W. Va. Mutual Insurance v. Betty J. Adkins

764 S.E.2d 757, 234 W. Va. 226, 2014 W. Va. LEXIS 1072
CourtWest Virginia Supreme Court
DecidedOctober 15, 2014
Docket13-0692
StatusPublished
Cited by1 cases

This text of 764 S.E.2d 757 (W. Va. Mutual Insurance v. Betty J. Adkins) is published on Counsel Stack Legal Research, covering West Virginia Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
W. Va. Mutual Insurance v. Betty J. Adkins, 764 S.E.2d 757, 234 W. Va. 226, 2014 W. Va. LEXIS 1072 (W. Va. 2014).

Opinions

LOUGHRY, Justice:

The petitioner, West Virginia Mutual Insurance Company, Inc. (“WVMIC”), appeals the circuit court’s May 30, 2013, order granting summary judgment in favor of the respondents 1 in this declaratory judgment action. Under the terms of a global settlement agreement, WVMIC has already tendered $3 million to the respondents under an extended reporting endorsement insuring the respondents’ surgeon against whom the respondents had asserted medical malpractice claims.2 The global settlement agreement further provided that the respondents and WVMIC would seek and abide by a judicial determination as to whether additional insurance limits are available for the respondents’ vicarious liability claims against their surgeon’s former employer, United Health Professional, Inc. (“UHP”). UHP is a medical corporation insured under a claims-made medical malpractice insurance policy issued by WVMIC for calendar year 2010 (“2010 Policy”).

The circuit court granted summary judgment in favor of the respondents finding there was an additional $6 million in policy limits available for their claims asserted against UHP under the 2010 Policy, which amount was in addition to the $3 million previously tendered for their claims asserted against their surgeon under the global settlement agreement. For the reasons set forth below, we reverse the circuit court’s ruling .and find, instead, that UHP has a total of $3 million in separate policy limits under the 2010 Policy for the respondents’ claims asserted against it. This $3 million will be in addition to the $3 million that WVMIC has already tendered under the global settlement agreement for the claims asserted against the surgeon.3

Factual and Procedural Background

WVMIC is a professional medical liability insurer that insures physicians, medical practices, and others in West Virginia. UHP,4 a West Virginia corporation engaged in providing professional medical services, is insured [229]*229by WVMIC.5 The medical malpractice claims underlying the current dispute were asserted by the respondents; they arise out of surgeries performed on them by Mitchell E. Nutt, M.D. The surgeries, which involved the implantation of a transvaginal mesh as treatment for pelvic organ prolapse, were performed in years 2006 and 2007, while Dr. Nutt was an employee of UHP. The respondents (“the Mesh Plaintiffs”) either filed suit or otherwise asserted medical malpractice claims against Dr. Nutt in 2008, 2009, and 2010. In 2010, they asserted vicarious liability claims against Dr. Nutt’s employer, UHP.

In August 2011, the parties reached a global settlement agreement pursuant to which WVMIC tendered Dr. Nutt’s $3 million in aggregate limits under his extended reporting endorsement, which is also referred to as “tail coverage.”6 Dr. Nutt’s tail coverage was acquired upon his departure from employment with UHP on March 14, 2008, at which time he was terminated from the 2008 claims-made policy. His termination was accomplished through an amendatory endorsement to the 2008 policy,- which states that “[i]n consideration of a return premium of $82,085.00, it is agreed and understood that the Policy Declarations has been amended to cancel Mitchell E. Nutt, M.D. effective 3/14/2008.” Because the 2008 policy provides insureds with the right to purchase an extended reporting period if the policy were canceled, upon his cancellation from the 2008 policy, UHP purchased the extended reporting endorsement for Dr. Nutt, which was issued by WVMIC. The tail coverage provides Dr. Nutt with separate limits of coverage of $1 million per covered medical incident with a $3 million annual aggregate.

Having tendered the annual aggregate limit of Dr. Nutt’s tail coverage under the global settlement, the parties agreed to resolve their remaining dispute — whether additional coverage is available under the 2010 Policy for the claims asserted against UHP— through the institution of a declaratory judgment action.7 In accordance with the terms of the settlement agreement, WVMIC “agree[d] to pay on behalf of [UHP] the total amount of insurance coverage the Court decides [UHP] has over and above the Three Million Dollars ($3,000,000.00) paid on behalf of Mitchell E. Nutt, M.D_”

The Mesh Plaintiffs instituted the underlying declaratory judgment action on December 20, 2010. Following discovery, they filed a motion for summary judgment seeking a declaration that there is additional insurance coverage in the amount of $6 million for their claims against UHP. Opposing the motion and asserting a cross-motion for summary judgment, WVMIC sought a ruling that there are no separate insurance limits available to UHP under the 2010 Policy. In the alternative, WVMIC argued that if the circuit court were to find that separate insurance limits were available to UHP for the subject claims under the 2010 Policy, then there was a mutual mistake that warranted an equitable reformation of the 2010 Policy. In this regard, WVMIC argued that although the Policy Declarations reflect that UHP has separate limits of coverage with a retroactive date of January 1, 2002,8 UHP actually intended the retroactive date to be January 1, 2008, for its separate limits and the retroactive date of January 1, 2002, to be for its shared limits, which would apply to the Mesh Plaintiffs’ claims. • Because WVMIC paid the $3 million aggregate limit under Dr. Nutt’s [230]*230tail coverage, WVMIC maintained that UHP shared in that limit and there was no further insurance coverage available under the 2010 .Policy for these claims.

On May 30, 2013, the circuit court entered its Order Granting Plaintiffs’ Motion for Summary Judgment. Relying on the parties’ stipulation that the 2010 Policy provisions are clear and unambiguous and upon prior precedent of this Court, the circuit court concluded the policy terms were not subject to judicial construction, interpretation, or reformation, and that full effect would be given to the plain meaning intended.

In applying the plain meaning of the 2010 Policy terms, the circuit court determined that the applicable retroactive date for coverage purposes for UHP was set forth in the Policy Declarations as January 1, 2002.9 The circuit court further found that the Mesh Plaintffs’ claims against UHP, which resulted from medical incidents that occurred after the retroactive date of January 1, 2002, and which were first reported during the 2010 policy period, were covered under the 2010 Policy. Citing a change in the language of the Limit of Insurance section of the 2010 Policy, as more fully discussed herein, the circuit court concluded that UHP’s insurance limit is calculated based on the policy year in which the medical incidents occurred. The circuit court reasoned that because the Mesh Plaintiffs’ medical incidents occurred during two separate policy periods (2006 and 2007), there was a total of $6 million in coverage available for their claims asserted against UHP.

The circuit court also addressed WVMIC’s argument that UHP did not intend to have separate limits of coverage for medical incidents that occurred prior to 2008. In this regard, the circuit court noted that UHP first requested the separate limits of coverage in January 2008.

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Bluebook (online)
764 S.E.2d 757, 234 W. Va. 226, 2014 W. Va. LEXIS 1072, Counsel Stack Legal Research, https://law.counselstack.com/opinion/w-va-mutual-insurance-v-betty-j-adkins-wva-2014.