Universal Health Services, Inc. v. Pennsylvania Property & Casualty Insurance Guaranty Ass'n

884 A.2d 889, 2005 Pa. Super. 330, 2005 Pa. Super. LEXIS 3458
Superior Court of Pennsylvania·Decided September 26, 2005·Published·Cited by 17 cases

Opinion

OPINION BY

TODD, J.:

¶ 1 In this declaratory judgment action, Pennsylvania Property and Casualty In[891] surance Guaranty Association (“PPCIGA”) appeals the May 5, 2004 order denying its motion for summary judgment and entering summary judgment in favor of Universal Health Services, Inc. (“UHS”). In this ease of first impression, we are asked to determine whether claims under a “reporting tail” endorsement to a claims-made policy, first reported more than BO days after an insurer’s insolvency, are obligations of PPCIGA under the Pennsylvania Property and Casualty Insurance Guaranty Association Act, codified at 40 P.S. §§ 991.1801-991.1820 (the “Guaranty Act”). For the following reasons, we find that they are, and we affirm.

¶ 2 This action arises as a result of the liquidation of PHICO Insurance Company (“PHICO”). Prior to the liquidation, UHS was insured by PHICO under a professional liability policy for claims related to UHS’s operation of various medical facilities. PHICO was declared insolvent and placed in liquidation by order of the Commonwealth Court on February 1, 2002 (the “Liquidation Order”) pursuant to the Insurance Department Act, codified at 40 P.S. §§ 211-221.68 (the “Liquidation Act”). The Liquidation Order, as we will discuss more fully below, triggered obligations of PPCIGA to provide statutory coverage to UHS to the extent provided under the Guaranty Act.

¶3 UHS’s policy with PHICO was a claims-made policy1 and was initially issued on January 1, 1998 and remained in effect until January 1, 2002 (the “Policy Period”). At the time of purchase, UHS also purchased a “reporting tail” endorsement of unlimited duration,2 which took effect at the end of the Policy Period. The purpose of the reporting tail was to provide coverage for claims made after the claims-made policy expired for events that took place during the Policy Period.

¶ 4 UHS received several claims based on events that took place during the Policy Period, but those claims were first reported to UHS more than 30 days after the determination of insolvency. PPCIGA denied coverage on these claims, asserting that its obligations to provide coverage extended no further than to claims reported within 30 days after the determination of insolvency, despite the reporting tail endorsement.3 As a result, PPCIGA maintained that its obligations had ended. UHS, on the other hand, contended that because of the unlimited reporting tail, there is no end date to PPCIGA’s obligations under its policy and the Guaranty Act. In essence, UHS contended that the [892] reporting tail converted the claims-made policy into an occurrence policy, claims under which it is undisputed PPCIGA would provide coverage.

¶ 5 UHS subsequently filed this declaratory judgment action against PPCIGA.4 The parties filed cross-motions for summary judgment. The trial court granted UHS’s motion, and denied PPCIGA’s motion, concluding that the reporting tail policy essentially converted UHS’s claims-made policy into an occurrence policy, warranting PPCIGA’s coverage of UHS’s claims. PPCIGA’s appeal followed, and on appeal it asks whether, under the Guaranty Act, a claim made more than 30 days after a liquidation order under a tail endorsement of a claims-made policy of an insolvent insurer is an obligation of PPCI-GA. (See Appellant’s Brief at 4.) It also asks whether the insurance commissioner’s decision to allow such claim is binding. (Id.) We address these questions together.

¶ 6 Our standard of review in a declaratory judgment action is narrow. O'Brien v. Nationwide Mut. Ins. Co., 455 Pa.Super. 568, 573, 689 A.2d 254, 257 (1997). We review the decision of the trial court as we would a decree in equity and set aside factual conclusions only where they are not supported by adequate evidence. Id. We give plenary review, however, to the trial court’s legal conclusions. See id. Furthermore, our standard of review of an order granting or denying a motion for summary judgment is well established:

We view the record in the light most favorable to the non-moving party, and all doubts as to the existence of a genuine issue of material fact must be resolved against the moving party. Only where there is no genuine issue as to any material fact and it is clear that the moving party is entitled to a judgment as a matter of law will summary judgment be entered. Our scope of review of a trial court’s order granting or denying summary judgment is plenary, and our standard of review is clear: the trial court’s order will be reversed only where it is established that the court committed an error of law or abused its discretion.

Pappas v. Asbel, 564 Pa. 407, 418, 768 A.2d 1089,1095 (2001) (citations omitted).

¶ 7 PPCIGA is an agency created by the Pennsylvania legislature under the Guaranty Act to provide limited statutory benefits when there is a covered claim arising under the insurance policy of a property or casualty insurer deemed to be insolvent. Carrozza v. Greenbaum, 866 A.2d 369, 375 n. 6 (Pa.Super.2004), appeal granted in part, 2005 WL 1939440 (Pa. Aug.12, 2005); see generally 40 P.S. §§ 991.1801-991.1820. Among the purposes of the Guaranty Act is “[t]o provide a means for the payment of covered claims under certain property and casualty insurance policies, to avoid excessive delay in the payment of such claims and to avoid financial loss to claimants or policyholders as a result of the insolvency of an insurer.” 40 P.S. § 991.1801(1).

¶ 8 The Act requires every insurer, as a condition of doing business in the Commonwealth, to participate in PPCIGA, thereby spreading out over all member insurance companies the risk of loss due to the insolvency of any one insurer. Carroz-za, 866 A.2d at 385. When an insurer becomes insolvent, PPICGA becomes a “guarantor” with a limit of liability of [893] $800,000 per claimant for a “covered claim”, defined as an unpaid claim “which arises out of and is within the coverage” of the policy of the insolvent insurer. See id. at 375 n. 6; 40 P.S. § 991.1802.5 Specifically, PPCIGA is obligated “to pay covered claims existing prior [to] the determination of the insolvency, arising within thirty (30) days after the determination of insolvency” or before the policy is expired or replaced. 40 P.S. § 991.1803(b)(l)(i).6 At issue in this case is whether UHS’s claims were claims “existing” prior to PHICO’s insolvency or “arising” within 30 days of the Liquidation Order.

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Universal Health Services, Inc. v. Pennsylvania Property & Casualty Insurance Guaranty Ass'n, 884 A.2d 889, 2005 Pa. Super. 330, 2005 Pa. Super. LEXIS 3458 (Pa. Ct. App. 2005).

884 A.2d 889 (Universal Health Services, Inc. v. Pennsylvania Property & Casualty Insurance Guaranty Ass'n) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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