An Iowa federal district court, in a case of first impression, has held that a medical record request did not constitute a “Claim” under a claims-made medical malpractice policy. Capson Physicians Ins. Co. v. Yates, 2017 WL 6997897 (S.D. Iowa Nov. 8, 2017).
The insured doctor performed surgery on a patient who died the following day. Several months later, the doctor received a letter from an attorney who requested the deceased patient’s medical records. The doctor notified his liability insurer of the record request, and the insurer advised the doctor that the request did not trigger coverage because it did not fall within the policy’s definition of a “Claim.” After the policy expired, the patient’s husband filed a lawsuit against the doctor and his practice. The insurer subsequently filed a declaratory judgment action seeking a determination that the policy did not afford coverage for the lawsuit.
The policy defined “Claim” as the insured’s receipt of “a notice of legal action for damages” or “a notification of an intention to hold the insured responsible for damage[s].” The court looked to other jurisdictions interpreting similar policy language to conclude that the record request failed to meet the policy’s definition of a “Claim.” The court emphasized that the request did not suggest or threaten litigation, demand money or damages, and did not otherwise reveal an “intention to hold the insured responsible.” Rather, the court viewed it “as a request for records in its simplest form” and opined that “[a] simple request for medical records hints at a potential claim for damages, which still falls short of the Claim definition at issue.”