Justia Insurance Law Opinion Summaries

Physicians Liability Insurance Company (PLICO) insured Defendant Mark Valentine pursuant to a claims made policy with a policy period from July 1, 2004, to December 31, 2006. On November 1, 2004, Valentine operated on David Wurtz. As a result of Valentine's negligence during the operation, Wurtz died. On March 10, 2005, the Oklahoma Board of Medical Licensure held a hearing to determine whether Valentine should be disciplined. At the hearing, the Board revoked Valentine's license. On March 22, 2005, PLICO notified Valentine by letter that the policy had been cancelled effective March 10, 2005, with "Company's Decision" stated as the reason for cancellation and offered to sell him tail coverage. That letter was followed by another that addressed the premium refund issues and stated that the policy had been cancelled at Valentine's request. On June 2, 2005, Wurtz' personal representative, Tracey Chandler, filed suit against Valentine and others for the wrongful death of Wurtz. Valentine forwarded the petition and summons served on him to PLICO; PLICO sent Valentine a letter denying coverage because the claim was not made until after the policy was cancelled and asserting the policy exclusion for acts performed while under the influence of intoxicating substances. Valentine's debts were discharged in bankruptcy in early 2006. Chandler filed a motion for summary judgment against Valentine; Valentine entered into a Consent Judgment with Chandler in the amount of $2,250,000.00. The trial court granted summary judgment in favor of Chandler and ruled that Valentine was entitled to a set off by virtue of settlements with other parties in the amount of $1,275,000.00. Chandler filed garnishment proceedings against PLICO in May of 2008. Chandler asserted that Valentine was indebted to Chandler. PLICO denied any indebtedness asserting a lack of coverage under any insurance policy. Both Chandler and PLICO filed motions for summary judgment in the garnishment action. The trial court entered summary judgment in favor of Chandler, holding that cancellation of the policy violated section 3625 of title 36 and was therefore void. The issue in this matter was whether an insurer may agree to cancel a "claims made" policy with the knowledge that a potential claim is pending without violating the statutory prohibition on retroactive annulment of an insurance policy following the injury, death, or damage for which the insured may be liable. Upon review, the Supreme Court held that it may not and affirmed the trial court. View "Chandler v. Valentine" on Justia Law

Dustin Watkins suffered an in utero stroke approximately two days before he was born (in 1990), allegedly arising out of the medical malpractice of the treating obstetrician, Dr. Richard Barry, which resulted in a brain injury. This medical malpractice action followed, and a November 2003 trial resulted in multiple damage awards. At issue in this case was the extent to which the Louisiana Patient's Compensation Fund (PCF) continued to be obligated to make advance payments for custodial/attendant care for a medical malpractice victim, after receiving information indicating that such care may no longer be needed, and whether the PCF had the right to unilaterally terminate such payments, without prior court approval, when a judgment was previously rendered ordering it to make said payments. Upon review, the Supreme Court held that when the PCF denies a claim for payment of a future medical or related expense and the district court thereafter exercises its continuing jurisdiction and issues a ruling as to that matter, the PCF is obligated to comply with the district court's ruling, order, or judgment unless it modified or set aside by the court. View "Watkins v. Lake Charles Memorial Hospital" on Justia Law

White Oak Manor, Inc. owns and operates a nursing home in York. After sustaining injuries from the improper replacement of a feeding tube, a White Oak resident filed a lawsuit against the nursing home. White Oak ultimately settled the lawsuit without the involvement of its insurer, Lexington Insurance Company. White Oak subsequently filed a declaratory judgment action against Lexington to determine coverage for the malpractice claim. The issue this case presented to the Supreme Court concerned the validity of a service-of-suit clause in an insurance policy in light of Section 15-9-270 of the South Carolina Code (2005) which provides for service of process on an insurer through the Director of the Department of Insurance. The circuit court upheld the service-of-suit clause and refused to relieve the insurer from default judgment. The court of appeals reversed, holding section 15-9-270 provided the exclusive method for serving an insurance company. In its review, the Supreme Court disagreed that section 15-9-270 provided the exclusive means of service on an insurer and held that insurance policy provisions creating alternative methods of service are valid and binding on insurers. Accordingly, the court of appeals' decision was reversed. View "White Oak Manor v. Lexington Insurance Company" on Justia Law

