Background
Narendra B. Tohan, a reproductive endocrinologist, was sued by Kayla Suprynowicz and Reilly Flaherty, who discovered through genetic testing in 2019 that they are half-siblings. Both were conceived through in vitro fertilization (IVF) procedures performed by Tohan at their respective parents’ request. The plaintiffs alleged that Tohan used his own sperm in the IVF procedures without informing the parents, and that one plaintiff inherited a genetic disease from the defendant’s sperm. The civil action included claims for negligence, fraudulent concealment, and violations of the Connecticut Unfair Trade Practices Act.
Tohan carried medical professional liability insurance from Integris Insurance Company under a “Physicians & Surgeons Professional Liability Claims Made” policy. In April 2021, Integris sent Tohan a reservation of rights letter stating it would defend him but reserved the right to deny coverage, claiming the conduct fell within policy exclusions. In April 2021, Integris commenced a declaratory judgment action seeking a determination that it had no duty to defend Tohan in the underlying civil action. The trial court granted Integris summary judgment, concluding all allegations fell within both the intentional conduct exclusion and the sexual conduct exclusion to coverage.
Tohan appealed, contending the court improperly determined that these exclusions clearly and unambiguously applied to every allegation in the civil complaint, particularly to the negligence counts.
The Court’s Holding
The Connecticut Appellate Court reversed in part. The court first held that the civil negligence action contained allegations that potentially fell within the coverage provided by Integris’s policy. Applying the policy’s language covering damages “arising out of a medical incident” involving “professional services,” the court concluded that Tohan’s performance of IVF procedures—regardless of the misconduct alleged in connection with them—constitutes professional services within the customary scope of a reproductive endocrinologist’s practice. The court relied on federal precedent holding that the relevant professional service is the insemination procedure itself, not the production of sperm.
The court then held that Integris improperly applied the intentional conduct exclusion to the negligence counts. Although the underlying complaint alleged that Tohan used his own sperm without consent, the negligence counts specifically alleged he did so “negligently” and “inadvertently.” The first negligence count further alleged that Tohan negligently used sperm containing a genetic disease when providing IVF services. The court found these allegations fell outside the intentional conduct exclusion because they characterized the conduct as negligent rather than intentional.
Finally, the court held that Integris failed to demonstrate the sexual conduct exclusion clearly and unambiguously applied to every claim. The court noted that the sexual conduct exclusion could not apply to the allegation that Tohan negligently utilized sperm containing a genetic disease, as this claim is “not sexual in nature.” Under Connecticut law, an insurer seeking to deny coverage based on a policy exclusion must show the exclusion clearly and unambiguously applies to each and every claim for which coverage might otherwise exist. Because at least one claim fell outside both exclusions, Integris had a duty to defend.
Key Takeaways
- An insurer’s duty to defend is triggered if even one allegation of a complaint falls possibly within the scope of coverage, regardless of other allegations that may not be covered.
- When evaluating whether professional services are provided, courts examine the nature of the act and its connection to the professional’s specialty, not incidental conduct elements.
- Policy exclusions for intentional conduct do not apply to allegations explicitly characterized as negligent, even if those allegations involve misconduct during the provision of professional services.
- Exclusions must clearly and unambiguously apply to every claim in an underlying complaint; any ambiguity or any claim falling outside the exclusion triggers the duty to defend.
Why It Matters
This decision significantly constrains insurers’ ability to use broad policy exclusions to deny coverage in medical malpractice cases. By holding that exclusions must apply clearly and unambiguously to every claim, and by focusing on how claims are pleaded rather than solely on underlying conduct, the court favored the insured and limited the insurer’s discretion. The ruling ensures that medical professionals facing multi-count complaints with varying legal theories cannot be left undefended simply because some counts allege intentional or sexual conduct.
The decision also establishes important precedent for reproductive medicine liability. By characterizing IVF procedures as professional services even when accompanied by misconduct allegations, the court expanded the potential scope of coverage for fertility specialists. This creates practical implications for how such cases are litigated and how insurers must evaluate their coverage obligations when defending reproductive endocrinologists and similar medical professionals.