Roesler v. TIG Insurance Co.

251 F. App'x 489
CourtCourt of Appeals for the Tenth Circuit
DecidedOctober 12, 2007
Docket05-7055
StatusUnpublished
Cited by10 cases

This text of 251 F. App'x 489 (Roesler v. TIG Insurance Co.) 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
Roesler v. TIG Insurance Co., 251 F. App'x 489 (10th Cir. 2007).

Opinion

ORDER AND JUDGMENT *

TERRENCE L. O’BRIEN, Circuit Judge.

Paul Roesler, a Certified Registered Nurse Anesthetist (doing business as Paul Roesler CRNA, Inc.), purchased professional liability insurance through TIG Insurance Company in May 2002. In August 2002, Roesler was sued for his involvement *491 in the June 1998 cesarian section birth of a severely brain-damaged infant. Roesler notified TIG of the suit on August 19, 2002. On September 27, 2002, TIG informed Roesler it had rescinded his policy based on his failure to include information of the surgical incident in his insurance application. On October 17, 2002, Roesler filed suit for breach of contract and breach of the implied duty of good faith and fair dealing. A jury found in favor of Roesler and awarded him $60,072 for TIG’s breach of the insurance contract and $2.31 million in compensatory damages for TIG’s bad faith. In addition, the jury awarded Roesler $2.3 million in punitive damages. TIG appeals claiming, inter alia, the district court erred in denying its motion for judgment as a matter of law and its motion for a new trial. Exercising jurisdiction pursuant to 28 U.S.C. § 1291, we conclude the trial court failed to correctly instruct the jury. Accordingly, we affirm in part, reverse in part, and remand for further proceedings.

I. BACKGROUND

Roesler is a certified registered nurse anesthetist (CRNA) and the sole employee of Paul Roesler, CRNA Inc. He and his company held a professional liability insurance policy with St. Paul Fire and Marine Insurance Company from 1989 to 2002. In 2002, St. Paul ceased offering CRNA professional liability coverage. Roesler applied to TIG for a liability insurance policy which provided retroactive coverage for claims from 1989 forward. Roesler considered retroactivity critical because approximately twenty percent of his work involved the delivery of babies and malpractice liability continues until the child turns nineteen.

On June 22, 1998, Roesler administered anesthesia during the emergency cesarean section birth of fourteen-year-old Amanda Burton’s daughter, Tala. The baby was born with signs of severe hypoxia, a lack of oxygen in útero which may result in brain damage, and scored a bare minimum on the Apgar tests. 1 Roesler testified it was a night he was “never going to forget.” (R. Vol. IV at 1045a.) He described the child’s condition as “the worst one that I had seen ... where the baby was still alive.” (Id. at 1053a.) He was aware at that time there was a problem with the baby and the outcome could be bad. He was correct; Tala had profound, permanent neurological damage.

Two days after the Burton birth, the hospital asked Roesler to write a narrative of the events. Although Roesler had been verbally consulted post-surgery on prior occasions, this was his first request for a written narrative. Roesler knew there was a controversy as to whether the other members of the team had timely responded and whether Dr. Claypool, the leading physician, had advised the team it must come to the hospital immediately. Roesler wrote a narrative addressing those points.

In August 2001, the Burtons filed suit against Dr. Claypool and the hospital, but did not name Roesler as a defendant. Roesler testified that shortly before the August suit was filed, he spoke with Clay-pool about its likelihood. He stated Clay-pool told him the Burtons would probably sue the doctor and the hospital, but not Roesler. Several days later, Roesler read in the newspaper the suit had been filed, but other than the names of the parties, *492 no details were provided. In September 2001, Roesler met with the hospital’s attorney, Leah Kinsey, to discuss his knowledge of the relevant events. Roesler testified he did not receive a copy of the complaint, nor did he seek to obtain one.

Prior to receiving TIG coverage in May 2002, Roesler was asked to fill out an application and a supplementary application, also known as a “no-known-loss letter.” The application form, completed in March 2002, contained question # 9 which asked: “Are you aware of any facts or circumstances (including a request for records) that might give rise to a claim against you?” 2 (R. Vol. VI at 1722a.) Roesler checked “no.”

The no-known-loss letter, completed in May 2002, 3 contained the following language:

Except that which is described below, I the undersigned have no:
[Bullet Point 2] knowledge of information relating to the providing or withholding of professional services which might result in a claim; and/or
[Bullet Point 6] knowledge or information relating to the providing or withholding of past professional services that resulted in ... a patient’s death or neurological injury.

(Id. at 1719a.) Roesler signed the supplemental application without mentioning the Burton birth or lawsuit in the “Exceptions” section.

TIG issued the requested policy on May 22, 2002. The policy contained a “prior knowledge exclusion” barring coverage for claims arising from professional services that “could reasonably have been expected to result in a Claim, Incident or Suit, as of the date the Insured applied for this policy.” (Id. at 1838a.) Because he received a retroactive policy from TIG dating back to 1989, Roesler did not purchase “tail” coverage (permanent coverage for the periods he was insured by St. Paul) from St. Paul. (Id. at 1721a.)

Less than three months after Roesler secured his policy, on August 12, 2002, the Burtons filed suit against Roesler. In this second suit, the Burtons claimed “Amanda Burton was not taken to the operating room until after 2 a.m., due to the late arrival of the ‘delivery team,’ including Paul Roesler, CRNA.” (Id. at 1771a.) On Monday, August 19, 2002, Roesler telephoned TIG to report the lawsuit. 4 He spoke with claims adjuster, Jennifer *493 Williams. 5 Williams’ contemporaneous notes reflect that Roesler told her about the events of June 28, 1998, and insisted the call that night was not a “stat” request. (Id. at 1821a.) The notes also indicate Roesler told her he wrote a detailed report of the events of that night “because it seemed like a situation where there could potentially be a lawsuit.” (Id.) The notes mark this statement with quotations and an asterisk. Williams stated she did so because it “raised a red flag.” (R. Vol. Ill at 800a.) Williams testified she asked Roesler when he first learned the baby was brain damaged and noted Roesler responded, “about six months ago when [the] doc[tor] & hosp[ital] were sued.” (R. Vol. VI at 1821a.)

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251 F. App'x 489, Counsel Stack Legal Research, https://law.counselstack.com/opinion/roesler-v-tig-insurance-co-ca10-2007.