William M. Mercer, Inc. v. Woods

717 S.W.2d 391
CourtCourt of Appeals of Texas
DecidedAugust 12, 1986
Docket9427
StatusPublished
Cited by17 cases

This text of 717 S.W.2d 391 (William M. Mercer, Inc. v. Woods) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
William M. Mercer, Inc. v. Woods, 717 S.W.2d 391 (Tex. Ct. App. 1986).

Opinion

*393 PER CURIAM.

William M. Mercer, Inc. and Marsh & McLennan Company appeal an adverse judgment in a suit involving the failure to provide professional liability insurance to Peggy Woods, a nurse, and violations of the Deceptive Trade Practices Act and the Insurance Code. Woods originally filed a limited appeal focusing mainly on the issues of exemplary and treble damages, and she now brings some of these same points through cross-points in Mercer’s and Marsh & McLennan’s appeal. Woods, Mercer, and Marsh & McLennan all appeal the granting of a judgment non obstante vere-dicto in favor of Glacier General Assurance Company.

The significant issues raised include the statutes of limitations for negligence, misrepresentation and deceptive trade practices; the determination of actual damages as a matter of law for failure to provide professional liability insurance; the trial court’s refusal to submit requested special issues on contributory negligence; the trial court’s refusal to inform the jury of the court’s legal interpretation of the insurance policy; the sufficiency of the evidence to support various jury findings; and the granting of a motion for judgment n.o.v. in favor of Glacier.

Woods was a nurse anesthetist at Good Shepherd Hospital in Longview. She was a member of the American Association of Nurse Anesthetists (AANA). As a benefit of this membership, she was entitled to obtain various types of insurance coverage, including professional liability insurance.

Marsh & McLennan administered the insurance program for the AANA. Mercer is a wholly-owned subsidiary of Marsh & McLennan, and was the administrator for the AANA account. From 1975 through the first quarter of 1978, the AANA professional liability insurance program was placed with Glacier General Assurance Company.

Good Shepherd Hospital obtained and paid for professional liability insurance for nurse anesthetists working there. The hospital would make payments for the nurses and handle other dealings with the insurance agency representing the group. These tasks were principally handled by Dwayne Benefield, the Assistant Administrator of Physical Services. In November 1977, he applied to Mercer for insurance for several nurses, including Woods. Woods’s policy covered the period from November 20, 1977 to February 20, 1978, and her policy was later renewed to May 20, 1978. This policy was a “claims-made” policy, which covers occurrences which may give rise to a claim that come to the attention of the insured and are made known to the insurer during the policy period. The liability limit was $100,000.00 per occurrence.

Glacier ceased to be the carrier for the AANA account at the end of the first quarter of 1978; the policy was not renewed at the request of AANA. The AANA account was placed with a different insurance carrier. The new insurance program provided an “occurrence” policy, which covers all claims based on an event occurring during the policy period, whether or not the claim or occurrence itself is brought to the attention of the insured or made known to the insurer during the policy period.

The transition from a claims-made policy to an occurrence policy created a potential gap in coverage. There could be claims in which the occurrence giving rise to the claim happened during the time period covered by the claims-made policy, but the insurer was not notified of the occurrence until after that period — such a claim would not be covered by either the first, claims-made policy or the second, occurrence policy. To bridge this gap, Glacier provided an opportunity in its policies for insureds to purchase “tail coverage,” which essentially extends the period of the claims-made policy to allow additional time to make claims that are based on injuries that occurred during the initial policy period.

Mercer was authorized to collect premiums for Glacier. During the initial stages of the Glacier program, Mercer was given some latitude in the date of acceptance for premium payments. On December 22, *394 1977, Benefield contacted a representative of Mercer concerning the payment of premiums due on December 23 and was advised by her that the payment would be accepted if he mailed it on December 22, the day before the due date. Relying on that statement, Benefield mailed the payment on December 22, 1977, and Mercer accepted it, although it was actually received by Mercer beyond the December 23 due date. In February 1978 Benefield sent a premium to Mercer on the 2nd, which was due on the 3rd, and sent premiums to Mercer on the 17th, which were due on the 20th. Mercer accepted these premiums.

A different procedure was used in the collection of premiums for tail coverage. However, Mercer also showed some flexibility in these procedures, until February 1978. By a letter dated February 21, Glacier indicated to Mercer that the policy terms were to be strictly enforced, stating that Glacier would not issue any tail endorsements after thirty days from the expiration date of the policy and rejecting a number of tail endorsement applications forwarded by Mercer.

The policy provision that deals with obtaining tail coverage states:

In the event of termination of insurance either by non-renewal or cancellation of this policy, or termination of a reporting period the Insured shall have the right upon the payment of an additional premium (to be computed in accordance with the Company’s rules, rates, rating plans and premiums applicable on the effective date of the endorsement) to have issued an endorsements) providing additional REPORTING PERIOD(S) in which claims otherwise covered by this policy may be reported. Such rights hereunder must, however, be exercised by the Insured by written notice not later than thirty (30) days after such termination date.

Mercer interpreted the terms of the policy to require that both the application and the premium be received before the expiration of thirty (30) days after the expiration of the policy. The trial court agreed with Mercer’s interpretation, granting a motion for partial directed verdict on this issue. The memorandum agreement between Glacier and Mercer stated that the initial premium or down payment should accompany each application. The Mercer procedural manual sent to Glacier also indicated that no endorsement could be issued until the premium was received.

In April 1978 Mercer sent a letter to those nurses whose policies expired in May, including Woods. The letter began:

On May 20, 1978 your Professional Liability Insurance sponsored by the American Association of Nurse Anesthetists is due for renewal. The following information should be read VERY CAREFULLY so that you are fully aware of the new procedures: ....

In regard to the change-over in insurance companies, and the resulting gap in coverage, the letter provided:

5. Since Glacier General’s policy was on a “claims-made” basis there is an option available upon termination. To remind you of the meaning “claims-made”; remember, any claim which has not been reported to the company by May 20, 1978 will not be covered. Therefore, when your Glacier General policy terminates there will be no coverage for any incident which may have occurred during your coverage with them, unless it has been previously reported.

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Bluebook (online)
717 S.W.2d 391, Counsel Stack Legal Research, https://law.counselstack.com/opinion/william-m-mercer-inc-v-woods-texapp-1986.