Reuter v. Lancet Indemnity Risk Retention Group, Inc.

262 F. Supp. 3d 1341
CourtDistrict Court, S.D. Florida
DecidedJune 20, 2017
DocketCase No. 16-80581-CIV-MARRA
StatusPublished
Cited by2 cases

This text of 262 F. Supp. 3d 1341 (Reuter v. Lancet Indemnity Risk Retention Group, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Reuter v. Lancet Indemnity Risk Retention Group, Inc., 262 F. Supp. 3d 1341 (S.D. Fla. 2017).

Opinion

ORDER GRANTING MOTION FOR SUMMARY JUDGMENT

KENNETH A. MARRA, United States District Judge

This Cause is before the Court upon Defendant Physicians Casualty Risk Retention Group’s (“Physicians”) Motion for Summary Judgment, filed on February 3, 2017 (DE 54), Plaintiff Merrill Reuter, M.D., filed a Response (DE 61) in opposition to the Motion, and Defendant Physicians filed a Reply (DE 62). The Court has carefully considered the Motion, the Response, and the Reply, and supporting documents, and is otherwise fully advised in the premises.

In the Motion for Summary Judgment, Physicians argues in this insurance coverage dispute that coverage is excluded under the subject policy’s Prior Notice Exclusion, which applies if an insured gave notice1 under a previous policy of an “Occurrence,” which is defined as “an unexpected accident or injury resulting from the insured’s rendering or failure to render services.” Specifically, Physicians argues that Plaintiff gave notice to his prior carrier, Lancet Indemnity Risk Retention Group, Inc. (“Lancet”), under a previous policy of an “Occurrence” when Plaintiff forwarded documents to Lancet pertaining to "a Florida Department of Health (“DOH”) investigation into the same incident that forms the basis of the claim for which Plaintiff seeks coverage.

As more fully discussed below, the Court’ concludes that Plaintiffs transmission of the DOH documents gave notice to his prior carrier of an “Occurrence” that triggered-the Prior Notice Exclusion, since the DOH documents contained allegations that Plaintiffs former patient suffered an unexpected cardiac arrest and that Plaintiff may have violated the Medical Practice Act in connection with the incident. Plaintiffs attempt to argue, for a more narrow construction of the Prior Notice Exclusion, one which would require a demand for monetary damages to constitute notice for purposes of the exclusion, is unsupported by the clear and unambiguous policy language.

Because the Prior Notice Exclusion applies, Physicians is not obligated to. afford coverage for the claim in question (which arose from the same occurrence that was the subject' of the'notice to Lancet). Accordingly, and as discussed more fully below, Defendant Physicians is entitled to summary judgment on the claims asserted against it in the Complaint.

[1344]*1344I. BACKGROUND

The undisputed facts, as culled from the deposition testimony and documentary evidence, in a light most favorable to the non-moving party for purposes of. the Motion for Partial Summary Judgment, are as follows:

A. The Physicians Policy

Physicians issued a “claims made” professional liability insurance policy to Plaintiff for the policy period of May 1, 2014 to May 1, 2015, with, a retroactive date of May 1, 2011 and “prior acts” coverage. (“Physicians Policy”). (DE 1-2, at 14, Compl. ¶26.) The Physicians Policy provides a number of exclusions under the “Exclusions” section as follows:

We are not obligated to defend or pay any damages, judg[ment]s or settlements for any Claim:
(1) Arising out of any Occurrence that
(a) Was the subject of any written notice given under a previous policy;
(b) Was the subject of any prior or pending written demand for monetary damages, administrative or arbitration proceeding, civil or criminal case against Insured, which existed prior to the date of the Policy Period;
(c) That was reported in the Application or was identified in any summary or statement of Claims or potential Claims submitted in connection with the Application;
(d) That was reported to any other source from which payment might be made before the initial effective date of the Policy Period of the policy we issued to you; or
(e)Arising out of Professional Services rendered prior tó the Retroactive Date of this Policy.

(DE 56-8, Physicians Policy, at 7 (emphasis added).) The term “Occurrence” means “an unexpected accident or injury resulting from the insured’s rendering or failure to render services.” (Id. at 14.) The term “Claim” is defined in the Physicians Policy as follows:

1. receipt by the Insured, of a written notification of an intention to hold the Insured responsible for damages as described above, or 2. the receipt, by the Company during the term of the policy, of a written demand for monetary damages on behalf of the injured to hold the Insured responsible for damages arising from the rendering or failure to render professional services by Insured or 3. The filing of a Complaint or request for arbitration hearing.

(Id. at 13.)

B. DOH Notifies Plaintiff of Investigation of Case Summary involving Y.G.

Prior to the issuance of the Physicians Policy, in a letter dated August 20, 2013, and addressed to Plaintiff, the Florida Department of Health (the “DOH” and the “Department”) notified Plaintiff that it was investigating a document (“Case Summary”) the DOH had received regarding Plaintiffs possible violations of the Medical Practice Act in connection with patient V. G.1 (“DOH Letter”). (DE 40-2, Sealed DOH Letter at 1-2.) (The DOH Letter and Case Summary are, collectively referred to as the “DOH Correspondence.”)

[1345]*1345The DOH Letter stated in relevant part, “We are currently investigating the enclosed document received by the Department of Health. This investigation was initiated after it was determined that you may have violated the Medical Practice Act.” (Id. at 1.) The DOH Letter outlined procedures governing the investigation. m2

The Case Summary, which was enclosed with the DOH Letter, indicates that Plaintiff was the Respondent in the case and lists his profession as “1501 Medical Doctor,” contains an incident date of June 10, 2013, and contains the following information regarding the incident and violations:

Possible Violation of SS. 456.072(l)(k)(dd), 458.331(l)(g)(t)(nn), F.S. Failure to perform legal obligation, Violate Statute/Rule of Board, Pract Below Standard of Care
Code 15 Report shows, 46 y/o F patient V.G., underwent a surgical procedure at Citrus Tower Ambulatory Surgery Center. V.G. reportedly vomited multiple times with resultant bradycardia and had a cardiac arrest. Transported to South Lake Hospital and admitted to ICU. V.G. transferred on 6-14-2013 Orlando Regional Medical Center for continuous neurological monitoring due to seizures and anoxic brain injury.

(Id. at 2.)

C.Plaintiff Forwards DOH Letter and Enclosed Case Summary to his Insurance Agent, who Forwards the Documents to Lancet’s Claims Representative,

Reuter sent the DOH Letter and the enclosed Case Summary to his insurance agent, Debby Arnemann. (DE 56-2, E-mail with subject of “DOH complaint — M. Reu-ter,” dated August 26, 2013 from Arne-mann to Chris Teter (“Please see the attached correspondence we received from Dr. Reuter this morning & let us know if any additional action is needed at this time.”).) Reuter’s agent Arnemann then sent by e-mail the DOH Letter and the enclosed Case Summary to Chris Teter, the claims representative with Lancet. (Id.)

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Bluebook (online)
262 F. Supp. 3d 1341, Counsel Stack Legal Research, https://law.counselstack.com/opinion/reuter-v-lancet-indemnity-risk-retention-group-inc-flsd-2017.