National Union Fire Insurance v. Sharon Regional Health System

69 Pa. D. & C.4th 374, 2004 Pa. Dist. & Cnty. Dec. LEXIS 135
CourtPennsylvania Court of Common Pleas, Alleghany County
DecidedDecember 1, 2004
Docketno. GD01-14026
StatusPublished
Cited by1 cases

This text of 69 Pa. D. & C.4th 374 (National Union Fire Insurance v. Sharon Regional Health System) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Alleghany County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
National Union Fire Insurance v. Sharon Regional Health System, 69 Pa. D. & C.4th 374, 2004 Pa. Dist. & Cnty. Dec. LEXIS 135 (Pa. Super. Ct. 2004).

Opinion

WETTICK JR., A.J.,

Five motions for summary judgment and/or partial summary judgment are the subject of this opinion and order of court.1

This lawsuit arises out of an underlying medical malpractice action brought in the Common Pleas Court of Mercer County by Marie and Joseph Viola against a radiologist and his professional corporation, an obstetrician and his professional corporation, and Sharon Regional Health System, in its capacity as the employer of [377]*377the radiologist and the obstetrician.2 The lawsuit, filed on May 21,1999, was based on a failure to detect breast cancer that was allegedly apparent on the radiograph of a mammogram taken on August 20,1994 and on the radiograph of a mammogram taken on October 4, 1996. On April 20, 2001, the jury returned a verdict of $12,844,000.

From September 1, 1991 to September 1, 1992, National Union Fire Insurance Company of Pittsburgh provided excess insurance coverage to Sharon. Sharon was one of a group of hospitals that were part of a pooled program. Sharon’s policy was renewed each year through September 1, 1999.

This lawsuit arises out of National Union’s refusal to provide coverage to Sharon. National Union denied coverage on the ground that National Union was never notified of the Viola litigation until after the rendering of the verdict.

National Union commenced this lawsuit by filing a complaint seeking a declaratory judgment that it had no duty to provide coverage because of Sharon’s failure to provide timely notice of the Viola claim. Sharon’s answer includes a counterclaim seeking recovery on the ground that National Union’s defense of a lack of timely notice has no merit.

I.

The motions for summary judgment filed by the parties include National Union’s motion for the entry of a judgment declaring that National Union has no duty to [378]*378provide coverage because it was not timely notified of the lawsuit, and Sharon’s motion for the entry of a judgment for the payments due under the policy. Both motions are based on the notice requirements of the insurance policies, evidence as to what notice was provided, and the case law governing noncompliance with an insurance policy’s notice provisions.

Sharon contends that the evidence establishes, as a matter of law, that it provided timely notice of the Viola lawsuit to National Union by furnishing notice of the lawsuit to Nichols & Associates Inc. within one week after the filing of the lawsuit; according to Sharon, Nichols was National Union’s agent for the purpose of receiving notice of claims against Sharon.

National Union contends that the evidence establishes just the opposite. It never had notice of the lawsuit until after the verdict was rendered and the failure to give notice bars recovery.

There is credible evidence that would permit a jury to find that Nichols had timely notice of the Viola lawsuit, through a written notice or through loss runs. However, there is also credible evidence that would permit a jury to find that neither Nichols nor National Union had notice of the Viola lawsuit until after the verdict was rendered. There is also credible evidence that would support either a finding that Nichols was only Sharon’s agent for all purposes, including receipt of notices of lawsuits and loss runs, or a finding that Nichols was a dual agent (i.e., an agent for Sharon and National Union), at least for purposes of receipt of notices of lawsuits. For these reasons, neither party may obtain a summary judgment based on that party’s evidence as to whether Nichols had [379]*379(or should have had) notice of the Viola lawsuit and as to the role of Nichols vis-a-vis National Union.

For purposes of determining the issues that will be tried, I will next consider the significance of a finding in National Union’s favor that Sharon did not comply with the notice provisions of the applicable policy. It is National Union’s position that it had no obligation to provide coverage unless it was notified of the Viola lawsuit by September 1, 1999, this being the expiration date of the final policy which National Union issued to Sharon. It is Sharon’s position that noncompliance with the notice provisions of the applicable insurance policy is a defense only upon a showing of actual prejudice.3

National Union’s argument that compliance with the policy’s notice provisions is a prerequisite to recovery is based on its contention that Sharon was covered for the Viola claim only by the following endorsement of the 1998-1999 policy:

“Endorsement no. 3
“Page 1 of 5
“This endorsement, effective 12:01 a.m., September 1, 1998, forms a part of policy no. *** ** ** issued to: VHA Pennsylvania Inc. and Participating Hospitals by: National Union Fire Insurance Company of Pittsburgh, PA.
[380]*380380
“This is a claims-made form. Please review the coverage carefully and discuss with your insurance agent or broker.
“Hospital professional liability — (Claims made) supplement
“(I) In consideration of the premium charged, it is agreed that coverage afforded by this policy is hereby extended to include the following additional coverage, hospital professional liability:
“The company will pay on behalf of the insured the ultimate net loss in excess of either the self-insured retention or the retained limit or designated underlying insurance as defined by the schedule of underlying insurance, which the insured shall become legally obligated to pay as damages because of injury caused by a ‘medical incident’ occurring on or after the retroactive date shown below and for which claim is first made against the insured and reported to the company during the policy period.” National Union’s appendix, exhibit 17.

National Union correctly states that the hospital professional liability coverage provided through this endorsement is claims based. The endorsement specifically provides that National Union will provide coverage for claims in the policy year “for which claim is first made against the insured and reported to the company during the policy period.” In this case, the claim was first made through the filing of a lawsuit on May 21,1999. Thus, the claim was covered by this endorsement covering the period between September 1, 1998 and September 1, 1999.

The policy specifically provides coverage only for a claim initially raised in the policy period which is “re[381]*381ported to the company during the policy period.” There is considerable merit to National Union’s position that the notice-prejudice rule governing occurrence policies should not be extended to claims-made policies. See the numerous federal court cases and cases of other state courts cited at pages 27-28 of National Union’s brief in support of motion for summary judgment or, in the alternative, for partial summary judgment which support the position that a claims-made policy protects the insured only as to claims reported to the insurance company during the policy period.

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Cite This Page — Counsel Stack

Bluebook (online)
69 Pa. D. & C.4th 374, 2004 Pa. Dist. & Cnty. Dec. LEXIS 135, Counsel Stack Legal Research, https://law.counselstack.com/opinion/national-union-fire-insurance-v-sharon-regional-health-system-pactcomplallegh-2004.