Pearl Archambault died while in the care of Haven Health Center of Greenville (Haven Health) after a nurse mistakenly administered a lethal overdose of morphine. The administratrix of her estate, Plaintiff, filed a medical malpractice action against Haven Health. Health Haven subsequently filed for Chapter 11 bankruptcy. Thereafter, Plaintiff amended her complaint to add Columbia Casualty Company, the professional liability insurer of Health Haven, as a defendant and asserted two counts against Columbia directly based on R.I. Gen. Laws 27-7-2.4, which permits an injured party to proceed against an insurer when the insured has filed for bankruptcy. The superior court entered default judgment against Haven Health. The court then granted summary judgment in favor of Columbia. The Supreme Court reversed and remanded with instructions to enter judgment against Columbia, holding that the superior court erred in interpreting Rhode Island law and that the insurance contract between Columbia and Health Haven should be construed in Plaintiff's favor. View "Peloquin v. Haven Health Ctr. of Greenville, LLC" on Justia Law

Plaintiff filed a medical malpractice action against a dentist (Dentist) and his dental practice, alleging that Dentist's failure to diagnose and treat his dental conditions resulted in a bone infection and a worsening of his dental problems, which caused severe and permanent physical and emotional damage. In preparation for trial, there was an ex parte predeposition conference conducted between Plaintiff's nonparty treating physician and counsel provided by Defendant's insurance company. Plaintiff contended that the ex parte meeting violated the State's physician-patient confidentiality statute as delineated in Fla. Stat. 456.057(8). The Supreme Court held that section 456.057 prohibits such meetings and quashed the decision of the Fourth District holding otherwise. In particular, the Court held that an ex parte meeting such as the one attempted here is prohibited irrespective of whether the attorney and physician claim they will discuss only non-privileged matters. View "Hasan v. Garvar" on Justia Law

When Cody Metheny underwent brain surgery, the physician (Doctor) mistakenly operated on the wrong side of his brain. Fifteen months later, Cody's parents (the Methenys) learned tissue had been removed from the wrong side of Cody's brain. The Methenys filed a direct-action suit, alleging medical negligence on the part of Hospital where Doctor practiced and against Hospital's liability-insurance carrier (Insurer). The jury returned a verdict in favor of the Methenys. Insurer appealed, arguing that the circuit court erred in (1) failing to instruct the jury in a manner that would allow it to apportion liability among it and certain physicians who were sued in a prior case but ultimately settled; (2) refusing to allow Insurer to present evidence of fault attributable to the settling physicians; and (3) denying Insurer's motion for judgment notwithstanding the verdict where the evidence supporting Cody's future damages was based on improperly bundled calculations. The Methenys cross-appealed the circuit court's order reducing the jury's verdict from $20 million to $11 million. The Supreme Court affirmed on direct appeal and cross-appeal, holding that the circuit court did not err in its judgment. View "ProAssurance Indem. Co. v. Metheny" on Justia Law

Attorneys Post and Reid were retained to defend a medical malpractice action. At trial, plaintiffs introduced evidence suggesting that Post and Reid had engaged in discovery misconduct. Fearing that the jury believed that there had been a “cover-up” involving its lawyers, and concerned with the “substantial potential of uninsured punitive exposure,” the hospital, represented by new counsel, settled the case for $11 million, which represented the full extent of its medical malpractice policy limits. The settlement did not release Post, Reid, the law firm where they began representation of the hospital, or their new firm from liability. The hospital threatened Post with a malpractice suit and sought sanctions. Post eventually brought claims of bad faith and breach of contract against his legal malpractice insurer. The district court awarded $921,862.38 for breach of contract. The Third Circuit affirmed summary judgment in favor of the insurer on the bad faith claim and remanded for recalculation of the award, holding that, under the policy, the insurer is responsible for all costs incurred by Post in connection with the hospital’s malpractice claim from October 12, 2005 forward and for all costs incurred by Post to defend the sanctions proceedings from February 8, 2006 forward. View "Post v. St. Paul Travelers Ins. Co." on Justia Law

