Zaleski v. West Virginia Physicians' Mutual Insurance

647 S.E.2d 747, 220 W. Va. 311, 2007 W. Va. LEXIS 62
CourtWest Virginia Supreme Court
DecidedJune 27, 2007
Docket33242
StatusPublished
Cited by5 cases

This text of 647 S.E.2d 747 (Zaleski v. West Virginia Physicians' Mutual Insurance) 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
Zaleski v. West Virginia Physicians' Mutual Insurance, 647 S.E.2d 747, 220 W. Va. 311, 2007 W. Va. LEXIS 62 (W. Va. 2007).

Opinion

ALBRIGHT, Justice.

This case is an appeal by the defendant below, West Virginia Physicians’ Mutual Insurance Company (hereinafter referred to as “Mutual”), of the April 27, 2006, final order 1 of the Circuit Court of Ohio County in a suit involving the reinstatement of medical malpractice insurance coverage for plaintiff below, Robert J. Zaleski, M.D. (hereinafter referred to as “Dr. Zaleski”). Among the matters being appealed are the lower court’s grant of partial summary judgment for Dr. Zaleski and denial of Mutual’s motions seeking dismissal of the case or for summary judgment. After due consideration of the briefs and arguments of counsel, 2 the record certified for our review and relevant law, the challenged order is affirmed, in part, and reversed, in part, and the case is remanded with direction as further explained below.

I. Factual and Procedural Background

The underlying suit is an action by Dr. Zaleski, who is an orthopedic surgeon, brought against Mutual after he was denied renewal of medical malpractice insurance coverage by Mutual. Mutual is a West Virginia corporation formed in 2004 in accord with statutory provisions enacted by the Legislature to address the “nationwide crisis in the field of medical liability insurance” causing “physicians in West Virginia [to] find it increasingly difficult, if not impossible, to obtain medical liability insurance either because coverage is unavailable or unaffordable.” W.Va.Code § 33-20F-2 (a)(1) and (6) (2003) (Repl.Vol.2006). The Legislature took temporary measures to alleviate the medical liability insurance problem by creating programs to provide coverage through the West Virginia Board of Risk and Insurance Management (hereinafter referred to as “BRIM”) until the legislative “mechanism for the for *315 mation of a physicians’ mutual insurance company” was actuated. W.Va.Code § 33-20F-2(b) (2003) (Repl.Vol.2006). The statutory scheme provided that all medical liability insurance obligations and risks associated with BRIM policies be transferred to the new company upon its formation. W.Va. Code § 33-20F-9(b)(l) (2003); see 2003 W.Va. Acts c. 147. 3

Dr. Zaleski was insured for professional liability through BRIM, and his policy was among the one thousand four hundred seventy other physician malpractice policies in the state that were transferred to Mutual on July 1, 2004. By certified letter dated September 8, 2004, Dr. Zaleski was notified by Mutual that his existing policy coverage would not be renewed at its natural termination date of December 22, 2004. 4 The notification did not state a reason for the non-renewal, and no attempt was made by Mutual to cancel the policy earlier than the termination date.

Dr. Zaleski notified Mutual by letter dated September 23, 2004, of his desire to appeal the non-renewal decision. Mutual responded by certified letter designating a date for the hearing and indicating that it would be limited in duration to fifteen minutes. As related in the April 27, 2006, order, this mailing also included a written description of the appeal process containing the following elements:

(a) Coverage is declined by underwriting.
(b) An appeal is requested by the Physician.
(c) The physician is requested to make a brief statement to the Underwriting Committee, can ask questions of the Committee, and can entertain questions from the Committee members.
(d) The Committee reviews the application for coverage and the information gathered during the appeal and makes a decision regarding the underwriting decision immediately following the Physician’s appearance before the Committee.
(e) The physician will receive a telephone call from a representative of the Committee the day following the appeal and will receive a follow-up letter by mail.

Dr. Zaleski appeared in person before Mutual’s Underwriting Committee on November 11, 2004, presented evidence on his own behalf and responded to questions from the Committee. No stenographic record was made of the hearing. The day following the hearing, Mutual informed Dr. Zaleski by phone that the Committee unanimously upheld the decision not to renew the doctor’s liability coverage. The information was also transmitted to Dr. Zaleski in writing by certified mail on November 12, 2004. In neither instance was Dr. Zaleski advised of any right to appeal Mutual’s non-renewal decision.

Dr. Zaleski responded to Mutual by letter dated November 30, 2004, requesting that Mutual provide him with a detailed explanation of why the insurance policy would not be renewed. Dr. Zaleski also lodged what he called a “formal complaint” with the West Virginia Insurance Commissioner on December 8, 2004, seeking information about the non-renewal of his malpractice coverage. The Insurance Commissioner’s Office forwarded the letter to Mutual and requested a written response. In its December 15, 2004, written response to the Insurance Commissioner, Mutual said its reason for not renewing Dr. Zaleski’s policy was because of the “frequency of lawsuits in his history.” 5 A *316 copy of Mutual’s December 15, 2004, letter was mailed to Dr. Zaleski by the Insurance Commissioner with written notification that no administrative action would be taken against Mutual because it did not appear that Mutual had violated any applicable statute or rule regarding non-renewal of the doctor’s policy. The notification did not include reference to any right to seek judicial review of the Insurance Commissioner’s determination through the Circuit Court of Kanawha County. See W.Va.Code § 33-2-14 (1957) (Repl.Vol.2006).

On April 4, 2005, Dr. Zaleski filed suit against Mutual asserting that the company’s decision not to renew his malpractice insurance policy amounted to breach of the covenant of good faith and fair dealing, arbitrary and capricious conduct, breach of fiduciary duty, intentional infliction of emotional distress, and negligent infliction of emotional distress. The relief sought in the complaint was “judgment against Physicians Mutual for compensatory damages in an amount to be determined by a jury and, [punitive damages] to the extent that the jury may determine that the aforesaid acts constitute actual malice.” Additionally, Dr. Zaleski sought award of attorneys fees and expenses, pre- and post-judgment interest and “any and other relief as determined by the Court.”

In response to all claims raised in Dr. Zaleski’s complaint, on June 2, 2005, Mutual filed a motion to dismiss or, in the alternative, for summary judgment. On August 5, 2005, the lower court held a hearing on the motion and concluded that Mutual’s status as a private, public, or quasi-public body was a predicate question of law that had to be determined before any other matter. The circuit court judge asked the parties to brief the issue. Dr.

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Bluebook (online)
647 S.E.2d 747, 220 W. Va. 311, 2007 W. Va. LEXIS 62, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zaleski-v-west-virginia-physicians-mutual-insurance-wva-2007.