North American Specialty Insurance v. Correctional Medical Services, Inc.

527 F.3d 1033, 2008 U.S. App. LEXIS 11527, 2008 WL 2186489
CourtCourt of Appeals for the Tenth Circuit
DecidedMay 28, 2008
Docket05-8038, 05-8082
StatusPublished
Cited by11 cases

This text of 527 F.3d 1033 (North American Specialty Insurance v. Correctional Medical Services, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals for the Tenth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
North American Specialty Insurance v. Correctional Medical Services, Inc., 527 F.3d 1033, 2008 U.S. App. LEXIS 11527, 2008 WL 2186489 (10th Cir. 2008).

Opinion

HOLMES, Circuit Judge.

The Estate of Orlando Patrick Roan Eagle (“Roan Eagle”) sued Correctional Medical Services, Inc., Bruce Kahn, J.D., M.D. and Stephen Goldman (collectively “CMS”) for alleged medical malpractice. National American Specialty Insurance Company (“NAS”), CMS’s insurer, declined to defend or indemnify CMS, but nonetheless agreed to settle the matter on CMS’s behalf. NAS then filed this action seeking a declaratory judgment that it had no duty to defend or indemnify CMS, and to re *1035 coup the settlement proceeds. CMS filed a counterclaim for, among other things, breach of contract.

On cross-motions for summary judgment, the district court determined that the NAS policy provided coverage for the Roan Eagle claim, denied NAS’s claim for reimbursement of the settlement proceeds, and found NAS liable for CMS’s defense costs and attorney’s fees. The district court, by later order, required NAS to pay CMS $118,219.82 in damages. NAS appealed from both orders.

We conclude that, although the district court’s order resolving the cross-motions for summary judgment was not a final order pursuant to 28 U.S.C. § 1291, the district court’s order awarding damages is a final order subject to our review. We further conclude that the district court properly determined that NAS was liable, under the terms of its policy, for CMS’s defense costs and attorney’s fees in the Roan Eagle litigation. We therefore AFFIRM;.

I.

A. Factual Background

CMS provided health care and staffing to the Wyoming State Penitentiary (“Penitentiary”). On July 3, 2000, while CMS was insured by PHICO Insurance Company (“PHICO”), Mr. Roan Eagle, a Penitentiary inmate, committed suicide while under the care of a CMS doctor. Subsequently, on July 20, 2000, Lawyers and Advocates for Wyoming (“LAW”), a not-for-profit public interest law firm, sent a letter to the Wyoming Department of Corrections requesting records, including medical records, related to Mr. Roan Eagle’s death. Specifically, LAW asked for “a complete copy of all city, county, state and/or federal records ... pertaining to” Mr. Roan Eagle’s death. ApltApp. at A-309. LAW further advised that the letter was intended to put the Wyoming Department of Corrections “on notice that all materials related to this incident shall not be destroyed, tampered with or lost.” Id.

The Wyoming Attorney General’s office forwarded the LAW records request (“LAW request”) to a law firm that represented CMS in several matters. On July 31, 2000, the law firm responded to the LAW request. And, on the last day of August 2000, it notified Medical Claims Management Group (“MCMG”), CMS’s third party administrator, of a “possible claim” by Roan Eagle. ApltApp. at A-517.

On October 31, 2000, NAS issued a claims-made insurance policy 1 for health care liability to CMS. The NAS policy offered coverage from October 1, 2000 until October 1, 2001, subject to CMS’s $100,000.00 self-insured retention.

The policy defined a “claim” as follows:

(1) an express demand for damages arising from a medical incident or a staff privileges incident to which this insurance applies; an express demand for damages shall be deemed *1036 to include a civil action in which damages to which this insurance applies are alleged and an arbitration proceeding to which the insured is required to submit by statute or court rule or to which the insured has submitted with Company’s consent; or
(2) an act or omission which the insured reasonably believes will result in an express demand for damages to which this insurance applies.

Aplt.App. at A-38.

The policy contained an array of general exclusions. Of particular importance to this litigation is exclusion (h)(3), which barred coverage for any claim against an insured “arising from a demand, summons or other notice received by the insured prior to the effective date of the policy.” ApltApp. at A-37 (emphasis added).

On December 7, 2000, the MCMG litigation administrator completed a Loss Advisory Form — a PHICO-provided form used to report claims — which assigned a claim date of August 11, 2000 for the Roan Eagle matter. However, PHICO did not receive the form. On July 25, 2001, LAW sent a Notice of Claims to the Penitentiary and the Wyoming Department of Health, expressly demanding $15,000,000.00 “for the claims of the Estate of Orlando Roan Eagle for his wrongful death.” ApltApp. at A-332. Almost a year later, Roan Eagle filed a wrongful death action against CMS. When CMS had almost exhausted its self-insured retention, it notified NAS of the claim.

After investigating, NAS determined that the Roan Eagle claim was not covered by its policy, and orally denied coverage. CMS nevertheless continued to request coverage. On June 6, 2003, NAS and CMS agreed that each would pay half of the legal fees and expenses for the Roan Eagle claim, and that they would revisit the coverage issues. On July 15, 2003, NAS formally denied coverage based, as pertinent here, on exclusion (h)(3).

A day after it denied coverage, however, NAS attended a mediation in the Roan Eagle case and agreed to settle the matter. NAS ultimately paid the Roan Eagle settlement.

B. Procedural History

After paying the settlement, NAS filed a complaint against CMS seeking a declaratory judgment that (1) its policy does not provide coverage to CMS, (2) CMS must reimburse NAS for its settlement of the Roan Eagle suit, and (3) CMS may not recoup any defense expenses incurred in the Roan Eagle litigation. NAS alleged that its policy excluded coverage because CMS had knowledge of the Roan Eagle claim prior to the policy’s effective date. Conversely, CMS denied that it received notice within the meaning of the policy prior to its effective date.

Both parties moved for summary judgment. On March 23, 2005, the district court granted in part and denied in part both motions. The district court noted that “other notice” was not a defined term and concluded that “giving the term its plain and ordinary meaning does not reveal the parties’ intention.” ApltApp. at A-574. Therefore, it declared the language to be ambiguous.

• Applying the ambiguity against the insurer, the district court determined that the LAW request was not “other notice” within the meaning of exclusion (h)(3). In reaching this result, the district court relied upon the contractual construction principle known as ejusdem generis, 2 *1037 which led the court to conclude that “ ‘other notice’ must be construed to be similar to the more specific terms of ‘demand’ or ‘summons.’ ” Aplt.App. at A-575. According to the court, the LAW request was not sufficiently similar to these terms:

The request for medical records did not contain a demand for money, did not mention malpractice, and did not mention the possibility of a future claim or lawsuit.

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Cite This Page — Counsel Stack

Bluebook (online)
527 F.3d 1033, 2008 U.S. App. LEXIS 11527, 2008 WL 2186489, Counsel Stack Legal Research, https://law.counselstack.com/opinion/north-american-specialty-insurance-v-correctional-medical-services-inc-ca10-2008.