St. Paul Fire and Marine Ins. Co. v. House

533 A.2d 301, 73 Md. App. 118
CourtCourt of Special Appeals of Maryland
DecidedFebruary 26, 1988
Docket322, September Term, 1987
StatusPublished
Cited by8 cases

This text of 533 A.2d 301 (St. Paul Fire and Marine Ins. Co. v. House) is published on Counsel Stack Legal Research, covering Court of Special Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
St. Paul Fire and Marine Ins. Co. v. House, 533 A.2d 301, 73 Md. App. 118 (Md. Ct. App. 1988).

Opinion

ALPERT, Judge.

A dispute over insurance coverage for a medical malpractice claim spawned this appeal, raising a question of first impression in the State of Maryland. The issue is whether article 48A, § 482 of the Annotated Code of Maryland, that requires an insurer to prove “actual prejudice” in order to disclaim coverage because of the insured’s failure to give notice, applies to professional liability insurance written in the form of a “claims made” or “discovery” policy. We hold that it does.

Homer C. House, M.D. (appellee herein), an orthopedic surgeon, performed arthroscopic surgery on Mrs. Shirley J. Platzer on October 29, 1985 and allegedly left “a foreign body” (a needle) in her knee. The needle was subsequently removed by Dr. House’s associate approximately one month later. In June and September, 1985, counsel for Mr. and Mrs. Platzer wrote to Dr. House, making a claim for damages and requesting that the matter be turned over to Dr. House’s insurance carrier. The record indicates that Dr. House took no action in response to these communications. On November 15, 1985, the Platzers filed a claim with the Health Claims Arbitration Board and the parties agreed to a settlement on December 4, 1986.

*120 During the foregoing time, Dr. House was insured by St. Paul Fire & Marine Ins. Co. (appellant) under a “Physicians' Professional Liability Policy—Claims Made.” The policy was in effect from January 1, 1983 to January 1, 1986, with a retroactive date of January 1, 1977. Pertinent provisions of the policy provided:

When you’re covered
To be covered the professional service must have been performed (or should have been performed) after your retroactive date that applies. The claim must also first be made while this agreement is in effect.
When is a claim made?
A claim is made on the date you first report an incident or injury to us or our agent. You must include the following information:
—Date, time and place of the incident.
—What happened and what professional service you performed.
—Type of claim you anticipate.
—Name and address of injured party.
—Name and address of any witness.

The policy’s retroactive date was January 1, 1977. Thus, the policy covered Dr. House for claims made between January 1, 1983 and January 1, 1986 relating to services that were performed or should have been performed between January 1, 1977 through January 1, 1986.

On February 12, 1986, Dr. House notified Swope-Offut, his insurance broker, of the Platzers’ suit. St. Paul learned of the claim indirectly shortly thereafter. Coincidentally, Swope-Offut was an agent for both appellant St. Paul and for Medical Mutual Liability Insurance Society, Dr. House’s new insurer. 1 Both insurance companies denied coverage for the Platzer claim.

*121 On July 1, 1986, Homer C. House, M.D. and Homer C. House, M.D., P.A., filed an action for declaratory judgment in the Circuit Court for Baltimore City seeking an order requiring St. Paul to insure him in the Platzer case then pending before the Health Claims Arbitration Board. Both Dr. House and St. Paul moved for summary judgment. The trial court, finding no genuine dispute as to any material fact, held § 482 of the Insurance Code controlling, granted judgment for Dr. House, and ordered St. Paul to defend Dr. House’s case before the Health Claims Arbitration Board. St. Paul filed this timely appeal.

Article 48A, § 482 of the Md.Code provides:

Where any insurer seeks to disclaim coverage on any policy of liability insurance issued by it, on the ground that the insured or anyone claiming the benefits of the policy through the insured has breached the policy by failing to cooperate with the insurer or by not giving requisite notice to the insurer, such disclaimer shall be effective only if the insurer establishes, by a preponderance of affirmative evidence that such lack of cooperation or notice has resulted in actual prejudice to the insurer.

Appellant argues that because of the basic differences between “claims made” and “occurrence” policies, § 482’s requirement that prejudice be shown is inapplicable to “claims made” policies. Section 482 was enacted to remedy the harsh result of Watson v. U.S.F. & G. Co., 231 Md. 266, 189 A.2d 625 (1963), which held that the insurance company could disclaim coverage of an occurrence policy for late notice even if it was not prejudiced thereby. Appellant notes that in a “claims made” policy the “operative event” pertinent to the insurer’s liability is the date of notification to the insurer; in an “occurrence” policy, however, the operative event is the date of the allegedly negligent act. Thus, according to appellant, a statutorily or judicially imposed extended notice period in a “claims made” policy *122 amounts to a rewriting of the contract negotiated by the parties and increases the coverage purchased by the insured. See Zuckerman v. National Union Fire Ins. Co., 100 N.J. 304, 495 A.2d 395, 406 (N.J.1985).

On the other hand, Dr. House, appellee, argues that the clear and unambiguous language of § 482 and the rules of statutory construction mandate application of the statute to the policy at bar. Appellee also contends that Washington v. Federal Kemper Insurance Co., 60 Md.App. 288, 482 A.2d 503 (1984), cert. den., 302 Md. 289, 487 A.2d 292 (1985), and Medical Mutual Liability Insurance Society of Maryland v. Miller, 52 Md.App. 602, 451 A.2d 930 (1982), “reveal an inclination by the Maryland Court of Special Appeals to regard Section 482 as applicable to claims made policies.”

Because this case presents an issue of first impression, an explication of “claims made” policies is both necessary and appropriate.

CLAIMS MADE POLICIES

“Claims made” or “discovery” insurance policies have gained popularity and wide use in the professional liability insurance field during the past 20 years. See J. Parker, “The Untimely Demise of the ‘Claims Made’ Insurance Form? A Critique of Stine v. Continental Casualty Company,” 1983 Det.C.L.Rev. 25, 28-29; Comment, “The ‘Claims Made’ Dilemma in Professional Liability Insurance,” 22 UCLA L.Rev. 925, 926 (1975). Generally, “claims made” policies cover liability inducing events if and when a claim is made during the policy term, irrespective of when the events occurred. Parker, supra, at 27-28.

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Bluebook (online)
533 A.2d 301, 73 Md. App. 118, Counsel Stack Legal Research, https://law.counselstack.com/opinion/st-paul-fire-and-marine-ins-co-v-house-mdctspecapp-1988.