CourtSupreme Judicial Court
DocketSJC-13821
ReleasedAugust 7, 2026
Full opinionRead the full text of the decision
Question
Does a medical professional liability insurer’s duty to provide regulatory defense costs extend to Board of Registration in Medicine proceedings based on a complaint alleging both criminal conduct (stalking, trespass, mail theft) and prescribing addictive medication when the patient’s primary care physician refused to continue such prescriptions due to addiction concerns?
Rule
On professional services under insurance policies. Under Massachusetts law, a professional service under a professional liability policy means one arising out of a vocation involving specialized knowledge where the labor or skill is predominantly mental or intellectual rather than physical or manual. Roe v. Federal Insurance Co., 412 Mass. 43, 48 (1992). Courts must look to the act itself, not the title or character of the party performing it. Id. Relevant considerations include whether membership in the profession requires special learning, whether rendering care calls upon that special learning, and whether there is a causal relationship between the alleged harm and the complained-of professional act. Id. at 49. The scope of professional services does not include all forms of a medical professional’s conduct simply because he or she is a doctor. Id.
On the duty to defend. An insurer’s duty to defend is triggered when allegations are reasonably susceptible to an interpretation that states or roughly sketches a claim covered by policy terms, notwithstanding that the claim may ultimately fail or that its merits are weak or frivolous. Holyoke Mutual Insurance Co. in Salem v. Vibram USA, Inc., 480 Mass. 480, 484 (2018). The allegations need only show a possibility that the liability claim falls within the insurance coverage. Billings v. Commerce Insurance Co., 458 Mass. 194, 201 (2010). Any uncertainty is resolved in favor of the insured. Deutsche Bank National Ass’n v. First American Title Insurance Co., 465 Mass. 741, 745 (2013).
On the in for one, in for all doctrine. Where an insurer is obligated to defend an insured on one of the counts alleged against it, the insurer must defend the insured on all counts, including those that are not covered. Mount Vernon Fire Insurance Co. v. VisionAid, Inc., 477 Mass. 343, 351 (2017). The rationale is that dividing representation between covered and noncovered claims is impractical. GMAC Mortgage, LLC v. First American Title Insurance Co., 464 Mass. 733, 738-739 (2013).
Holding
The insurer’s duty to provide regulatory defense coverage was triggered. The allegations of criminal conduct (stalking, trespass, mail theft, harassment) do not constitute professional services because they required no medical expertise, involved no rendering of patient care, and bore no causal relationship to any medical act. These acts required no professional skill in medicine, and their only connection to the medical profession was that they were allegedly performed by a physician.
The allegation regarding prescription of addictive medication, however, does constitute a professional service. Prescribing medication is an act requiring membership in the medical profession and special learning, as only certain licensed healthcare professionals may prescribe medication under State and Federal law. Prescribing controlled substances when rendering patient care requires specialized knowledge and the application of mental and intellectual skill. The operative complaint can be read to allege that the physician was rendering care to the patient who had been receiving prescriptions from her primary care physician, and a fair inference arises that the patient was potentially harmed by the physician’s continued prescriptions when another physician refused to continue them due to the medication’s addictive qualities, establishing a potential causal relationship between the professional service and alleged harm.
Because the operative complaint alleges at least one count potentially covered by the policy (the prescription allegation), the in for one, in for all doctrine applies. The insurer must defend all counts, including the uncovered criminal allegations. The allegations need only show a possibility of coverage, and that standard is met here even though some or many of the underlying claims fall outside the coverage.
Result
The Superior Court judgment for the insurer was vacated and the case remanded for further proceedings consistent with the opinion.
Players
- Court: Supreme Judicial Court (direct transfer from Appeals Court)
- Opinion by: Wendlandt, J.
- Panel: Budd, C.J., Gaziano, Kafker, Wendlandt, Georges, Dewar, & Wolohojian, JJ.
- Below: Superior Court Department, Bristol County; Elaine M. Buckley, J.; civil action commenced August 15, 2023; judgment for insurer
- Plaintiff: William E. O'Connor (physician, insured)
- Defendant: MAG Mutual Insurance Company (insurer)
- Counsel for plaintiff: Christopher C. Trundy
- Counsel for defendant: Sean M. Ennis
When the Board of Registration in Medicine moved to suspend Dr. William O’Connor’s license based on a patient’s complaint, his insurer refused to pay defense costs. The board complaint described a grim pattern: stalking, trespass, stolen mail, harassment. It also alleged that O’Connor had prescribed an addictive medication to the patient for six years, continuing to write prescriptions after her primary care physician stopped doing so because of addiction concerns.
