification before hiring Burnett.

The business owner's package policy issued by American to NSU states, inpertinent part, that American "will pay those sums that the insured becomeslegally obligated to pay as damages because of bodily injury or property damageto which this insurance applies." The policy excludes coverage for intentionalinjury "(1) expected or intended from the standpoint of the insured" or "(2)arising out of sexual molestation *** inflicted upon any person by or at thedirection of an insured." The policy also excludes coverage for the following:

"PROFESSIONAL LIABILITY. We will not pay for damages due to bodilyinjury or property damage arising out of the rendering of or thefailure to render professional services by any insured, who is a(an):

* * *

(4) nurse or X-ray or medical technician;

(5) health care practitioner of any kind."

American argues that the act of hiring Burnett was intentional andtherefore was not an "occurrence" within the meaning of the policy so as toprovide coverage. "Occurrence" is defined in the policy as "an accident,including continuous or repeated exposure to substantially the same generalharmful conditions." American relies on Erie Insurance Co. v. American PaintingCo., 678 N.E.2d 844, 846 (Ind. App. 1997), in support of its argument that, inthe context of insurance coverage, the act of the employer in negligently hiringthe employee is intentional, not accidental, and therefore there is no coverage. We disagree with this argument for several reasons.

First, the premise that the act of hiring is intentional is inconsistentwith Illinois law, which holds that negligent hiring is a tort separate from theemployee's intentional conduct. See, e.g., State Security Insurance Co. v. GlobeAuto Recycling Corp., 141 Ill. App. 3d 133, 136 (1986)(intentional tort ofemployer not covered; negligent hiring potentially covered).

Second, Illinois courts have focused on whether the injury is expected indetermining whether an occurrence is an "accident." Country Mutual Insurance Co.v. Hagan, 298 Ill. App. 3d 495, 507 (1998). "[A]n occurrence which is definedas an accident involves the consideration of whether the injury was expected orintended from the standpoint of the insured." (Emphasis added.) State Farm Fire& Casualty Co. v. Watters, 268 Ill. App. 3d 501, 506 (1994). In Illinois,therefore, if an injury is not expected or intended by the insured, it isconsidered an accident. Hagan, 298 Ill. App. 3d at 508. There are noallegations in the underlying complaint that NSU intended to injure Jane Doe. Rather, Enright alleges that NSU was negligent in not adopting properpreemployment screening, reference investigating, and administrative review. American seems to focus on the employer's final decision to hire an individual,an act that is intentional, rather than on the processes involved before andafter the individual is hired, acts that could be handled negligently.

Third, American also predicates its argument on the assumption thatBurnett's intentional act is not a separate and distinct act from NSU's allegednegligent act. We find the case of United States Fidelity & Guaranty Co. v. OpenSesame Child Care Center, 819 F. Supp. 756 (N.D. Ill. 1993), instructive here. In Open Sesame, the insurer brought a declaratory judgment action seeking todetermine whether, under the special multiperil policy, it owed a duty to defendthe insured daycare center in an action brought by the mother of a childallegedly abused by the daycare's employee. The insurer promised to "pay onbehalf of the insured all sums which the insured shall become legally obligatedto pay as damages because of *** bodily injury or *** property damage to whichthis insurance applies." Open Sesame, 819 F. Supp. at 757.

The court acknowledged those cases from other jurisdictions in which thecourts refused to separate the employer's alleged negligence from the abuser'sintentional conduct. Open Sesame, 819 F. Supp. at 759. However, the courtbelieved that refusing to separate the employer's alleged negligence from theemployee's intentional conduct would disregard the clear language of theinsurance policy. "The policy excludes bodily injury or property damage expectedor intended from the standpoint of the insured. In other words, only theinsured's intentional conduct falls outside the ambit of the policy." (Emphasisomitted.) Open Sesame, 819 F. Supp. at 760. The court believed that the otheropinions also discounted the employer's independent acts that gave rise to theunderlying alleged tort. The court reasoned that, in holding that the employee'sintentional conduct places the insured's negligence outside the definition of"occurrence," the exclusion is read too broadly. Because the predominant purposeof an insurance contract is to provide coverage to the insured, the courtconcluded that the allegation of negligent hiring in the underlying complaint isan "occurrence" despite the employee's intentional conduct. Open Sesame, 819 F.Supp. at 760; see also Montgomery v. Petty Management Corp., 323 Ill. App. 3d514, 519 (2001)(under a theory of negligent hiring, the proximate cause ofplaintiff's injuries is the employer's negligence in hiring the employee, ratherthan the employee's wrongful act); Doe v. Shaffer, 90 Ohio St. 3d 388(2000)(intentions of molester immaterial to determining coverage for allegednegligent hiring); Silverball Amusement, Inc. v. Utah Home Fire Insurance Co.,842 F. Supp. 1151 (W.D. Ark. 1994) (allegations against insured determines dutyto defend for negligent hiring employee who sexually molested a minor; otherwiseit would dissolve distinction between intentional and negligent conduct).

