Chicago Hospital Risk Pooling Program v. Illinois State Medical Inter-Insurance Exchange

925 N.E.2d 1216, 397 Ill. App. 3d 512, 339 Ill. Dec. 95, 2010 Ill. App. LEXIS 48
CourtAppellate Court of Illinois
DecidedJanuary 26, 2010
Docket1—07—2195, 1—07—2258 cons.
StatusPublished
Cited by14 cases

This text of 925 N.E.2d 1216 (Chicago Hospital Risk Pooling Program v. Illinois State Medical Inter-Insurance Exchange) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Chicago Hospital Risk Pooling Program v. Illinois State Medical Inter-Insurance Exchange, 925 N.E.2d 1216, 397 Ill. App. 3d 512, 339 Ill. Dec. 95, 2010 Ill. App. LEXIS 48 (Ill. Ct. App. 2010).

Opinion

JUSTICE THEIS

delivered the opinion of the court:

Plaintiff and counterdefendant, Chicago Hospital Risk Pooling Program (CHRPP), brought an action against defendant and counter-plaintiff, Illinois State Medical Inter-Insurance Exchange (ISMIE), under a theory of equitable contribution seeking to recover a portion of a settlement payment it made on behalf of a physician in an underlying medical malpractice suit. ISMIE filed a counterclaim seeking to recover its defense costs in defending the physician. Subsequently, CHRPP amended its complaint seeking reimbursement under both theories of equitable contribution and equitable subrogation. Ultimately, both parties filed cross-motions for summary judgment on CHRPP’s claims and ISMIE filed a motion for summary judgment on its counterclaim.

The circuit court made the following rulings on the parties’ cross-motions for summary judgment: (1) judgment in favor of ISMIE and against CHRPP on the equitable contribution claim; and (2) judgment in favor of CHRPP and against ISMIE on the equitable subrogation claim, awarding CHRPP $666,666.67 plus prejudgment interest. In addition, the court granted ISMIE’s motion for summary judgment on its counterclaim, awarding it half of its requested attorney fees in the amount of $21,820.94 plus prejudgment interest, finding that ISMIE and CHRPP were equally responsible for the physician’s defense costs.

On appeal, ISMIE contends that CHRPP is not entitled to equitable subrogation for certain amounts it purportedly paid on behalf of the physician from its excess trust fund for the following reasons: (1) numerous equitable theories including the doctrines of waiver, estoppel, “unclean hands,” and “mend the hold” bar CHRPP from asserting new facts disclosing the involvement of its excess layer of coverage and seeking equitable subrogation for the first time after four years of litigating its reimbursement claim; (2) it artificially constructed occurrence limits to reduce its primary limits of liability; (3) its excess fund does not provide “true excess” coverage; (4) its settlement allocations were never disclosed to ISMIE or documented at the time of the settlement until four years into this litigation; and (5) it cannot now rely on the affidavit of its trust administrator to prove its allocation.

ISMIE also contends that the circuit court erred in granting it only half of its defense costs for the following reasons: (1) CHRPP owed the physician a duty to defend; and (2) the physician’s target tender was sufficient to estop CHRPP from seeking contribution and entitling ISMIE to a full reimbursement of its costs.

CHRPP cross-appeals from that part of the trial court’s orders awarding ISMIE half of its defense costs on its counterclaim. It maintains that it owed no duty to defend and the target tender was ineffective to warrant ISMIE’s reimbursement. For the reasons that follow, we reverse the judgment of the circuit court granting summary judgment in favor of CHRPP on its equitable subrogation claim and reverse that portion of the judgment of the circuit court granting summary judgment in favor of ISMIE on its counterclaim for only one-half of its defense costs. We remand for further proceedings consistent with this opinion.

BACKGROUND

Underlying Litigation

In September 1993, Luz Rivera filed a medical malpractice action against several defendants, including Norwegian-American Hospital (the Hospital), Dr. Enrique Lipezker, Dr. Ha Nguyen, Dr. Carlos Baldoceda, and several nurses, alleging that they were negligent during the labor and delivery of her twins on December 13, 1992, causing the wrongful death of Joshua Rivera and severe neurological damage to the other twin, Joseph Rivera. Rivera v. Norwegian-American Hospital, No. 93 L 11731 (the Rivera action). Based upon the allegations of the complaint, Dr. Lipezker was sued in his individual capacity as Luz Rivera’s private obstetrician providing prenatal care. 1 The Hospital was sued for its institutional or direct corporate negligence and its vicarious liability for the acts of its employees. Drs. Nguyen and Baldoceda and several nurses were sued in their individual capacity and in their capacity as agents or employees of the Hospital.

The Parties Involved in This Litigation

At the time of the incident, Dr. Baldoceda had entered into an oral employment agreement with the Hospital under which he agreed to provide services to certain obstetrical patients as a hospital-employed “house physician.” As part of his agreement, the Hospital agreed to provide him with insurance coverage for treatment he rendered as an employed house physician. The Hospital paid a premium for coverage on his behalf.

This litigation involves the medical malpractice coverage afforded to Dr. Baldoceda as an employed physician at the Hospital through CHRPP while acting within the scope of his employment, and the medical malpractice coverage afforded to him through ISMIE, his private professional liability insurance carrier.

CHRPP administers a trust established pursuant to the Religious and Charitable Risk Pooling Trust Act (the Risk Pooling Act or Act) (215 ILCS 150/1 et seq. (West 1998)), whereby certain participating nonprofit hospitals pool certain risks associated with the care and treatment provided to their patients. Under the seventh amended trust agreement (the Trust Agreement or the Primary Trust), participating hospitals agree to contribute certain sums to CHRPP in consideration of CHRPP’s promise to make payments on behalf of the Hospital and other “Covered Persons,” including Hospital employees while acting within the scope of their employment, for a “Covered Loss.” The term “Covered Loss” is defined under appendix A, section 1.2, of the Trust Agreement as follows:

“All sums that any Covered Person, as defined herein, shall become legally obligated to pay as damages, including punitive damages:
(3) because of Malpractice Injury, to which this Trust Agreement applies, arising directly or indirectly out of or in connection with *** the rendering of or failure to render patient care or professional services by a Covered Person.”

The limits of liability for the period of participation were $1 million per occurrence and $3 million in the aggregate. It is undisputed that the Hospital was a participant in CHRPP and both the Hospital and Dr. Baldoceda, as an employee of the Hospital acting within the scope of his duties, were “Covered Persons” under the Trust Agreement.

The Hospital was also a signatory to a separate excess trust agreement (the Excess Trust) also administered by CHRP!) which provides coverage “in excess of a *** professional liability primary program or plan which provides, at a minimum, $1,000,000 for each occurrence and a $3,000,000 annual aggregate.” The limits of liability set forth in the Excess Trust are $10 million per occurrence and $20 million in the aggregate. Dr. Baldoceda was also considered a “Covered Person” under the Excess Trust.

ISMIE provided Dr.

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Bluebook (online)
925 N.E.2d 1216, 397 Ill. App. 3d 512, 339 Ill. Dec. 95, 2010 Ill. App. LEXIS 48, Counsel Stack Legal Research, https://law.counselstack.com/opinion/chicago-hospital-risk-pooling-program-v-illinois-state-medical-illappct-2010.