Medical liability and filler treatments: the Florence Court of Appeal on insurance indemnity

The Court of Appeal of Florence, in its recent judgment no. 1099 of 10 June 2025, has further defined the boundaries of an insurer’s duty to indemnify in cases of medical professional liability, with a specific focus on damages arising from aesthetic treatments. The ruling clarifies the regime for legal costs and the application of deductibles in a case involving filler complications, providing essential guidance for physicians and healthcare facilities on the distinction between defense costs and "loss-of-suit" costs (costs awarded to the winning party).

The case: from filler complications to compensatory damages

The case originated from a claim for damages brought by a patient against a physician following an aesthetic treatment involving filler injections. The procedure resulted in permanent scarring and adverse reactions, leading to the physician’s liability for professional negligence in the court of first instance.

The central issue of the appeal concerned the internal relationship between the physician and their insurance company. The professional sought full coverage under the policy to be held harmless from both the principal debt (compensation for aesthetic damage) and the significant legal costs. Conversely, the insurer raised objections regarding contractual limits related to the deductible and the specific nature of the procedural costs.

Legal issue: defense costs vs. loss-of-suit costs

The most significant aspect of the decision lies in the clarification of the different categories of legal costs within the context of aesthetic medicine. The Court draws a sharp distinction between:

1. Indemnity for loss-of-suit costs: these are the costs the physician is ordered to pay to the successful claimant. These fall under the general liability coverage pursuant to Art. 1917, paragraph 1, of the Italian Civil Code.
2. Reimbursement for defense costs: governed by Art. 1917, paragraph 3, of the Italian Civil Code, this right arises directly from the insurance contract. It is independent of the judgment against the insured, as its purpose is to cover the costs incurred for defending the case against the third party's claims.

The Court’s decision and the legal principle

The Court of Appeal partially upheld the physician’s appeal, reforming the first-instance decision. The principle affirmed is clear: the insurer is required to guarantee full coverage of the amount owed to the patient (minus the agreed deductible), including the procedural costs awarded to the claimant.

Regarding defense costs, the Court reaffirmed that these are the responsibility of the insurer up to a limit of one-quarter of the policy’s coverage limit. The judgment emphasizes that the management of professional risk—particularly in high-litigation sectors such as aesthetic medicine—must include the legal protection of the professional as an integral part of the insurance contract’s scope.

Practical implications for aesthetic medicine

Ruling no. 1099/2025 highlights the importance of a thorough analysis of insurance policies for those operating in the aesthetic medicine sector. Two fundamental takeaways emerge:

• Specificity of coverage: It is essential that policies explicitly cover fillers and injectable treatments, while professionals must verify the exact amount of the deductible that remains their direct responsibility.
• Protection of legal defense: The distinction between loss-of-suit costs and defense costs confirms that professionals have a right to be reimbursed for the costs of their defense. This is a crucial element in safeguarding one’s assets against claims for aesthetic damages.