American argues that Open Sesame is not controlling because the definitionof "occurrence" in that policy is different from the definition in American'spolicy. The two definitions of "occurrence " are identical except the definitionin the Open Sesame policy contains the additional phrase "neither expected norintended from the standpoint of the insured." Open Sesame, 819 F. Supp. at 757.We agree that this is a distinction without a difference. The additionallanguage is superfluous because, as stated above, bodily injury that is expectedor intended from the standpoint of the insured is not considered an accidentunder the policy here. See Hagan, 298 Ill. App. 3d at 508.

American argues that we should not follow the reasoning in Open Sesame, asit conflicts with United States Fidelity & Guaranty Co. v. Jiffy Cab Co., 265Ill. App. 3d 533, 541 (1994). In Jiffy, the court held that, in determiningwhether an act is covered by the policy, the court must look to the act of theindividual who was hired and, if the act of the employee would fail to invokecoverage or is excluded by a provision of the policy, the claim for negligenthiring of that employee will not be deemed to invoke coverage. American contendsthat, because the allegations of negligent hiring are related to andinterdependent on the allegations of Burnett's intentional act, there is nocoverage for NSU.

In Jiffy, a passenger was fatally stabbed by a Jiffy cab driver after thepassenger exited the cab following an argument over a driving route. The policyprovided that the insurer would pay all sums because of bodily injury "caused byan accident and resulting from the *** use of a covered auto." Jiffy, 265 Ill.App. 3d at 538. The court held that the act of leaving the vehicle andinflicting the battery was an event of independent significance that was tooremote, incidental, or tenuous to support a causal connection with the use of thevehicle. The court also found that the battery of the passenger by the cabdriverwas not the type of risk that the parties to the insurance contract reasonablycontemplated would be protected by a general automobile liability policy. Thecourt further held that coverage was not invoked for the claim against the cabcompany for negligent hiring because the policy did not cover the employee. Jiffy Cab, 265 Ill. App. 3d at 541-42.

We disagree with American that Open Sesame conflicts with Jiffy Cab. Thecourt in Open Sesame addressed whether negligent hiring was an occurrence so asto invoke coverage. The issue raised in Jiffy Cab was whether the claim fornegligent hiring was covered as arising out of the use of an auto. The courtreasoned that, since the driver's act of stabbing the passenger was not coveredby the policy because it did not result from the use of an auto, then the claimfor negligent hiring was not covered under the policy either. Jiffy Cab, 265Ill. App. 3d at 541-42.

The only similarity between Jiffy and the present case is that Burnett andthe cab driver personally committed intentional acts that were excluded by thepolicies. Unlike in Jiffy, the type of risk involved here, negligent hiring, isthe type of risk that the parties to the insurance contract reasonablycontemplated would be covered by a general liability business policy. Moreimportantly, we cannot adopt a general rule of law that holds that coverage isnot invoked for an employer simply because the policy does not cover the employeefor his intentional act. If we were to do so, we would ignore the independentnegligent act of the employer that gave rise to the allegation in the underlyingcomplaint. We also would disregard the clear intent of the policy to excludeintentional conduct on the part of the "insured."

In seeking to avoid coverage, American relies on two exclusions in itspolicy, one based on sexual molestation and the other based on professionalservices. The "professional services" exclusion bars coverage for bodily injuryarising out of the rendering of or the failure to render professional servicesby an insured who is an X-ray or medical technician or a health care practitionerof any kind. American argues that this exclusion applies because the complaintalleges that Burnett was performing a "professional service" at the time of theincident. Again, American incorrectly continues to assert that the allegationsof negligent hiring emanated from Burnett's criminal act and, therefore, NSU isexcluded from coverage. However, we reject this assertion because, for purposesof insurance coverage analysis, the focus must be on the allegations against NSUfor negligent hiring, not the allegations against Burnett for sexual assault. Accordingly, we reject American's argument that this exclusion applies.

