Shin v. State Farm General Ins. Co. CA4/1

CourtCalifornia Court of Appeal
DecidedDecember 14, 2023
DocketD081678
StatusUnpublished

This text of Shin v. State Farm General Ins. Co. CA4/1 (Shin v. State Farm General Ins. Co. CA4/1) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shin v. State Farm General Ins. Co. CA4/1, (Cal. Ct. App. 2023).

Opinion

Filed 12/14/23 Shin v. State Farm General Ins. Co. CA4/1 NOT TO BE PUBLISHED IN OFFICIAL REPORTS California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

COURT OF APPEAL, FOURTH APPELLATE DISTRICT

DIVISION ONE

STATE OF CALIFORNIA

MICHAEL SHIN et al., D081678

Plaintiffs and Appellants,

v. (Super. Ct. No. 37-2020- STATE FARM GENERAL 00036998-CU-BC-CTL) INSURANCE COMPANY et al.,

Defendants and Respondents.

APPEAL from a judgment of the Superior Court of San Diego County, John S. Meyer, Judge. Affirmed. Corbett, Steelman & Specter and Bruce R. Corbett for Plaintiffs and Appellants. Hughes & Nunn, Randall M. Nunn, and E. Kenneth Purviance for Defendants and Respondents. Michael Shin, Ajay Bhatt, Aloha Wound Care Group, LLC (Aloha), and Karl Stemmler (collectively, Plaintiffs) appeal from a judgment entered against them after the trial court granted a motion for summary judgment in favor of State Farm General Insurance Company (State Farm) and Greg Johnson Insurance Agency, Inc. (Johnson; collectively, Defendants). The core of the dispute is whether Johnson, as an insurance agent for State Farm, had a duty to provide or suggest errors and omissions coverage—a special type of liability coverage, like malpractice insurance, that protects against claims arising out of alleged errors and omissions in the performance of professional services—for Stemmler’s medical billing business in response to Stemmler’s

general request for comprehensive business liability insurance.1 The trial court concluded that Defendants did not owe Plaintiffs such a duty and, thus, that Plaintiffs could not maintain their sole cause of action for negligence. On the record before us, we agree. We therefore affirm the judgment. I. FACTUAL AND PROCEDURAL BACKGROUND Stemmler started Physicians Professional Billing Service (PPBS), a

medical billing company, in 1998.2 Stemmler described PPBS as a sole

1 Croskey et al., California Practice Guide: Insurance Litigation (The Rutter Group 2023) ¶ 7:2400 describes “ ‘Errors and omissions’ Insurance” as follows: “A special type of liability insurance is available for professionals (lawyers, accountants, medical care providers, architects, engineers, etc.): ‘Errors and omissions’ (E&O) insurance, including ‘malpractice insurance,’ protects such persons against claims arising out of alleged errors and omissions in the performance of services within the scope of their profession. (See typical insuring clause at ¶ 7:2452.) “E&O coverage can extend beyond professional malpractice insurance. Financial institutions and other business entities often purchase E&O insurance to protect against third party claims alleging economic losses.” 2 Defendants submitted a letter to this court, dated March 20, 2023, attaching copies of certain exhibits lodged with the trial court in support of their motion for summary judgment. We construe the letter as a motion to augment the record with the attached exhibits and hereby grant the request. (Cal. Rules of Court, rule 8.155(a)(1)(A).)

2 proprietorship and stated that he and his wife, Elena Stemmler, ran it together without any formal partnership agreement. Stemmler first obtained insurance through Johnson, as an appointed agent for State Farm, sometime around 2001. At that time, Stemmler asked Johnson to provide insurance policies for all of his needs, including his personal home and auto insurance, as well as insurance for the PPBS business. According to the operative second amended complaint (SAC) Stemmler told Johnson “that his business was providing professional medical billing services to physicians” and “that he wanted coverage for all his business liabilities.” “Stemmler ha[d] no experience in insurance and relied on Johnson to provide all the necessary coverage.” Stemmler did not use the words “errors and omissions,” but also did not recall the exact words that he did use. In 2005, Stemmler purchased an office condominium for PPBS. The mortgage lender for the condo had certain building insurance requirements for the loan, which they communicated directly to Johnson. Johnson provided an updated insurance policy for PPBS, satisfying the lender’s stated requirements, in late 2005. “[Stemmler] understood that his insurance carried forward his prior coverage for all his business liability. Johnson never advised [Stemmler] otherwise or that he needed additional or different coverage.” Stemmler looked at the policy when he first received it in the mail and “understood that he was covered for his business liability.” In October 2018, Dr. Shin, Dr. Baht, and Aloha filed a complaint against PPBS and Karl and Elena Stemmler. Dr. Shin and Dr. Baht were licensed physicians that worked for Aloha. They alleged that they had a contract with PPBS for professional billing services, which they attached as an exhibit to the complaint, and that PPBS made numerous errors, including

3 “failing to prepare and mail billing statements, failing to post insurance payments, failing to file insurance claims in a timely manner, failing to provide monthly report updates, and failing to follow up on past due amounts.” In addition, they asserted that Elena Stemmler represented herself to them as an experienced, certified medical coder but then made false representations about their ability to obtain certain reimbursements in an effort to generate greater revenues and, later, to avoid liability. Based on those claims, they asserted causes of action for breach of contract, fraud, negligence, breach of fiduciary duty and accounting against PPBS and Karl and Elena Stemmler. Stemmler made a demand on State Farm for defense and coverage. At the time, Stemmler had a worker’s compensation policy and a business office liability policy from State Farm. The business office liability policy covered claims such as employee dishonesty, loss of income due to suspension of operations, monetary losses due to theft or destruction, and utility interruption. It also had a number of exclusions. The policy stated that State Farm would have the right and duty to defend lawsuits seeking damages for “ ‘bodily injury,’ ‘property damage’ or ‘personal and advertising injury’ ” as defined by the policy. It specifically excluded coverage for expected or intended injuries, contractual liability, and claims “arising out of the rendering or failure to render any professional service or treatment.” (See Croskey et al., Cal. Practice Guide: Insurance Litigation, supra, ¶ 7:2400 [explaining that errors and omissions coverage typically protects against such claims].) State Farm denied Stemmler’s claim and request for defense based, in part, on the foregoing exclusions. Stemmler had not heard the phrase “errors and omissions” coverage before and this was the first time that he learned

4 that the policy that State Farm had provided did not cover such claims. Stemmler proceeded in the litigation without assistance from State Farm and later entered into a settlement agreement that included a partial assignment to the Plaintiffs of his claims against Defendants. Plaintiffs then jointly filed the SAC against Defendants. In the SAC, Plaintiffs assert a single cause of action for negligence against Defendants.

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Bluebook (online)
Shin v. State Farm General Ins. Co. CA4/1, Counsel Stack Legal Research, https://law.counselstack.com/opinion/shin-v-state-farm-general-ins-co-ca41-calctapp-2023.