Auber v. Jellen

469 S.E.2d 104, 196 W. Va. 168, 1996 W. Va. LEXIS 16
CourtWest Virginia Supreme Court
DecidedMarch 1, 1996
Docket22879
StatusPublished
Cited by14 cases

This text of 469 S.E.2d 104 (Auber v. Jellen) is published on Counsel Stack Legal Research, covering West Virginia Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Auber v. Jellen, 469 S.E.2d 104, 196 W. Va. 168, 1996 W. Va. LEXIS 16 (W. Va. 1996).

Opinion

ALBRIGHT, Justice:

This is an appeal from a declaratory judgment entered by the Circuit Court of Ohio County. The principal question raised by the appeal is whether the medical malpractice insurance policies issued to appellees, AV. Jellen, M.D. and AV. Jellen, M.D., P.C., a professional corporation through which Doctor Jellen apparently conducted his medical practice, provide a single policy limit or may be aggregated to provide a greater sum of coverage with respect to a series of five misdiagnoses made by Doctor Jellen with regard to appellant, Lewis R. Auber. Additional issues are whether appellants, Lewis R. Auber and Jo-Ann Auber, his wife, are entitled to prejudgment interest from the date of a settlement agreement giving rise to the declaratory judgment and whether they are entitled to an award of attorney’s fees incurred in obtaining the declaratory judgment.

The trial court found that coverage of $500,000 was afforded by one of the policies with respect to the first misdiagnosis, that coverage was afforded by a second policy with respect to the remaining four misdiagnoses, that the four misdiagnoses so covered involved one “incident” under that policy, that the policy limit for one “incident” of $1,000,000 applied under that policy and, in effect, that the applicable policy limits of the two policies could be aggregated, resulting in coverage in the total sum of $1,500,000. The trial court further concluded that prejudgment interest was not payable and that attorney’s fees may not be awarded.

Appellants claim that, in addition to the policy limit provided by the first policy for the first misdiagnosis, they are entitled to treat the four misdiagnoses covered by the second policy as four separate “incidents”, invoking a higher aggregate limit for multiple “incidents” stated in that policy and that, as previously stated, they are entitled to prejudgment interest and an award of attorney’s fees for having substantially prevailed in the declaratory judgment. We disagree and, accordingly, we affirm the judgment of the Circuit Court of Ohio County.

Doctor Jellen first saw Mr. Auber in 1983, but the matters relevant here commenced in 1985. On December 2, 1985, appellant was examined and diagnosed with pain in the *171 entire lower abdomen. On December 5, 1986, appellant was examined and diagnosed with acute anal fissure. On June 5, 1987, appellant was examined and diagnosed with joint dysfunction, lumbar, or JDF lumbar plus SI joints with acute facet joint syndrome. On August 12, 1987, appellant was examined and diagnosed with spastic colon with severe chronic constipation. On August 28, 1987, appellant was examined and diagnosed with febrile infection, possibly caused by diverticulitis.

In October, 1987, Doctor Jellen referred appellant to Ahmed H. Kalla, M.D., who is a colon and rectal surgeon. Doctor Kalla performed a pathology examination and diagnosed appellant as having adenocarcinoma of the rectum, or rectal cancer. Appellant underwent surgeries, treatments, and hospitalizations for the condition diagnosed by Doctor Kalla. He is now disabled and unable to run his business, a retail tire store which he had owned and operated for some years.

Appellants, Lewis R. Auber and Jo-Ann Auber, filed a civil action in the Circuit Court of Ohio County on October 2, 1989, against A.V. Jellen, M.D. and A.V. Jellen, M.D., P.C., the previously mentioned professional corporation. The complaint alleged that Doctor Jellen injured appellants by reason of medical malpractice. Particularly, appellants’ complaint alleged that Doctor Jellen failed to properly diagnose rectal cancer on the occasion of the five separate examinations previously detailed in this opinion.

In the course of that action, the parties agreed by stipulation that when Doctor Kalla performed surgery in October, 1987, Doctor Kalla’s opinion, to a reasonable degree of medical certainty, based upon the size of the tumor and type of cancer, was that the tumor and cancer had been present in Mr. Auber for more than two years, thus placing the onset of the cancerous condition prior to Doctor Jellen’s first examination of Mr. Au-ber on December 2,1985.

Also, during the pendency of the malpractice action, appellants asked appellees how much insurance coverage was available. Doctor Jellen’s insurance carrier, Insurance Company of America (ICA), represented that the policy limit applicable to the malpractice action was $500,000. Appellants disputed that representation. In April and May, 1992, the parties negotiated a settlement of the malpractice action.

Under the negotiated settlement, ICA paid appellants $500,000 and appellants delivered to appellees an “Agreement of Release” dated May 28, 1992, which contained a general release of the defendants in the civil action, a release of any “bad faith” claim which appellants might have against the defendants’ insurer and a section denominated “Settlement Terms”. The release provided that appellants “will proceed to file a declaratory judgment action in the Circuit Court of Ohio County, West Virginia, the purpose of which is to determine if A.V. Jellen, M.D., and A.V. Jellen, M.D., P.C., possess any additional medical liability insurance coverage with Insurance Corporation of America applicable to this claim, aside from the Five Hundred Thousand Dollars and No/100 ($500,000.00)” paid incident to the settlement. The settlement further provided that:

At the conclusion of the declaratory judgment action and after the exhaustion of any and all appeal rights following, if it is determined that additional coverage is available, Insurance Corporation of America, will pay that coverage amount so determined, up to but not exceeding an additional One Million Five Hundred Thousand and No/100 Dollars ($1,500,000.00). (Emphasis added.)

Appellants filed the petition for a declaratory judgment, as provided for in the settlement, on May 7, 1992, after the parties had at least verbally agreed to the settlement, although the release reducing the settlement terms to writing bears the date of May 28, 1992. ICA filed an answer to the petition for declaratory judgment in which it claimed that the limit of its liability arising from the malpractice action was $500,000, the amount paid at settlement. ICA admitted to that amount of liability by reason of a policy issued to Doctor Jellen by ICA for the policy period from January 1, 1985 to January 1, 1986. Further, ICA admitted that it had sold additional policies providing coverage to Doctor Jellen and that a justiciable controversy existed as to the coverage provided by *172 those policies but denied that those policies afforded any additional coverage. In due course, appellants filed a motion for summary judgment on the declaratory judgment petition. The trial court issued a letter opinion, stating its findings of fact and conclusions of law supporting the grant of the summary judgment motion, and entered the declaratory judgment order in conformity with that letter opinion, from which appellants have taken this appeal.

During discovery incident to the declaratory judgment petition, ICA produced five separate policies of insurance covering Doctor Jellen. In all of the policies Doctor Jellen was the named insured and the professional corporation, “A.V. Jellen, Inc.” was made an “additional insured” by an endorsement included with each policy.

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Bluebook (online)
469 S.E.2d 104, 196 W. Va. 168, 1996 W. Va. LEXIS 16, Counsel Stack Legal Research, https://law.counselstack.com/opinion/auber-v-jellen-wva-1996.