The policy also excludes damages due to bodily injury arising out of sexualmolestation inflicted upon any person "by or at the direction of an insured." American argues that this exclusion bars coverage because the injury arose outof Burnett's sexual act. However, there are no allegations that NSU directedBurnett to sexually molest Jane Doe.

American argues that the use of the words "an insured" versus "the insured"is crucial because it means that the policy does not cover anyone for injuriesarising out of sexual molestation regardless of the theory of liability assertedin the underlying complaint. American fails to recognize that the act of sexualmolestation must be inflicted "by or at the direction of an insured" in order forthe exclusion to apply. As stated above, the underlying complaint does notallege that NSU directed Burnett to sexually molest Jane Doe. Nor is it allegedthat NSU sexually molested the minor. Accordingly, we also reject this argument.

We conclude that the allegations of the underlying complaint at issue hereunquestionably seek to hold NSU liable for its own negligent conduct, a claimthat falls within, or potentially falls within, the scope of coverage under theterms of American's policy. Accordingly, the trial court correctly found thatAmerican has a duty to defend and indemnify NSU.

II. Ace's Duty to Defend NSU

We next address whether Ace owes a duty to defend NSU. Ace contends thatit owes no duty to defend NSU because the underlying allegations of negligenthiring, investigation, and supervision are not claims against NSU for"professional services." We agree.

The policy issued to NSU by Ace is entitled a "Professional/SupplementalLiability Insurance Policy." The policy contains several sections. One sectionis entitled "Professional Liability Coverage." Under this provision, Acepromises to "pay all amounts up to the limit of liability" that the insuredbecomes "legally obligated to pay as a result of injury or damage" to which theinsurance applies. The injury or damage "must be caused by a medical incidentarising out of professional services by [NSU] or anyone for whose professionalservices [NSU is] legally responsible." (Emphasis added.)

The second section, entitled "Supplemental Liability Coverage," providesthat Ace will "pay all amounts up to the limits of liability" that NSU becomes"legally obligated to pay as a result of injury or damage. The injury or damagemust occur in the course of providing [NSU's] professional services." (Emphasisadded.)

The third section is entitled "Personal Injury Coverage." This section ofthe policy does not contain any promise by Ace to pay any amount that NSU becomeslegally obligated to pay. Rather, it simply defines "injury, as respects only[NSU's] professional services," to include "assault, battery, mental anguish,mental shock or hallucination." (Emphasis added.)

The underlying complaint alleges, inter alia, that NSU breached a duty toexercise ordinary and reasonable care and was negligent when it failed to adoptappropriate administrative review or to conduct adequate preemployment screeningand reference verification. The policy defines "professional services" to mean"those services you are licensed, trained, or being trained to provide within theallied health field specified in your application and approved by us forcoverage." Unquestionably, Enright seeks damages against NSU for acts that werenot taken in the course of providing professional services and were not drawnfrom NSU's professional training, skill, experience, or knowledge assonographers. Put another way, the allegations in the underlying complaint arebased on administrative acts that have nothing to do with NSU's professionaltraining, skill, experience, or knowledge as a sonographer. See Pekin InsuranceCo. v. L.J. Shaw & Co., 291 Ill. App. 3d 888, 895 (1997)(focus must be on whetherthe claim is seeking to impose liability for acts taken in the course of theprofessional's training, skill, experience, or knowledge); see also Mork Clinicv. Fireman's Fund Insurance Co., 575 N.W.2d 598 (Minn. App. 1998) (regardingallegations of employees's sexual abuse, clinic's negligence in hiring andsupervising employee is in the nature of administrative actions that do not fallwithin ambit of policy provision of professional services); Community Hospitalat Glen Cove v. American Home Assurance Co., 171 A.D.2d 639, 567 N.Y.S.2d 122(1991)(claim against hospital for negligent hiring, training, and supervision ofphysician accused of sexual abuse of patient does not constitute medicalincident, which is defined as an act or omission arising out of furnishing ofprofessional health care services).