The Supreme Judicial Court ruled that the insurer must cover O’Connor’s defense costs for the entire proceeding. The court held that while criminal allegations do not constitute professional services, the prescription allegation does. Because at least one count fell within the policy’s regulatory defense provision, the insurer must defend all counts, including the uncovered ones.
The Policy
O’Connor purchased his policy from MAG Mutual for the year beginning September 1, 2019. The policy included a limited regulatory defense provision requiring the insurer to pay defense costs for administrative proceedings that arise out of a patient complaint about the insured’s professional activities. Professional activity was defined as providing medical professional services to a patient. The policy did not define professional services.
The Complaint and Denial
In December 2019, the patient’s husband filed a complaint with the board. He recounted that an abuse prevention order had issued against O’Connor for stalking and that the physician had violated it by trespassing and attempting to break into the patient’s home. An arrest warrant had issued. The husband also stated that O’Connor had been in a romantic relationship with the patient from 2008 to 2016 and had prescribed an addictive medication to her for about six years during this period. The husband alleged that O’Connor prescribed the drug when the patient’s primary care physician refused to continue prescriptions due to addiction concerns. The patient believed O’Connor used the drug’s addictive qualities as leverage to keep her in the relationship.
The board investigation confirmed the allegations. In February 2020, the board’s complaint counsel moved for summary suspension of O’Connor’s license, arguing he posed a serious threat to the public.
O’Connor notified MAG Mutual and requested regulatory defense coverage. The insurer refused. It reasoned that the alleged conduct predated the coverage period, that the complaint came from the husband rather than the patient, and that the allegations of stalking, trespass, and theft did not relate to professional services. The insurer suggested that even the prescribing allegation might involve violations of laws unrelated to the standard of care.
What the Superior Court Held
O’Connor sued for declaratory relief, breach of contract, and violations of chapter 93A. The case proceeded on agreed facts. The trial judge ruled for the insurer, finding that the board proceedings did not arise from professional activities but from criminal conduct. The judge stated that prescribing medication for the purpose of coercing the patient to continue the relationship could not be construed as providing professional services.
The SJC’s Analysis
Justice Wendlandt wrote for the court. The analysis turned on whether the operative complaint was reasonably susceptible to an interpretation stating a claim covered by the policy. The insurer’s duty to defend arises before the merits are resolved. Any uncertainty is resolved in favor of the insured.
The court applied the test from Roe v. Federal Insurance Co. A professional service arises out of work involving specialized knowledge where the labor is predominantly mental or intellectual. The inquiry focuses on the act itself, not the actor’s credentials. Membership in the profession must require special learning, the professional must apply that learning when rendering patient care, and there must be a causal relationship between the alleged harm and the professional act.
The criminal allegations failed this test. Stalking, leaving harassing messages, stealing mail, surveilling property, trespassing, and attempting to break into a house require no medical training. There is no causal relationship between those acts and any professional service. The only connection to the medical profession is that a physician allegedly committed them.
Prescribing as Professional Service
The prescription allegation required a different result. Prescribing medication is an act requiring membership in a licensed profession. State and federal law govern who may prescribe and under what circumstances. The Controlled Substances Act mandates that prescriptions be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.
Prescribing medication, especially controlled substances, requires specialized knowledge and the application of special learning. The operative complaint could be read to allege that O’Connor was rendering care to the patient, who had been receiving the medication from her primary care physician. A fair inference is that the patient was potentially harmed by O’Connor’s continued issuance of prescriptions when another physician judged that the drug’s addictive qualities counseled against further prescriptions. This establishes the requisite causal relationship.
The court distinguished Roe, where a dentist sexually assaulted a patient after administering novocaine. That case involved indemnification, not the duty to defend, and there was no finding that the novocaine itself harmed the patient. Here, the complaint gives rise to an inference that the patient suffered injury from the continued prescriptions, separate from the prolonging of an unwanted relationship.
In for One, In for All
Having concluded that the prescription allegation constitutes a professional service, the court applied the rule that when an insurer is obligated to defend on one count, it must defend on all counts, including those not covered. The rationale is practical: dividing representation between covered and uncovered claims is unworkable.
The court vacated the judgment for the insurer and remanded for further proceedings.
Why It Matters
The decision clarifies the scope of regulatory defense provisions in medical liability policies. Insurers cannot avoid their duties by pointing to uncovered allegations when the complaint also includes covered ones. The opinion also confirms that prescribing medication is a core professional service for purposes of coverage analysis, even when the prescribing occurs in a context involving personal misconduct. Physicians facing administrative proceedings that blend professional and personal allegations can expect their insurers to shoulder the entire defense if any allegation relates to professional services.
Read the full opinion: O'Connor v. MAG Mutual Insurance Company (SJC-13821, August 7, 2026).