Q.

The insured came to us with a situation and asked if we saw any problems with the insurance if they hire a client or former client to work for them.  The only area we had concerns about and wanted clarification on was under the professional liability. Since the professional excludes coverage for BI to an employee, we wanted to know if the professional would defend and/or provide coverage in a situation where the employee was injured and alleged that it was as a result of his ailment which was being treated by the insured.

For example: Insured hires a client who is on medication and knows the client has a history of going off the medication.  The employee/client is injured at work and alleges that it was as a result of not taking his medication and that the insured knew this was a problem he had and, therefore should not have asked him to perform the work.  This is just one example, but we could see other situations similar to this happening.  We want to be sure to be able to let the insured know if their professional liability will respond in this situation.
 

A.

The language of the insurance policies issued by the Mental Health Risk Retention Group defines the coverage afforded by the company.  Unfortunately, it is not possible to tell ahead of time in enough detail the facts of a specific claim to determine whether or not there is coverage in accordance with the policy.  When a claim is made to the company, an experienced claims examiner will review the legal documents and compare the facts to the language of the policy. If necessary, an outside insurance attorney will be consulted for an opinion on coverage.

In every instance any possible contention that coverage is not afforded is carefully considered prior to determination.

Your best information on coverage questions is the specific language of the policy. Anything else at this point would simply be speculation and not helpful.