The dissent asserts that, because Burnett injured Jane Doe while she wasreceiving an ultrasound, the injury occurred "in the course of providingprofessional services" and is therefore covered under the "Supplemental LiabilityCoverage" section. The dissent focuses on Burnett's intentional act rather thanNSU's hiring practices, which are the subject of the underlying claim in thecomplaint. If NSU becomes "legally obligated to pay," it will be for negligenthiring, not Burnett's intentional conduct. Because the negligent hiring did notoccur in the course of rendering a professional service, there is no coverageunder the supplemental liability coverage section or any other section of thepolicy. Accordingly, we respectfully disagree with the dissent.

Because we conclude that Ace has no duty to defend NSU, the decision as towhich insurance policy is primary or excess is moot. Accordingly, the trialcourt erred in finding that Ace has a duty to defend NSU and in finding thatAce's policy is excess to American's policy.

III. Ace's Duty To Defend Burnett

We next address whether Ace has a duty to defend Burnett. Ace raises threearguments: (1) Burnett is not covered by the policy because he is not a namedinsured; (2) even if Burnett is considered an insured, the allegations in theunderlying suit do not involve a "professional service" or a "medical incident"as required by the policy; and (3) even if Burnett's act is considered to arisefrom or occur during the course of a professional service, Burnett's conduct isexcluded from coverage because it was expected or intended, resulted from awillful violation of a statute imposing criminal penalties, and arose out ofsexual abuse.

The professional liability policy issued by Ace to NSU is a malpracticepolicy that provides coverage for liability arising from errors and omissionsthat occur during the rendering of professional services. See Crum & Forster,156 Ill. 2d at 392. The only named insured on the policy is NSU. Generally, "acorporation is only a legal entity and can act only through a person." Shapirov. DiGuilio, 95 Ill. App. 2d 184, 192 (1968). This does not necessarily meanthat insurance covering the corporation also covers its employees. See Shapiro,95 Ill. App. 2d at 192 (policy specifically defined insured to include anyexecutive officer, director, or stockholder while acting within the scope of hisduties as such). In this case, the policy does not specifically define who arethe insureds. Because the policy covers liability arising from errors andomissions stemming from professional services, it logically follows that thoseemployees who provide these professional services could be considered insureds. However, we need not reach this issue because, assuming arguendo that Burnett isconsidered to be an insured under the policy, we agree with Ace that his act isexcluded from coverage.

The professional liability section excludes coverage for an act "which wasexpected or intended" or an act "which is also a willful violation of a statute*** imposing criminal penalties." The supplemental liability section alsoexcludes coverage for intentional acts. The record establishes that Burnettpleaded guilty to and was sentenced for aggravated sexual assault. Withoutquestion, therefore, his act was intentional and a willful violation of a statuteimposing criminal penalties, which is excluded from coverage.

Enright argues that exclusion J of the professional liability section ofthe policy requires Ace to defend Burnett because the claim specifically arosefrom sexual abuse. Exclusion J excludes from coverage:

"[those] [c]laims arising out of physical abuse, threatened abuse,sexual abuse or sexual harassment, immoral or sexual behaviorwhether or not intended to lead to, or culminating in any sexualact, whether caused by, or at your instigation, or omission, or thatof your employee, or any person. However, notwithstanding theforegoing, you shall be provided with a defense against any claim orsuit which may be brought against you for any such alleged act,provided that the defense shall be limited to the amount of theprofessional coverage. No damages shall be paid for you or on yourbehalf and no defense or appeal shall be provided when a judgment orfinal adjudication adverse to you establishes that such act or actsoccurred." (Emphasis added.)

We agree that the policy initially requires Ace to defend Burnett forclaims that arise out of sexual abuse. However, Enright ignores the finalsentence, which provides that Ace need not defend if "a judgment" establishesthat the sexual abuse occurred. Because a judgment adverse to Burnettestablished that the sexual abuse did occur, Ace has no duty to defend orindemnify Burnett.

Enright argues in favor of construing the policy as ambiguous in order tofind coverage. Enright contends that exclusion J conflicts with the "PersonalInjury Coverage" section, which "covers" claims of assault and battery. Enrightmisconstrues the intent of this section. There is no promise under this sectionto always provide insurance coverage for this type of injury. Rather, thissection broadens only the definition of the word "injury" to include such actsas assault or battery.

