Saga Continues in Case Arising from South Carolina Malpractice Actions of Impostor “Doctor” – Agape Senior Primary Care, Inc. v. Evanston Insurance Company

Several months ago, we told you about a federal court of appeals’ decision in a case in which a medical malpractice insurance company sought a declaratory judgment as to its responsibility to cover certain acts of malpractice after it was discovered that a fake nursing home “doctor” had illegally assumed the identity of a physician who was out of the country.

In that decision, the appellate court held that the principles of equity demanded that there be coverage for the innocent co-insureds under the medical malpractice policy that was in place during the impostor’s time at the nursing home.

Now, the United States District Court for the District of South Carolina, Columbia Division, has issued a new opinion in a related matter.

Facts of the Case

In the case of Agape Senior Primary Care, Inc. v. Evanston Insurance Company, the plaintiff nursing home filed suit against the defendant insurance company in state court in April 2016, alleging bad faith or, alternatively, breach of contract. According to the plaintiff’s complaint, the defendant had failed to provide coverage or a defense in a certain matter of litigation (which, although not described in detail, appeared to be a malpractice action filed against the plaintiff by the estate of a former patient) and had mishandled prior claims by reassigning claims to new counsel midway through the claims process and failing to properly participate in the mediation, adjustment, and settlement of certain claims.

The defendant removed the matter to federal district court, based on the diversity jurisdiction found at 28 U.S.C. §§ 1441, 1446. Thereafter, the defendant moved for the dismissal of the plaintiff’s case, based on its alleged failure to state a claim upon which relief could be granted.

The Federal District Court’s Decision

After carefully reviewing the allegations contained in the plaintiff’s complaint and accepting them as true for the purposes of the defendant’s motion, the district court granted the motion in part and denied it in part. According to the district court, the plaintiff had failed to state a claim with regard to its breach of contract cause of action regarding the mishandling of prior claims. However, the plaintiff had asserted allegations that, if true, constituted a plausible claim for relief on its bad faith cause of action regarding the particular litigation and the defendant’s mishandling of prior claims. The court also acknowledged that the plaintiff had stated a claim for breach of contract due to the defendant’s failure to defend the particular litigation.

If You Would Like to Schedule an Appointment with a South Carolina Medical Malpractice Attorney

Litigation against nursing homes, hospitals, physicians, and other medical providers is often complex and protracted. If you believe that you or a loved one has a claim, you should talk to a lawyer as soon as possible. To set up a free consultation with South Carolina medical malpractice attorney Patrick E. Knie at our Greenville or Spartanburg offices, call us today at (864) 582-5118.

Related Blog Posts:

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.

$90,000 Jury Verdict in Favor of South Carolina Woman Whose Son Was Stillborn Affirmed on Appeal – Jamison v. Hilton

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