Rapid City Regional Hospital, Inc. v. South Dakota Insurance Guaranty Ass'n

436 N.W.2d 565, 1989 S.D. LEXIS 32, 1989 WL 17714
CourtSouth Dakota Supreme Court
DecidedMarch 1, 1989
Docket16215, 16242
StatusPublished
Cited by10 cases

This text of 436 N.W.2d 565 (Rapid City Regional Hospital, Inc. v. South Dakota Insurance Guaranty Ass'n) is published on Counsel Stack Legal Research, covering South Dakota Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Rapid City Regional Hospital, Inc. v. South Dakota Insurance Guaranty Ass'n, 436 N.W.2d 565, 1989 S.D. LEXIS 32, 1989 WL 17714 (S.D. 1989).

Opinion

HENDERSON, Justice.

PROCEDURAL HISTORY/ISSUES

Plaintiff, the Rapid City Regional Hospital, Inc. (Hospital), sought a declaratory judgment in the circuit court for Pennington County to determine whether defendants South Dakota Insurance Guaranty Association (Guaranty) and North Star Hospital Mutual Assurance Company, Ltd., * were obligated to reimburse Hospital for $150,000 paid in settlement of a medical malpractice claim against Hospital after Hospital’s two insurers became insolvent. The circuit court granted summary judgment to Guaranty. Hospital appeals, alleging that Guaranty is obligated to pay the $150,000 in question under the terms of an umbrella liability policy issued by the insolvent Transit Casualty Company (Transit).

Guaranty, by notice of review, contests the circuit court’s holding that Guaranty can be liable for claims against two insolvent insurers arising from a single injury.

We affirm the circuit court’s award of summary judgment to Guaranty on the basis that the policy issued by Transit does not cover the $150,000 at issue, and Guaranty, under SDCL ch. 58-29A, is not obligated to Hospital for that amount. We do not reach the issue raised by Guaranty’s notice of review, as consideration of that issue would not affect the outcome of this case.

*566 FACTS

In May 1986, Hospital participated in a $900,000 settlement of a medical malpractice claim, which stemmed from hospitalization, in February 1980, of Jason Enos, a minor. Hospital contributed $450,000 of the agreed amount. The Ideal Mutual Insurance Company of New York (Ideal) provided primary coverage of medical malpractice claims against Hospital, up to a $1,000,000 limit on individual claims. An “umbrella liability” policy, issued by the Transit Casualty Company (Transit), provided coverage for amounts in excess of coverage under the Ideal policy, to a maximum of $10,000,000 for an individual occurrence. Both Ideal and Transit became insolvent prior to settlement of Enos’ claim, and Guaranty acknowledged liability, under Ideal’s policy, for $300,000 of the settlement amount. Guaranty refused to pay the remaining $150,000 on the grounds that its liability was limited to $300,000 for a single injury, under SDCL ch. 58-29A, and Transit’s excess liability policy did not provide for coverage of amounts under $1,000,000 when the underlying insurer, Ideal, became insolvent.

The circuit court decided that Guaranty could be liable for two claims against insolvent insurers under SDCL ch. 58-29A, but awarded summary judgment to Guaranty because the coverage of the Transit policy did not encompass the $150,000 claimed by Hospital.

DECISION

Guaranty, under SDCL ch. 58-29A, becomes the insurer of entities to whom insurance policies are issued by insurers which become insolvent. SDCL 58-29A-17 provides:

The association shall be deemed the insurer to the extent of its obligation on the covered claims and to such extent shall have all rights, duties, and obligations of the insolvent insurer as if the insurer had not become insolvent.

The extent of Guaranty’s obligation is limited to a maximum of $300,000 for each “covered claim.” SDCL 58-29A-16. “Covered claim” is defined as “an unpaid claim ... which arises out of and is within the coverage and not in excess of the applicable limits of an insurance policy ...” issued by an insolvent insurer. SDCL 58-29A-3(4). There is no question that Guaranty is responsible for $300,000 coverage under the Ideal policy. However, the crux of this appeal immediately follows.

Hospital argues that Guaranty is also obligated for the additional $150,000 under the Transit excess policy, as the Declarations page of the policy states that coverage extends to liability in excess of “[t]he amount recoverable under the underlying insurance” to a limit of $10,000,000 per occurrence. We disagree.

