Pinheiro v. Medical Malpractice Joint Underwriting Ass'n

406 Mass. 288
Massachusetts Supreme Judicial Court·Decided December 14, 1989·Published·Cited by 23 cases

Opinions

Greaney, J.

In these cases, we are called on to decide the scope of a limitation of liability provision in a medical malpractice insurance policy issued by The Medical Malpractice Joint Underwriting Association of Massachusetts (JUA). The provision in question reads as follows:

“The limit of liability stated in the declarations as applicable to ‘each claim’ is the limit of the company’s liability for loss resulting from any one claim or suit or all claims or suits because of injury to or death of any one person.”

Specifically, we must decide whether the patient’s claim for malpractice, and any claim for the loss of the patient’s consortium brought by a spouse or child, constitute a single “claim” or separate “claims” for purposes of the limitation. The answer to this question determines whether the malpractice plaintiff and the consortium plaintiff or plaintiffs each may recover up to the policy’s stated limit for “each claim” or whether their aggregate recovery is confined to a single amount. We conclude that the malpractice and consortium claims are distinct and separate claims, each of which is subject to separate “per claim” limits of recovery under the terms of the JUA policy.

The facts have been agreed on and may be summarized as follows.

The Pinheiro case. Edward Pinheiro was treated by a physician in 1976. Pinheiro subsequently sued the physician for negligence, claiming damages for pain and suffering, loss of income, and medical expenses. Additionally, Pinheiro’s wife, [290]*290Maria, and his daughter, Suzanne, brought claims for loss of consortium. At the time he treated Pinheiro, the physician was insured under a 1975 JUA policy which included a liability limit of $100,000 for “each claim” and an “annual aggregate” limit of $300,000. JUA has conditionally settled the claims brought by the Pinheiros, and will pay Maria and Suzanne an agreed-on amount if it is judicially determined that their consortium claims are separate claims under the applicable policy.

The O’Connor case. In 1978, Edward J. O’Connor was treated by a physician. He died the following year, and his widow, as administratrix and individually, sued the physician for negligence, wrongful death, and loss of consortium. A jury returned a verdict for the plaintiff on all claims. The physician was insured under a 1977 JUA policy. The insurer has paid the per claim limit of the policy toward the judgment and has submitted the question of its liability on the remaining unpaid amount, which pertains to the consortium claim, for judicial determination. With these facts established, a judge of the Superior Court reported the coverage question to the Appeals Court. We granted an application for direct appellate review.

1. The JUA’s position that the plain language of the limitation precludes a ruling that a consortium claim is a separate “claim” is principally based on two portions of the limitation: (1) the language which concerns a loss resulting from claims “because of injury to or death of any one person,” and (2) the language which applies to a loss resulting “from all claims or suits.” We discuss each in turn.

“injury to or death of any one person'’'

The JUA argues that “[i]n the context of a medical malpractice policy, this . . . phrase [‘injury to or death of any one person’] is not ambiguous and refers to- the primary injury, which will ordinarily be a physical injury to or death of the physician’s patient.” Although the JUA acknowledges, as it must, that the term “injury,” as used in its policy, encom[291]*291passes injuries other than bodily injuries,3 the JUA’s brief consistently argues that their policy should be construed in the context of the “typical malpractice situation in which the patient suffers physical injury or death.” In attempting to analogize the policy’s language to that of an automobile insurance policy we construed in Liberty Mut. Ins. Co. v. Commissioner of Ins., 395 Mass. 765 (1985), the JUA argues that, in the Liberty Mut. context, “the phrase ‘injury to one person’ is not ambiguous, any more than the language of the JUA policy is ambiguous. In context, they both clearly refer to physical injury” (emphasis in original). This interpretation of the words “injury” and “person” would prevent a consortium plaintiff’s suit from constituting a separate “claim” because the consortium plaintiff suffered no physical injury and was not a patient of the insured physician. The only independent “claim” would belong to the bodily-injured patient — the malpractice plaintiff. Based on this analysis, JUA concludes that the consortium plaintiff’s right to recover under the policy is essentially derivative — that it arises “because of’ the injury to the patient — and thus must be consolidated with the malpractice plaintiff’s action for purposes of limiting JUA’s liability for “each claim.”

