Employers' Fire Insurance Company v. ProMedica Health Systems, Inc.

524 F. App'x 241
CourtCourt of Appeals for the Sixth Circuit
DecidedApril 30, 2013
Docket12-3104
StatusUnpublished
Cited by6 cases

This text of 524 F. App'x 241 (Employers' Fire Insurance Company v. ProMedica Health Systems, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Employers' Fire Insurance Company v. ProMedica Health Systems, Inc., 524 F. App'x 241 (6th Cir. 2013).

Opinion

JULIA SMITH GIBBONS, Circuit Judge.

This case involves a dispute between an insurance provider, Employers’ Fire Insurance Co. (“OneBeacon”) 1 and one of its policyholders, ProMedica Health System, Inc. (“ProMedica”). OneBeacon denied coverage to ProMedica for the costs of defending administrative and civil actions brought by the Federal Trade Commission (“FTC”) to enjoin ProMedica’s acquisition of a suburban Toledo hospital. OneBeacon did so on the ground that ProMedica failed to report the claim within the time period required by ProMedica’s insurance policy. OneBeacon argues that a “claim” arose in August 2010 when the FTC began to formally investigate ProMedica’s acquisition *243 of the hospital. ProMedica argues that a “claim” did not arise until January 2011 when the FTC filed administrative and civil complaints against ProMedica, and, therefore, ProMedica’s January 2011 notice to OneBeacon was timely. OneBeacon filed suit in district court, seeking a declaration that ProMedica is not entitled to coverage, and ProMedica filed a counterclaim seeking a declaration that OneBea-con is required to pay ProMedica’s defense expenses. The district court granted summary judgment to OneBeacon, holding that a “claim” arose in August 2010, and ProMedica’s failure to notify OneBeacon in a timely manner precludes coverage. We hold that a “claim” did not arise until January 2011 when the FTC initiated administrative and civil actions against ProMedica and that ProMedica’s notification was therefore timely. We vacate the district court’s grant of summary judgment to OneBeacon and remand this case to district court for further proceedings consistent with this opinion.

I.

A.

This case involves two essentially identical insurance policies: a policy that One-Beacon issued to ProMedica for the period from September 29, 2009 to September 29, 2010 (the “2009 Policy”) and a renewal policy for the period from September 29, 2010 to September 29, 2011 (the “2010 Policy”). Each policy provides ProMedica with up to fifteen million dollars of Directors, Officers, and Organization liability coverage.

The policies at issue are “claims-made” policies, which cover “Loss from any Claim first made against [ProMedica] during the Policy Period or applicable Extended Reporting Period for a Wrongful Act; provided that such Claim is reported to the Underwriter in accordance with Section VIII of this Coverage Section.”

The dispute in this case turns on when a “claim” arose. Both policies define “claim” to mean:

(1) a written demand for monetary, non-monetary or injunctive relief (including any request to toll or waive any statute of limitations); or
(2) a civil, criminal, administrative, regulatory or arbitration proceeding for monetary, non-monetary or injunctive relief commenced by:
(a) the service of a complaint or similar pleading;
(c) the filing of a notice of charges, formal investigative order or similar document,
against an Insured for a Wrongful Act....

The policies define “Wrongful Act” to include an “Antitrust Violation,” which is defined to include “any actual or alleged ... violation of ... the Clayton Act of 1914 ... [or] the Federal Trade Commission Act of 1914.... ”

Section VIII of the policies’ coverage sections requires ProMedica to report claims to OneBeacon in order to receive coverage:

[ProMedica] must, as a condition precedent to any right to coverage ... give the Underwriter written notice of such Claim as soon as practicable after [ProMedica] first becomes aware of such Claim, and in no event later than:
(1) with respect to any Claim first made during the Policy Period, ninety (90) days after the end of the Policy Period; or
(2) with respect to any Claim first made during any applicable Extended Reporting Period, ninety (90) days af *244 ter the end of the Extended Reporting Period.

The policies contain a “Related Claims” provision that addresses “all Claims ... in any way involving the same or related facts.... ” “Related Claims, whenever made, shall be deemed a single Claim made when the earliest of such Related Claims was first made.... ”

The policies also include a “Notice of Circumstances” provision that gives ProMedica the option to report “Wrongful Acts” in order to ensure that future claims are covered:

If, during the Policy Period, [ProMedi-ca] first becomes aware of a specific Wrongful Act which may subsequently give rise to a Claim, and:
(1) gives the Underwriter written notice of such Wrongful Act ... before the end of the Policy Period; and
(2) requests coverage ... for any Claim subsequently arising from such Wrongful Act;
then any Claim subsequently made against [ProMedica] arising out of such Wrongful Act shall ... be treated as if it had been first made during the Policy Period.

B.

The facts of this case are undisputed. ProMedica operates a not-for-profit healthcare system serving northwest Ohio and southeast Michigan. Before the acquisition, St. Luke’s Hospital (“St. Luke’s”) was an independent, not-for-profit hospital located in Maumee, Ohio, a suburb of Toledo. In May 2010, ProMedica and St. Luke’s entered into an agreement (the “Joinder Agreement”) by which the parties agreed that ProMedica would acquire St. Luke’s. The Joinder Agreement provided that the transaction would close on July 30, 2010. The following events occurred while ProMedica’s 2009 Policy was in effect.

On July 15, 2010, the FTC sent a letter to ProMedica informing ProMedica that it would be “conducting a non-public preliminary investigation to determine whether the acquisition of St. Luke’s by ProMedica may be anticompetitive and in violation of Section 7 of the Clayton Act ... or Section 5 of the Federal Trade Commission Act....” The letter advised ProMedica that if the FTC determined that the acquisition would have anticompetitive effects, the FTC could seek a preliminary injunction blocking or rescinding the acquisition. It also asked ProMedica to preserve documents and information related to the acquisition. On July 16, 2010, the FTC sent a second letter to ProMedica requesting copies of specified documents and additional information. The letter clarified that “[n]either this letter nor the existence of this non-public investigation should be construed as indicating that a violation has occurred or is occurring” and stated that the purpose of its request was to “determine whether further investigation of the acquisition is necessary.”

On July 29, 2010, representatives from ProMedica and St. Luke’s met with FTC staff members in Washington, D.C., to discuss the acquisition. ProMedica voluntarily agreed to delay closing of the transaction until August 27, 2010, to allow additional time for the FTC to complete its investigation.

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Bluebook (online)
524 F. App'x 241, Counsel Stack Legal Research, https://law.counselstack.com/opinion/employers-fire-insurance-company-v-promedica-health-systems-inc-ca6-2013.