This appeal involved the interpretation of a claims-made professional liability insurance policy that Appellant Physicians Insurance Company of Wisconsin, Inc., d.b.a. PIC Wisconsin (PIC), issued to nonparty dentist Hamid Ahmadi, D.D.S. The policy covered dental malpractice claims made against Dr. Ahmadi and reported to PIC during the policy period. On cross-motions for summary judgment, the district court determined that PIC received constructive notice of Respondent Glenn Williams’s malpractice claim against Dr. Ahmadi while the policy was in force and held that this was enough to trigger coverage. Upon review, the Supreme Court reversed, finding that a "report" of a potential demand for damages to qualify as a "claim" required sufficient specificity to alert the insurer’s claim department to the existence of a potential demand for damages arising out of an identifiable incident, involving an identified or identifiable claimant or claimants, with actual or anticipated injuries. The Court did not find an ambiguity that would permit the PIC policy to have been triggered by the report of a default judgment against the doctor filed in public records. As such, the Court remanded the case with instructions to enter summary judgment in favor of PIC. View "Physicians Insurance Co. v. Williams" on Justia Law

At issue in this direct appeal to the Supreme Court was a statutory prerequisite to the obligation of the Insurance Department to defend certain medical professional liability actions asserted against health care providers, and to the requirement for payment of claims asserted in such actions from the Medical Care Availability and Reduction of Error Fund. Specifically, resolution of the appeal turned on when, under the governing statute, a "claim" is "made" outside a specified four-year time period. On June 4, 2007, Joanna Ziv filed a praecipe for a writ of summons naming Appellant Phillip Yussen, M.D. and other medical providers as defendants. A complaint was filed on August 2, 2007, alleging medical negligence last occurring on July 7, 2003. Appellant’s primary insurer, Pennsylvania Healthcare Providers Insurance Exchange, requested that the claim be accorded Section 715 status by the Insurance Department. The Department denied such request, however, on the basis that the claim had been made less than four years after the alleged malpractice. Appellant initially challenged this determination in the administrative setting, and a hearing ensued. Before the examiner, Appellant argued that, consistent with the policy definition of a "claim," the date on which a claim is made for purposes of Section 715 cannot precede the date on which notice is provided to the insured. Appellee, on the other hand, contended that a claim is made when it is first asserted, instituted, or comes into existence - including upon the tender of a demand or the commencement of a legal action - and that notice to the insured or insurer is not a necessary prerequisite. In this regard, Appellee Medical Care Availability & Reduction of Error Fund highlighted that Section 715 does require "notice" of the claim to trigger the provider's obligation to report the claim to the Fund within 180 days, but the statute does not contain such an express notice component in delineating the four-year requirement. The Commonwealth Court sustained exceptions to the hearing examiner's recommendation lodged by Appellee and entered judgment in its favor. In its review, the Supreme Court found "claim" and "made" as used in Section 715 ambiguous. The Court determined that for purposes of Section 715, the mere filing of a praecipe for a writ of summons does not suffice to make a claim, at least in absence of some notice or demand communicated to those from whom damages are sought. The Court remanded the case for entry of judgment in Appellant's favor.

Plaintiffs brought a declaratory judgment action seeking a determination that certain medical malpractice claims that they had asserted in an action against a medical association were covered under an insurance policy issued to the facility by Insurer. Due to Insurer's insolvency during the pendency of the action, Connecticut Insurance Guaranty Association assumed liability for Insurer's obligations to the extent that claims were covered under the Connecticut Insurance Guaranty Act. The Association filed a counterclaim, contending that the claims against the medical association were not covered because they were subject to a policy provision that excluded them from corporate coverage liability. The trial rendered rendered judgment in Plaintiffs' favor. The Supreme Court affirmed, holding that that the policy exclusion was inapplicable to the medical association's coverage for claims brought against it predicated solely on liability that it may have occurred through the acts of one of its nurse practitioners.