The Transit policy’s Declarations page provides that the limit of Transit’s liability is “subject to all the terms of this policy having reference thereto.” Item 3, Section IA, of the Declarations, upon which Hospital relies heavily, authorizes coverage up to $10,000,000 for amounts in excess of the “amount recoverable under the underlying insurance as set out in Schedule A attached [.] ” (Emphasis added.) Schedule A, as attached, specifies that Ideal’s coverage limit is “$1,000,000 each occurrence.” Endorsement No. 8, a supplement to Transit’s policy, provides that Transit’s “Company limit” is $10,000,000 for each claim, and the “underlying limit” of the Ideal policy is $1,000,000 for each claim. Endorsement No. 8 further states that coverage is “[t]o indemnify the Insured, in accordance with the applicable provisions of the ‘underlying insurance’ for the amount of ‘loss’ which is [in] excess of the applicable limits of the ‘underlying insurance’ described in the Declarations.” As the underlying insurance is the Ideal policy, and both Schedule A, referenced in the Declarations, and Endorsement No. 8 specifically define the limit of the Ideal policy as $1,000,000, the Transit policy clearly provides coverage for amounts between $1,000,000, the limit of the Ideal policy, and $10,000,000. Transit’s lower limit is Ideal’s upper limit. The Transit policy makes no reference to its coverage “dropping down” to replace underlying coverage in the event of the underlying carrier’s (Ideal’s) insolvency. The *567 sole policy provision allowing Transit’s coverage to “drop down” below the limits of the Ideal policy is Endorsement No. 8, Section III, which is inapplicable. It applies only when the “aggregate limit” of Ideal’s policy is reduced or exhausted by “payment of ‘loss’ solely as the result of claims made....”

When viewed as a whole, the Transit policy is not amenable to an interpretation favoring Hospital’s claim. The $150,000 Hospital paid is within the $1,000,000 individual claim limit of the underlying Ideal policy, and thus outside Transit’s coverage. Guaranty is not liable for this $150,000 because Transit, if solvent, would not be liable. See SDCL 58-29A-17. To focus on a single reference to the “amount recoverable” under the underlying insurance to the exclusion of the balance of the contract is “ ‘distorted and legally inappropriate.’ ” Werner Indus., Inc. v. First State Ins. Co., 112 N.J. 30, 37, 548 A.2d 188, 191 (1988) (citation omitted). A review of the entire document and attachments is vital to arrive at a sound judgment in determining the contracting intent of the parties. While any uncertainty or ambiguity in a contract of insurance must be construed most strongly against the insurer and in favor of the insured, Dairyland Ins. Co. v. Kluckman, 86 S.D. 694, 703, 201 N.W.2d 209

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

Related

National Union Fire Ins. v. Miss. Ins. Guar. Ass'n
990 So. 2d 174 (Mississippi Supreme Court, 2008)
Aramark Leisure Services v. Kendrick
523 F.3d 1169 (Tenth Circuit, 2008)
Autoridad de Acueductos y Alcantarillados v. Librotex, Inc.
142 P.R. Dec. 820 (Supreme Court of Puerto Rico, 1997)
St. Paul Fire & Marine Insurance Co. v. Schilling
520 N.W.2d 884 (South Dakota Supreme Court, 1994)
Louisiana Ins. Guar. Ass'n v. Interstate Fire & Casualty Co.
630 So. 2d 759 (Supreme Court of Louisiana, 1994)
Coca Cola Bottling Co. v. Columbia Casualty Insurance
11 Cal. App. 4th 1176 (California Court of Appeal, 1992)
Donegal Mutual Insurance v. Long
597 A.2d 1124 (Supreme Court of Pennsylvania, 1991)
Sunshine Insurance Co. v. Sprung
452 N.W.2d 782 (South Dakota Supreme Court, 1990)
Alaska Rural Electric Cooperative Ass'n v. INSCO Ltd.
785 P.2d 1193 (Alaska Supreme Court, 1990)

Cite This Page — Counsel Stack

Bluebook (online)
436 N.W.2d 565, 1989 S.D. LEXIS 32, 1989 WL 17714, Counsel Stack Legal Research, https://law.counselstack.com/opinion/rapid-city-regional-hospital-inc-v-south-dakota-insurance-guaranty-assn-sd-1989.