EmCode Reimbursement Solutions, Inc. v. Nutmeg Insurance

512 F. Supp. 2d 603, 2007 U.S. Dist. LEXIS 18204, 2007 WL 803965
CourtDistrict Court, N.D. Texas
DecidedMarch 15, 2007
DocketCivil Action 3:05-CV-1551-D
StatusPublished
Cited by1 cases

This text of 512 F. Supp. 2d 603 (EmCode Reimbursement Solutions, Inc. v. Nutmeg Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
EmCode Reimbursement Solutions, Inc. v. Nutmeg Insurance, 512 F. Supp. 2d 603, 2007 U.S. Dist. LEXIS 18204, 2007 WL 803965 (N.D. Tex. 2007).

Opinion

MEMORANDUM OPINION AND ORDER

SIDNEY A. FITZWATER, District Judge.

The principal question presented in this insurance coverage dispute is whether the insured gave timely notice of its claim under a claims-made policy. Concluding that it did not, the court grants summary judgment dismissing plaintiffs’ breach of contract action. The court also concludes that plaintiffs have failed to demonstrate that they have viable extracontractual claims or that granting them leave to amend would not be futile. Accordingly, the court dismisses this case with prejudice.

I

In this removed action, plaintiffs Em-Code Reimbursement Solutions, Inc. (“EmCode”) and EmCare, Inc. (“Em-Care”) sue defendant Nutmeg Insurance Co. (“Nutmeg”) on claims for declaratory judgment, bad faith denial of coverage, unfair settlement practice, breach of contract, and attorney’s fees arising from Nutmeg’s refusal to defend and indemnify EmCode and EmCare in litigation filed in the United States District Court for the Northern District of Oklahoma. In that lawsuit — the “Given Country Litigation” — Green Country Emergency Physicians, P.C. (“Green Country”), a professional group for emergency physicians, sued Healthcare Administrative Services, Inc. (“HASI”) and EmCare, both wholly-owned subsidiaries of EmCode, for breach of contract and conversion, eventually adding a negligence claim. 1 In January 2001 Green Country entered into separate contracts with EmCare, d/b/a Medtrust Healthcare Services, and HASI to provide billing and financial management services (EmCare contract) and administrative support services (HASI contract) to Green Country. In the Given Country Litigation, Green Country alleged in its complaint that HASI and EmCare were liable for breach of contract and conversion arising from their failure, neglect, and refusal to provide the services they had agreed to perform.

Nutmeg insured EmCode under three successive one-year term insurance policies for the period May 16, 2002 through May 16, 2005. Each policy was a “claims-made and reported”-type insurance policy. 2 The terms of the Policy required disclosure of pending or potential suits against the insured prior to its initial inception and before subsequent renewals. EmCode re *605 newed the Policy annually until May 16, 2005, when the Policy expired.

When Green Country sued HASI and EmCare in March 2003 for breach of contract and conversion, EmCode did not forward a copy of the complaint to Nutmeg or otherwise disclose or report the factual allegations of the lawsuit to Nutmeg during the 2002-03 Policy term. Nor did it do so during the 60-day reporting period that followed the expiration of the 2002-03 Policy (i.e., the tail period).

Green Country amended its complaint in June 2003, asserting in its first amended complaint two claims for breach of contract (addressing two separate contracts) and one claim for conversion. EmCode did not forward to Nutmeg a copy of the first amended complaint or otherwise disclose or report the factual allegations of the Green Country Litigation to Nutmeg during the 2003-04 Policy term or the 60-day reporting period that followed.

When EmCode renewed the Policy for the third and final annual period of May 16, 2004 to May 16, 2005, it did not report the Green Country Litigation to Nutmeg in accordance with the terms of the renewal. In January 2005 Green Country filed a second amended complaint alleging, in addition to the breach of contract and conversion claims, a new cause of action for negligence based essentially on the same factual allegations asserted in its complaint and first amended complaint. A few days later, EmCode forwarded a copy of the second amended complaint to Nutmeg, who tendered a defense, subject to a full reservation of rights. About two weeks later, Nutmeg received copies of Green Country’s complaint and first amended complaint.

After reviewing the complaint and first amended complaint, Nutmeg denied coverage. It concluded that EmCode had breached conditions precedent to coverage by failing to report the claim during the 2002-03 Policy term, when it was “first made,” or during the Policy’s 60-day reporting period.

EmCode and EmCare then brought this lawsuit against Nutmeg in Texas state court, alleging that Nutmeg had a duty to defend and indemnify EmCode and Em-Care. 3 Nutmeg removed the case to this court based on diversity of citizenship. The following five motions are pending for decision: (1) Nutmeg’s May 18, 2006 motion for summary judgment; (2) plaintiffs’ June 9, 2006 motion for leave to amend complaint; (3) plaintiffs’ June 26, 2006 motion for leave to supplement evidence in support of summary judgment response; (4) Nutmeg’s September 5, 2006 motion to exclude expert opinions of Olie R. Jolstad (“Jolstad”); and (5) Nutmeg’s September 12, 2006 motion to extend the discovery deadline.

II

The court turns first to Nutmeg’s motion for summary judgment.

A

Nutmeg contends that Green Country’s complaint, filed in March 2003, alleged “wrongful acts” involving professional services against HASI and EmCare 4 that *606 constituted a “claim” under the Policy during the 2002-03 Policy period. It maintains that because the specific allegations gave rise to a claim no later than March 2003, they were not first made during the May 16, 2003 to May 16, 2004 Policy. And because the claim was not reported until February 2005, it is not covered under the Policy because EmCode failed to report the claim as soon as practicable, but in no event later than 60 days after the expiration of the Policy period, as the Policy required. Nutmeg therefore argues that EmCode failed to comply with the following conditions precedent: report the claim within the Policy period in which the claim was first made, or during the 60-day tail period; immediately forward to Nutmeg any suit papers and the like; and provide written notice of the claim details as soon as practicable.

Nutmeg also contends that the Policy required immediate notice of every demand, notice, summons, of other process. It posits that because the Green Country Litigation was filed and the first claim made no later than the 2002-03 Policy period, EmCode was required to report the lawsuit immediately, provide additional written information as soon as practicable, and no later than 60 days following the expiration of the Policy period; the 22-month delay in forwarding the complaint did not satisfy the Policy’s requirement that the insured “immediately forward process” to the insurer; and because Texas law clearly mandates compliance with a claims-made policy’s reporting requirements as a condition precedent to coverage, the failure to timely report the claim barred coverage, regardless whether Nutmeg was prejudiced.

Plaintiffs generally accept Nutmeg’s statement of facts and its supporting evi-dentiary appendix. 5

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Bluebook (online)
512 F. Supp. 2d 603, 2007 U.S. Dist. LEXIS 18204, 2007 WL 803965, Counsel Stack Legal Research, https://law.counselstack.com/opinion/emcode-reimbursement-solutions-inc-v-nutmeg-insurance-txnd-2007.