Impostor’s Fraud Does Not Vitiate South Carolina Medical Malpractice Insurance Coverage for Facility or Innocent Co-Insureds – Evanston Insurance Company v. Agape Senior Primary Care, Inc.

A smiling young healthcare worker in his white clean uniform

There are several issues that are common in nursing home and senior care litigation, such as falls, medication errors, bedsores, and medical malpractice. In the recent unreported per curiam opinion of Evanston Insurance Company v. Agape Senior Primary Care, Inc., the United States Court of Appeals for the Fourth Circuit was asked to review a case arising in the United States District Court for the District of South Carolina at Columbia that presented a more unique issue.

In early 2012, the defendant facility hired a man who held himself out to be a board-certified physician. In actuality, the man was an impostor, and he had stolen the identity of the real physician, who was out of the country at the time. Approximately six months later, the defendant learned of the impostor’s fraud when he was arrested. He was later convicted and sentenced to two years in federal prison for aggravated identify theft.

Parties to the Lawsuit

The plaintiff in the case was an insurance company who provided professional liability insurance coverage to the defendant facility and certain of its employees, doctors, and nurse practitioners during the time that the facility employed the impostor. Once the impostor’s deceit was discovered, the insurance company sought a declaration as to whether it was obligated to provide coverage for incidents arising during the time that he was impersonating the board-certified physician.

The Issue Before the Court on Appeal

Does fraudulent misrepresentation on a medical malpractice insurance application vitiate coverage for other, innocent co-insureds when the fraud is committed by a single individual who is masquerading as a board-certified doctor, “fooling employers and patients alike?”

The Court’s Decision

The court affirmed the district court’s decision to the effect that South Carolina state law, along with its principle of equity, demand that the medical malpractice insurance coverage for the co-insureds under the policy remain in place. Although the circumstances of the case were “novel,” the court found that the district court had correctly interpreted the policy at issue in favor of coverage for the innocent co-insureds. In so holding, the court noted that a fraudulent misrepresentation on an application for medical malpractice insurance by a person posing as a doctor should not vitiate the policy with regard to an innocent employer or the impostor’s fellow employees.

For Help with a South Carolina Nursing Home Negligence Case

If you believe that a loved one is suffering or may have passed away because of the negligence, abuse, or other misconduct of nursing home personnel or medical staff in a long-term care or assisted living facility, you owe it to your loved one and others similarly situated to discuss your concerns with an experienced South Carolina nursing home negligence attorney. For a free initial consultation about your case, call the Law Offices of Patrick E. Knie today at (864) 582-5118. We have offices in both Spartanburg and Greenville, and we can serve clients anywhere in the state of South Carolina.

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