KEYKO GIL VS. CLARA MAASS MEDICAL CENTERÂ (L-8434-11, ESSEX COUNTY AND STATEWIDE), A-4034-14T4

Background

In 2011 Keyko Gil sued Dr. Huseyin Copur, FirstChoice OB/GYN LLC, and Clara Maass Medical Center alleging malpractice in a 2004 C-section that caused birth defects; plaintiffs later sought coverage claims against Clara Maass’s insurers.
Clara Maass is part of the Saint Barnabas Health Care System; FirstChoice was an LLC formed by Copur and another physician and had a services agreement with Clara Maass.
Copur and FirstChoice’s own insurer paid its policy limit and assigned any rights under the hospital policies to plaintiffs; plaintiffs then sued Executive Risk (primary excess) and several excess carriers.
The insurers moved for summary judgment on coverage; the trial court ruled for insurers — finding Copur and FirstChoice were not covered as employees, leased workers, or under the “associated/affiliated” catch‑all; plaintiffs appealed.
Policies expressly covered “named insureds” and defined “employee” (Executive Risk: on regular payroll, taxes withheld; Lexington and excess: “a person paid by [Clara Maass]”), excluded independent contractors and temporary workers, and defined “leased worker” as a person leased by a labor‑leasing firm.
The Appellate Division applied the Brill summary‑judgment standard and affirmed: policy language could not plausibly be read to cover Copur or FirstChoice.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Dr. Copur was an "employee" under the policies	Copur functionally was an employee; undefined "independent contractor" means common‑law tests should apply so Copur qualifies as an employee	Policy definitions control; Copur was not on Clara Maass payroll nor paid by Clara Maass, so he fails the express employee definition	Not an employee; court enforces the policy's specific payroll/payment definition rather than importing common‑law tests
Whether common‑law tests (control / relative‑nature) should determine employee status for coverage	Plaintiffs urged use of control and relative‑nature tests to show Copur was not an independent contractor	Insurers said contract language governs and parties intended a narrower, contractual definition	Court refused to import remedial/common‑law standards into private insurance definitions; even applying tests, Copur fails to qualify as employee
Whether FirstChoice is covered by the policy "catch‑all" (owned/controlled/associated/affiliated)	Catch‑all is ambiguous and could include FirstChoice; underwriter testimony allegedly admits ambiguity	Catch‑all should be read in context; "associated/affiliated" implies ownership/control links and does not cover ordinary contractors	Not covered; court construes catch‑all in harmony with neighboring terms (ownership/control), and FirstChoice lacks that relationship
Whether Copur was a "leased worker" under the policies	FirstChoice leased physicians to Clara Maass; thus Copur was a leased worker	"Leased worker" requires a labor‑leasing firm (business of leasing employees) and work at the hospital's direction; FirstChoice was a medical practice, not a labor‑leasing firm, and Copur exercised independent medical judgment	Not a leased worker; FirstChoice not a labor‑leasing firm and Copur did not perform at hospital's direction as required

Key Cases Cited

Brill v. Guardian Life Ins. Co. of Am., 142 N.J. 520 (1995) (summary‑judgment standard for proceedings that resolve legal interpretation disputes)
Lowe v. Zarghami, 158 N.J. 606 (1999) (explains control and relative‑nature tests in determining employee status for Tort Claims Act/workers contexts)
Zacarias v. Allstate Ins. Co., 168 N.J. 590 (2001) (insuring language is given its ordinary meaning when construing policies)
Chubb Custom Ins. Co. v. Prudential Ins. Co. of Am., 195 N.J. 231 (2008) (ambiguity exists only if policy language is reasonably susceptible to more than one meaning)
Wakefern Food Corp. v. Liberty Mut. Fire Ins. Co., 406 N.J. Super. 524 (App. Div. 2009) (plaintiff bears burden to show coverage where summary judgment resolves coverage dispute)