Moreover, this section does not alter or conflict with any of the othersections of the policy. For coverage purposes, if the "injury" is defined toinclude battery or assault, the battery must be caused by a "medical incidentarising out of a professional service" or it must "occur in the course ofproviding a professional service." This situation might arise when a sonographerinjures a patient while performing the wrong test on a patient. In such a case,the patient could bring a claim against the sonographer for battery. The claimwould be covered by the policy because it arose out of a professional service. It would not be excluded from coverage under the expected or intended exclusionbecause, although the sonographer intended to provide the service, he did notintend the injury to result. Conversely, if it is proved that the sonographerintended to commit the battery, the claim would be excluded from coverage.

American argues that Ace intended to treat certain allegations of sexualabuse as professional incidents because exclusion J provides a duty to defend butlimits the defense to the amount of professional coverage. American argues that,if Ace had intended that an act of sexual abuse could never be deemed aprofessional incident, then there would have been no reason to include languagelimiting the amount to the professional coverage limits. American maintains thatany other conclusion would render exclusion J meaningless.

We note first that American has no interest regarding Ace's duty to defendBurnett because the trial court found that American owes no duty to defendBurnett and no party in these appeals has challenged that finding. In any event,we do not find that any of the terms used in exclusion J render it meaningless. The meaning of "professional incident" is not synonymous with "professionalcoverage." A "professional incident" is defined in the policy as any negligentact, error, or omission in the rendering of or failure to render professionalservices that results in damages. Although the term "professional coverage" isundefined, the term is placed in the "Professional Liability Coverage" sectionand, thus, the definition of professional coverage is intended to define thescope of the policy coverage.

Additionally, American fails to comprehend the intent of this exclusion. Ace must defend a claim that arises out of sexual abuse, but only if theallegation is proved to be false. In that case, the cost of the defense islimited to the amount prescribed under the professional liability coveragesection. If the allegation is proved to be true, then neither the damages northe cost of the defense will be covered by the policy. Clearly, exclusion J isintended to cover those instances in which the insured is falsely accused ofsexual abuse. We have reviewed the remaining contentions and find them to bemeritless. Accordingly, the trial court erred in finding that Ace owes a dutyto defend Burnett in the underlying lawsuit.

CONCLUSION

In sum, we conclude that American owes a duty to defend and indemnify theclaim against NSU for negligent hiring and Ace owes no duty to defend orindemnify the underlying claims against NSU or Burnett. For the foregoingreasons, the decision of the circuit court of Lake County is affirmed in part andreversed in part.

Affirmed in part and reversed in part.

CALLUM, J., concurs.

JUSTICE O'MALLEY, specially concurring in part and dissenting in part: 

I agree with the majority's conclusions that American owes a duty to defendand indemnify the claim against NSU for negligent hiring and that Ace does notowe a duty to defend or indemnify Burnett. However, I must dissent from themajority's resolution that Ace owes no duty to defend NSU under Ace'ssupplemental professional liability coverage part.

In this case, NSU paid Ace for not only professional liability coverage butalso supplemental liability coverage. When an insured pays an additional premiumfor supplemental liability insurance coverage, the law presumes that the insuredintended to obtain broader liability coverage. See International Surplus LinesInsurance Co. v. Pioneer Life Insurance Co. of Illinois, 209 Ill. App. 3d 144,149-50 (1990). During its review of whether there is potential coverage underthe policy that triggers a duty to defend, the court should consider that theinsured purchased the supplemental professional liability coverage to expand itsprofessional liability coverage. See Pekin Insurance, 291 Ill. App. 3d at 895. The majority's reading of the supplemental liability coverage part not onlyignores the policy's plain language but also renders any expanded liabilitycoverage under that part illusory.

Contrary to the majority, I would hold that the "Supplemental LiabilityCoverage" part, at the very least, potentially grants coverage for the negligenthiring claim against NSU. In reaching this conclusion, I am guided by the ruleof insurance contract interpretation that the entire document is to be examinedto determine the parties' intentions with consideration given to the contract'ssubject matter and purpose as well as the policy's language. Hannigan v. CountryMutual Insurance Co., 264 Ill. App. 3d 336, 339 (1994). I find it significantthat Ace's policy consists of three "Coverage Part[s]": professional liabilitycoverage, supplemental professional liability coverage, and personal injurycoverage.

