State ex rel. McReynolds v. United Physicians Insurance Risk Retention Group

921 S.W.2d 176, 1996 Tenn. LEXIS 254
CourtTennessee Supreme Court
DecidedApril 22, 1996
StatusPublished
Cited by6 cases

This text of 921 S.W.2d 176 (State ex rel. McReynolds v. United Physicians Insurance Risk Retention Group) is published on Counsel Stack Legal Research, covering Tennessee Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State ex rel. McReynolds v. United Physicians Insurance Risk Retention Group, 921 S.W.2d 176, 1996 Tenn. LEXIS 254 (Tenn. 1996).

Opinion

REID, Justice.

This case presents for review the decision of the Court of Appeals nullifying the deadline for reporting medical incidents fixed by the receiver during the liquidation of an insolvent insurance company. This Court finds that the receiver was authorized by statute to terminate coverage and thereby reduce the time allowed for complying with the terms of the policy regarding notice, and that the Court of Appeals erred in allowing the claim for which notice was given subsequent to the date set. The decision of the Court of Appeals is reversed.

This case arose during rehabilitation and subsequent liquidation proceedings of the United Physicians Insurance Risk Retention Group (UPI) by the Commissioner of Commerce and Insurance, pursuant to the Insurer’s Rehabilitation and Liquidation Act, Tenn.Code Ann. §§ 56-9-101 to 56-9-510 (1994) (the Act). The stated purpose of the Act is “the protection of the interests of insureds, claimants, creditors and the public generally, with minimum interference with the normal prerogatives of the owners and managers of insurers_” Tenn.Code Ann. § 56-9-101(d). One statutory means of accomplishing that purpose is by

“[pjroviding for a comprehensive scheme for the rehabilitation and liquidation of insurance companies and those subject to this chapter as part of the regulation of the business of insurance, insurance industry and insurers in this state_” Tenn.Code Ann. § 56-9-101(d)(7).

The appellee, Dr. Vasudev V. Kulkami, who is a physician, was the insured under a policy issued by UPI providing liability coverage for medical malpractice claims. Kul-kami insists that the claim which is the basis of this case is covered by the policy issued by UPI. Ms. Jeanne Barnes Bryant, receiver for UPI, contends that the claim was not filed within the time allowed and, therefore, is not covered. Resolution of the issue requires the application of the terms of the policy, the provisions of the Act, and the notice given by the receiver to the sequence of significant events.

On November 30,1991, UPI issued to Kul-kami the medical malpractice policy under which the claim is made. It is a “discovery” or “claims made” policy rather than an “occurrence” policy.1 The policy provided cov[178]*178erage for claims made from January 1, 1992, to January 1, 1993, arising from “medical incidents” occurring after March 31, 1987.

On December 9, 1991, within the retroactive coverage period, Kulkarni treated four-year-old Tommie L. Gray, III, in a hospital emergency room. This treatment was the basis of the subsequent claim on behalf of Gray that Kulkami negligently failed to diagnosis Gray’s condition of spinal meningitis, which resulted in the loss of the patient’s legs and other disabilities.

On May 1,1992, upon petition of the Commissioner of Commerce and Insurance, the Chancery Court of Davidson County entered an order placing UPI in receivership for the purpose of rehabilitation and appointed the appellant receiver.2

On July 16, 1992, upon petition of the Commissioner, the court entered an order requiring that UPI be liquidated pursuant to the Act. The order provided “that all outstanding policies and coverage be cancelled on August 21, 1992,” and that the deadline for filing claims and “proper proof thereof’ be July 21,1993.

On July 24,1992, the receiver sent a notice to UPI policy holders including Kulkarni, advising that UPI was in liquidation proceedings, that their policies were cancelled effective August 21, 1992, and that all “medical incidents” must be reported to the receiver not later than August 25,1992.

On August 17, 1992, another notice was sent by the receiver to Kulkami and other policy holders reminding them that UPI had been placed in receivership on July 16, 1992, and that their policies were cancelled as of August 21, 1992. The notice was accompanied by a proof of claim form and the admonition from the receiver that proofs of claims must be filed by July 21, 1993, and, further, that “you must abide by the written notice requirements of your policy in order to have a valid claim.”

August 21, 1992, was the cancellation date for coverage under all outstanding policies subject to cancellation,3 which included medical malpractice policies.

August 25, 1992, was the date designated by the receiver within which all “medical incidents” were required to be reported in order to be within the coverage afforded by the policy.

In October 1992, Kulkami was notified by counsel for Gray that a claim for malpractice was being made against him based on his treatment of Gray on December 9, 1991.

On November 17, 1992, Gray’s attorney gave the receiver notice of the claim.

On December 28, 1992, an action for malpractice was filed against Kulkami on behalf of Gray.

On January 19, 1993, Kulkarni filed with the receiver a proof of claim based on the Gray suit, which was received at the receiver’s office on January 25,1993.

By letter dated January 26,1993, Kulkami was notified that his claim had been denied because he faded to report the medical incident involving Gray by August 25,1992.

Kulkarni filed an objection to the denial, as authorized by the Act. Tenn.Code Ann. § 56-9-327. A special master appointed to hear the matter found that Kulkami had not followed the required procedure and denied the claim of coverage. The trial court affirmed the report of the special master. See Tenn.R.Civ.P. 53.04(2). The Court of Appeals reversed, finding that coverage for the claim should not be denied.

The policy on which the claim is based provided coverage for claims arising from medical care provided by the insured from [179]*179March 31, 1987, to January 1, 1993. Consequently, the medical care provided to Gray on December 9, 1991, was within that period of time covered by the policy.

However, the policy required as a condition for coverage that the claim be made during the policy period or that the “medical incident” on which a claim is based be reported during the policy period. The policy provides:

In consideration of the payment of premium, in reliance upon the statements made on the Application and made a part hereof and subject to all of the terms and conditions of this Policy, the Company agrees with the Insured as follows:
To pay all sums which the Insured shall become legally obligated to pay as Damages, subject to the terms, conditions, exclusions and limits of the Policy, because of a Medical Incident which occurred while the Insured was rendering Professional Service during the Policy Period and for which Claim is first made against the Insured and reported to the Company during the Policy Period....

“Medical incident” and “claim” are defined in the policy as follows:

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Cite This Page — Counsel Stack

Bluebook (online)
921 S.W.2d 176, 1996 Tenn. LEXIS 254, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-ex-rel-mcreynolds-v-united-physicians-insurance-risk-retention-tenn-1996.