The obvious difficulty with this interpretation is that the provision purports to cover claims resulting from an “injury [292]*292to . . . any one person” (emphasis added). Thus the provision, by its express language, recognizes that there may be more than one person who suffers an “injury” because of a single act of malpractice. To be sure, the provision encompasses the claim or claims made by the patient.4 But it also encompasses the claim or claims of any other person who is harmed as the result of the malpractice. It is settled that a consortium plaintiff suffers an injury which is separate and distinct from the loss incurred by the injured spouse or patient.5 The limitation straightforwardly promises to pay up to the policy limit for a single claim or multiple claims stemming from the “injury” incurred by each “person” as a result of the malpractice. Although the JUA would like to have the limitation read to substitute the word “patient” for “person,” or to insert the word “bodily,” or the word “physical,” before the word “injury,” the clause must be construed as written. See Barnstable County Mut. Fire Ins. Co. v. Lally, 374 Mass. 602, 605-606 (1978); Ober v. National Casualty Co., [293]*293318 Mass. 27, 30 (1945). We conclude that use of the words “injury to . . . any one person” in the JUA limitation, fairly and reasonably construed, see Cody v. Connecticut Gen. Life Ins. Co., 387 Mass. 142, 146 (1982), provides that each consortium plaintiff has a separate claim for limitation of liability purposes.6

“all claims or suits”

JUA also relies on the “all claims or suits” language in the limitation as requiring a conclusion in its favor. The use of the plural in this phrase, contends JUA, means that all causes of action brought as a result of a single instance of malpractice constitute only one “claim” for limitation of liability purposes regardless of how many individual plaintiffs are involved.

The JUA’s interpretation of this language is reasonable, but it is not the only reasonable interpretation. The language also could be interpreted as stating that “all claims or suits” brought by one person will be treated as a single “claim” for limitation of liability purposes. This interpretation also draws support from the policy language itself.

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

Pinheiro v. Medical Malpractice Joint Underwriting Ass'n, 406 Mass. 288 (Mass. 1989).

406 Mass. 288 (Pinheiro v. Medical Malpractice Joint Underwriting Ass'n) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Massachusetts Insurers Insolvency Fund v. Smith
940 N.E.2d 385 (Massachusetts Supreme Judicial Court, 2010)
Great American Insurance v. Plymouth County Sheriff's Department
24 Mass. L. Rptr. 350 (Massachusetts Superior Court, 2007)
Martin v. Commonwealth
760 N.E.2d 313 (Massachusetts Appeals Court, 2002)
Stewart v. State Farm Mutual Automobile Insurance
533 S.E.2d 597 (Court of Appeals of South Carolina, 2000)
Stop & Shop Companies, Inc. v. Federal Insurance
946 F. Supp. 99 (D. Massachusetts, 1996)
United States Fidelity & Guaranty Co. v. Hicks
5 Mass. L. Rptr. 149 (Massachusetts Superior Court, 1996)
McEachern v. Sperling
4 Mass. L. Rptr. 320 (Massachusetts Superior Court, 1995)
Liquor Liability Joint Underwriting Ass'n v. Hermitage Insurance
644 N.E.2d 964 (Massachusetts Supreme Judicial Court, 1995)
Chisholm v. Commonwealth Mortgage Co.
639 N.E.2d 733 (Massachusetts Appeals Court, 1994)
Metropolitan Leasing, Inc. v. Pacific Employers Insurance
633 N.E.2d 434 (Massachusetts Appeals Court, 1994)
Andrade v. Aetna Life & Casualty Co.
617 N.E.2d 1015 (Massachusetts Appeals Court, 1993)
Commerce Insurance Co. v. Bairos
1 Mass. L. Rptr. 7 (Massachusetts Superior Court, 1993)
Sullivan v. Boston Gas Co.
605 N.E.2d 805 (Massachusetts Supreme Judicial Court, 1993)
Vickodil v. Lexington Insurance
587 N.E.2d 777 (Massachusetts Supreme Judicial Court, 1992)
Freda Cohen v. Union Warren Savings Bank
1991 Mass. App. Div. 95 (Mass. Dist. Ct., App. Div., 1991)
Murphy v. Noonan
571 N.E.2d 409 (Massachusetts Appeals Court, 1991)
Worcester Insurance v. Fells Acres Day School, Inc.
558 N.E.2d 958 (Massachusetts Supreme Judicial Court, 1990)
Santos v. Lumbermens Mutual Casualty Co.
556 N.E.2d 983 (Massachusetts Supreme Judicial Court, 1990)