The Ace policy's "Professional Liability Coverage" is triggered only whenan injury or damage is caused by a "medical incident arising out of professionalservices" by the insured. The "Supplemental Liability Coverage" covers an injuryor damage that occurs in the course of NSU's professional services, but, unlikethe "Professional Liability Coverage" part, it does not require that the injuryor damage stem from a medical incident.

The main difference between the supplemental and primary professionalliability coverage parts is that the requirement that the injury or damage becaused by a "medical incident" is deleted from the supplemental coverage part. The Ace policy defines a "medical incident" as "any negligent act, error oromission in the rendering of or failure to render professional services thatresults in damages." This is a broad definition that encompasses any negligentacts or omissions arising from the insured's performance of or failure to performits professional services. Thus, before coverage will be found under the primaryprofessional liability coverage part, the complaint must allege negligent actsor omissions that satisfy the definition of a "medical incident."

The supplemental liability coverage part, however, requires that the"injury or damage must occur in the course of providing your professionalservices." (Emphasis added.) Therefore, if Enright's complaint alleges factsindicating that Jane Doe's injury occurred in the course of NSU's professionalservices, there is potential coverage under Ace's supplemental liability coveragepart. I believe that Enright's complaint alleges such facts.

Enright states in her complaint that Jane Doe was injured while NSU'semployee, Burnett, was performing ultrasound procedures on her. Because NSU'sbusiness was to furnish licensed ultrasound technicians to various health carefacilities, Burnett's administration of the ultrasound procedures to Jane Doewas providing NSU's "professional services," as defined by the Ace policy (slipop. at 2).

The majority concludes that the professional services requirements of eachsection of the policy preclude coverage for NSU in the underlying action. Icannot agree. The majority focuses exclusively on NSU's allegedly negligentactions in hiring and training and whether these acts satisfy the Ace policy'sdefinition of "professional services." However, coverage under the supplementalliability coverage part is not triggered by the negligent acts alleged in thecomplaint. Unlike the "Professional Liability Coverage" part, the supplementalliability coverage part provides coverage depending upon when (i.e., "in thecourse of NSU's professional services") the alleged injury or damage occurred. This policy language is different from the language used in the cases cited bythe majority that only consider whether a complaint's allegations were "due to"or "arise from" professional services, as opposed to whether the injury occurred"in the course of" the professional services. See Pekin Insurance, 291 Ill. App.3d at 890-91 (construing whether a complaint's allegations were "due to" therendering or failure to render professional services and thus falling within theprofessional services exclusion of a "Businessowners Policy"); see also MorkClinic, 575 N.W.2d at 603-04 (holding that "victim's injuries [from sexual abuse]were not a consequence of the delivery of professional services"); CommunityHospital, 171 A.D.2d at 639, 567 N.Y.S.2d at 122-23 (negligent hiring claim didnot "arise out of" rendering of professional services). I conclude that thedamage alleged in Enright's complaint occurred in the course of the professionalservices of the ultrasound procedures administered by NSU's technician and, thus,is at least potentially covered by the plain language of the supplementalliability coverage part.

Ace's policy additionally states that the supplemental professionalliability is "occurrence" coverage and defines an "occurrence" as an "accident*** which results in injury neither expected or intended by you." The policydoes not define "accident." The "occurrence" definition in the Ace policy issimilar to the American policy's "occurrence" definition, and I determine thatthe majority's reasoning that the Enright complaint sufficiently alleged an"occurrence" under American's policy results in the same outcome under Ace'spolicy. Slip op. at 5-9. Simply stated, "[t]here are no allegations in theunderlying complaint that NSU intended to injure Jane Doe" (slip. op. at 5);therefore, under Illinois law, Jane Doe's injury is considered an accident.

Although I find that Ace's supplemental professional liability policypotentially grants coverage for Enright's negligent hiring, investigation, andsupervision claim, I also recognize that the "Supplemental Liability Coverage"part of the policy, like the "Professional Liability Coverage" part, specificallyexcludes "injury or damage caused by or resulting from non-professional servicesactivities," which arguably might preclude coverage. However, immediatelyfollowing this exclusion, the supplemental coverage part contains an exceptionto that exclusion. The exception states that the nonprofessional servicesexclusion does not apply to "activities which are ordinarily incidental to yourprofessional services activities." Thus, coverage is intended for thoseactivities that are not "professional services" as defined by the Ace policy butare "ordinarily incidental" to performing those services.

