Moscarillo v. Professional Risk Management Services, Inc.

921 A.2d 245, 398 Md. 529, 2007 Md. LEXIS 185
CourtCourt of Appeals of Maryland
DecidedApril 16, 2007
Docket61, Sept. Term, 2006
StatusPublished
Cited by36 cases

This text of 921 A.2d 245 (Moscarillo v. Professional Risk Management Services, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Moscarillo v. Professional Risk Management Services, Inc., 921 A.2d 245, 398 Md. 529, 2007 Md. LEXIS 185 (Md. 2007).

Opinion

*532 GREENE, J.

This appeal arises out of an action filed in the Circuit Court for Montgomery County by Petitioner, Dr. Frank Moscarillo (“Dr. Moscarillo”), against Respondents, Professional Risk Management Services, Inc. (“PRMS”), Property and Casualty Insurance Guaranty Corporation (“PCIGC”), and Legion Insurance Company (“Legion.”) Dr. Moscarillo brought a declaratory judgement action that included allegations of breach of contract. Additionally, Dr. Moscarillo sought damages as a result of Legion’s refusal to pay or reimburse the losses that he incurred in defending a lawsuit which had been filed against him. The Circuit Court denied Dr. Moscarillo’s motion for partial summary judgment and granted Respondents’ cross-motions for summary judgment, finding no duty to defend existed under Legion’s policy (the “Policy”) because the allegations against Dr. Moscarillo were related to intentional misconduct and not negligent conduct. On appeal, the Court of Special Appeals held that the Policy did not provide coverage for fraud. Additionally, that court held that the complaint and extrinsic evidence only supported a cause of action for fraud.

The issue we must decide in this case is whether Legion had a duty to defend Dr. Moscarillo in a lawsuit brought against him by William M. Mercer, Inc', and Marsh & McLennan Co., Inc. (collectively, “Mercer”). We hold that there was no duty to defend Dr. Moscarillo because there was no potentiality of coverage under the Policy. Accordingly, we shall affirm the judgment of the Court of Special Appeals.

I.

We adopt the facts as stated by Judge Peter B. Krauser, writing for the Court of Special Appeals in this case:

On November 4, 1998, [Dr. Moscarillo] purchased a “claims-made” professional liability insurance policy from *533 Legion, which was retroactive to May 1, 1996. It provided that Legion would “pay on behalf of an Insured all sums which the Insured shall become legally obligated to pay as Damages arising out of a Medical Incident, to which this policy applies.” It further provided that Legion had a “duty to defend any Claim or Suit against an Insured for Damages which are payable under the terms of this policy, even if any of the allegations of such actions or proceedings are groundless, false, or fraudulent.”
In the Legion policy, a “Claim” meant “a written demand received by an Insured for money including the service of Suit, demand for arbitration or the institution of any other similar legal proceeding to which this policy applies”; “Damages” included “any compensatory amount which an Insured is legally obligated to pay for any Claim to which this insurance applies”; and a “Medical Incident” encompassed “any negligent act or omission in the furnishing of Psychiatric Services by a Named Insured or any person for whose acts or omissions the Named Insured is legally responsible.”
The Legion policy contained several exclusions, but only one is at issue here. That exclusion provided: “This policy does not apply to: ... [a]ny Claim arising out of or in connection with any dishonest, fraudulent, criminal, maliciously or deliberately wrongful acts or omissions, or violations of law committed by an Insured.”
The Mercer Litigation
On February 24, 1999, Mercer and Marsh & McLennan, Mercer’s parent company, filed suit in federal district court against [Dr. Moscarillo] and his patient, Evelyn Toni Mulder, alleging fraud and conspiracy to defraud in connection with Mulder’s application for and receipt of disability benefits. The complaint stated that Mercer hired Mulder as an actuary in 1992. On February 27, 1997, the head of Mulder’s practice group, Henry Essert, met with Mulder to advise her that, as part of Mercer’s restructuring plan, her office was to be closed. Two months later, he sent Mulder a *534 letter offering her a severance package and notifying her that her employment would end on May 31,1997.
Two weeks after that letter was sent, on May 22, 1997, Mulder sought treatment from [Dr. Moscarillo,] a psychiatrist. She continued to see [Dr. Moscarillo] during the spring and summer of that year. During that time, [Dr. Moscarillo] prescribed Prozac and other antidepressants for her. By June, [Dr. Moscarillo] had concluded that Mulder was suffering from major depression. That diagnosis enabled Mulder to apply for and receive disability benefits under the Marsh & McLennan benefit plan.
According to the Mercer complaint, three weeks later, on June 23, 1997, Mulder told [Dr. Moscarillo] about the employment dispute she was having with Mercer. At that time, [Dr. Moscarillo] and Mulder “completed” Mulder’s application for short-term disability benefits. The application stated that Mulder had major depression and had been unable to work since May 14, 1997. In July and August of 1997, [Dr. Moscarillo] purportedly told a disability coordinator and a health care consultant for Marsh & McLennan that Mulder had not yet recovered from that depression.
The Mercer complaint further alleged that on October 23, 1997, a senior Mercer human resources representative told Mulder that, consistent with Mercer’s original decision, there was no longer any position for her at Mercer; her disability benefits were terminated effective November 1, 1997. On October 31st, the day before her benefits were to end, Mulder sent a letter to Mercer appealing the termination of her benefits. In reply, Mercer suggested that Mulder submit to an independent medical examination. That suggestion, according to the complaint, prompted [Dr. Moscarillo] to write a note to Mercer’s medical consultant stating that Mulder would be able to return to work on December 1,1997.[ 1 ]
*535 When the Mercer litigation commenced, [Dr. Mosearillo] invoked Legion’s duty to defend him under the terms of his insurance policy. That request was denied. On April 26, 1999, [Dr. Mosearillo] filed an answer, and discovery commenced.
Nine months later, on January 29, 2001, Mercer and Marsh & McLennan filed a stipulation under seal stating that, “following extensive discovery and intense discussions between counsel ... plaintiffs’ counsel has advised his clients of his opinion that the allegations that Dr. Mosearillo himself engaged in fraud or conspiracy to defraud with respect to his diagnosis and treatment of defendant Mulder or with respect to Mulder’s application for disability benefits would likely be rejected by a finder of fact.” On January 30, 2001, Mercer and Marsh & McLennan agreed to dismiss with prejudice their claims against [Dr. Mosearillo].
Thereafter, [Dr. Mosearillo] demanded payment from [Legion] of the costs he had incurred during the Mercer litigation. On June 29, 2000, and October 15, 2001, PRMS, PCIGC,[ 2 ] and Legion denied coverage of [Dr. Moscarillo’s] claim. Two years later, on July 28, 2003, Legion was declared insolvent by the Commonwealth of Pennsylvania.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
921 A.2d 245, 398 Md. 529, 2007 Md. LEXIS 185, Counsel Stack Legal Research, https://law.counselstack.com/opinion/moscarillo-v-professional-risk-management-services-inc-md-2007.