Essex Ins. Co. v Galilee Medical Center, S.C.

815 F.3d 319 (7th Cir. 2016)

Words & Phrases

Rescission

Trial Judge

David Atkins

Appellate Judge

Neville

Holding

Recission of professional liability policy for physician and medical group was affirmed where insureds misrepresented drugs used for weight loss purposes.

Fact Summary

Nos. 14-1791, 14-1801 (March, 2016) 7th Cir.

Galilee’s application asked, “Do[] the Applicant’s em­ployees or independent contractors use drugs for weight re­duction for patients?” Galilee answered in the negative. The question continued: “If yes, attach a list of drugs used and percentage of practice devoted to weight reduction.” Galilee did not identify any such drugs. Galilee also answered “no” to the question of whether its employees or independent contractors performed any experimental procedures.

The fact that Angarita made his recommendation at his Galilee office, and then administered the treatment in his home office, does not change this analysis. Angarita admits that he recommended mesotherapy to Ravelo, a Galilee pa­tient, while working at Galilee, and that he followed up on his recommendation by administering the treatment. Per­haps this would be a different case if Angarita had referred Ravelo to another provider for treatment, or made a recom­mendation that Ravelo ignored. But here, a reasonable per­son would not find a meaningful distinction between the recommendation and the treatment. There is no evidence that Angarita informed Ravelo that he was administering mesotherapy in his individual capacity, and Ravelo likely relied on Angarita’s employment at Galilee, a reputable medical center, when she took him up on his offer. It is also irrelevant that Galilee may have been unaware that Angarita was recommending and administering mesotherapy to his patients—under § 154, “a misrepresentation, even if inno­cently made, can serve as the basis to void a policy.” Golden Rule Ins. Co. v. Schwartz, 786 N.E.2d 1010, 1015 (Ill. 2003).

More specifi­cally, defendants contended that mesotherapy is a body shaping procedure that is used to reduce fat in isolated parts of the body, not to reduce a patient’s overall weight.

The district court rejected this argument, describing the distinction between weight reduction and size reduction as “disingenuous at best.” We agree. Defendants fail to con­vince us that there is a meaningful difference between “weight reduction” and “size reduction” that would excuse the negative and incomplete answers on their insurance pol­icy applications.

 

 

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