The majority's analysis of the meaning of "professional services" under thepolicy is fine. I have no quarrel with the cases cited and quoted by themajority in arriving at the definition of professional services, but those casesdid not deal with a policy that has separate "Coverage Part[s]" entitled"Professional Liability Coverage" followed by "Supplemental Liability Coverage." See Pekin Insurance, 291 Ill. App. 3d at 890-91 (construing professional servicesexclusion in "Businessowners Policy"). In addition, the foreign cases cited bythe majority that found no coverage for negligent hiring as professional servicescontain no mention of coverage for activities ordinarily incidental toprofessional services. See Mork Clinic, 575 N.W.2d at 603-04 (determining thatnegligent hiring claim was not covered as a professional service by the clinic'sprofessional liability policy); Community Hospital, 171 A.D.2d at 639, 567N.Y.S.2d at 122-23 (under professional liability policy, negligent hiring was nota covered medical incident). Through its exception to the exclusion, the Acepolicy's supplemental coverage part does not limit professional liabilitycoverage only to injury or damage occurring in the course of providing theprofessional services but, rather, supplements it to include injury or damagecaused by activities ordinarily incidental to professional services. Consequently, I find the majority's discussion of professional servicesinsufficient without including an inquiry into whether NSU's administrativeactivities in hiring, investigating, and supervising its employees are activitiesthat are ordinarily incidental to performing its professional services. Thatinquiry follows.

The Ace policy does not define what activities are ordinarily incidentalto professional services. When words are not defined by an insurance policy,courts give them their plain and popular meaning. Outboard Marine Corp. v.Liberty Mutual Insurance Co., 154 Ill. 2d 90, 115 (1992). The word "ordinary"is defined as "usual; normal," and "incidental" means "something necessary,appertaining to, or depending upon another." Black's Law Dictionary 762, 1097(6th ed. 1990). Applying these definitions shows that the hiring, investigating,and supervising of the employees who actually perform the professional servicescovered under this policy are clearly incidental and necessary to thoseprofessional services. Thus, I see the policy as unambiguously providingcoverage.

At a minimum, that which I see as unambiguous is at least a reasonableinterpretation of the policy. If an insurance policy's language is capable ofmore than one reasonable interpretation, then the interpretation that favorscoverage prevails. Outboard Marine Corp., 154 Ill. 2d at 119. In fact, if suchactivities are not incidental to providing ultrasounds, then I find it difficultto envision what activities would be considered incidental under the policy. Both Ace and the majority fail to identify any. If we cannot envision what wouldbe considered incidental, then that language is ambiguous and needs to beconstrued against Ace. All doubts and uncertainties in an insurance policy'slanguage must be construed strictly against the drafter and in favor of coverage. Outboard Marine Corp., 154 Ill. 2d at 121. Consequently, I conclude that thefacts alleged by Enright in the underlying complaint are, at the very minimum,potentially within the policy's coverage.

In summary, NSU purchased not only professional liability coverage from Acebut also coverage that was supplemental to the professional liability coverageand expressly included coverage for activities ordinarily incidental toprofessional services. The supplemental coverage part was intended to expandNSU's professional liability coverage, as evidenced by the coverage part's title,the "Coverage Agreements" under Roman numeral I of the policy, and the fact thatit covers an injury or damage not stemming from a medical incident. Given thatthis coverage part provides NSU supplemental and expanded liability coverage, Ibelieve that the parties intended for the facts alleged in Enright's complaintto be covered and that Ace is required to defend NSU. Moreover, even if Ace didnot intend to cover this risk, courts cannot rely on an insurer's intentions todefeat coverage for an insured. Marshall v. Metropolitan Life Insurance Co., 337Ill. App. 498, 509 (1949) ("[I]f the language of the insurance policy issusceptible to two interpretations, the question of intention is not germane, andthat interpretation which will not defeat the insured's claim will be adopted"). If Ace had wanted to limit the definition of "ordinarily incidental" so that theterm would not cover NSU's hiring and supervising activities, it could have doneso. I would affirm the trial court's ruling that Ace owes a duty to defend NSUfor the reasons expressly stated above and would then find it unnecessary toaddress the merits of the parties' other contentions concerning the Ace policy. On this basis, I dissent from the majority's determination that Ace does not owea duty to defend NSU.