RICHARD D. BENNETT, District Judge.
This declaratory judgment action is a medical malpractice insurance coverage dispute. Defendant Dr. Barry I. Aron ("Dr. Aron") is an obstetrician/gynecologist who had purchased an insurance policy from Plaintiff Catlin Specialty Insurance Co. ("Catlin"). After becoming aware of a claim by Defendant Sherry Marie Pfenninger ("Ms. Pfenninger") against Dr. Aron arising out of a 2010 surgery, Catlin filed this declaratory judgment action to determine the scope of its duty to defend and indemnify Dr. Aron and Barry I. Aron, M.D., P.C. (Dr. Aron's professional
This Court reviews the facts and all reasonable inferences in the light most favorable to the nonmoving party. Scott v. Harris, 550 U.S. 372, 378, 127 S.Ct. 1769, 167 L.Ed.2d 686 (2007); see also Hardwick ex rel. Hardwick v. Heyward, 711 F.3d 426, 433 (4th Cir.2013).
Dr. Aron purchased one-year insurance policies from Catlin Specialty Insurance Co. over the course of several years.
The 2012 Policy explains the extent of coverage as follows:
Pl.'s Am. Compl. Ex. G 15, ECF No. 6-8 (hereinafter "2012 Policy").
The 2012 Policy defines the term "claim" accordingly:
2012 Policy at 21-22. The 2012 Policy also explains how the timing of the claim and the reporting of the claim are to be calculated. Specifically, the Policy states that:
2012 Policy at 19. Meanwhile, a claim is considered reported "on the date when [Catlin Specialty Insurance Co.] first receives
Finally, the Policy identifies several coverage exclusions. Of particular import in this case is Exclusion 11(ii), which expressly excludes coverage for
Defendant Dr. Barry Aron ("Dr. Aron") is an obstetrician/gynecologist practicing in Charles County, Maryland. Defs.' Mem. Supp. Mot. Partial Summ. J. 5, ECF No. 26 (hereinafter "Def. Mem. MPSJ"). This suit arises out of a surgery that Dr. Aron performed on Defendant Sherry Marie Pfenninger ("Ms. Pfenninger") on December 30, 2010. The surgery — known as a pelvic laparotomy — required Dr. Aron to make an incision in the abdominal wall. Pl.'s Mem. Supp. Mot. Summ. J. 6, ECF No. 30 (hereinafter "Pl.'s Mem. MSJ"). Dr. Aron removed a cystic mass in the right pelvic area and tied off a number of vessels.
As noted above, Dr. Aron renewed his policy with Catlin Specialty Insurance for the 2012 calendar year. The renewal application contained the following question: "Has any claim or suit for alleged malpractice ever been brought against you, or are you aware of circumstances that might reasonably lead to such a claim or suit?" Pl.'s Mem. MSJ 12. Dr. Aron responded to that question in the affirmative in his November 11, 2011, renewal application. Id. However, he did not include a "claims supplement" with respect to Ms. Pfenninger's claim as the application directed.
Ms. Pfenninger's counsel first contacted Dr. Aron on August 22, 2012, and requested Ms. Pfenninger's medical file from Dr. Aron. Pl.'s Mem. MPSJ 8 n. 5. On November 26, 2012, Ms. Pfenninger's counsel mailed Dr. Aron a demand letter which stated that Ms. Pfenninger intended to file a medical negligence claim against Dr. Aron and made a settlement demand of $725,000. Pl.'s Mem. MSJ 11. Ms. Pfenninger's counsel mailed another letter on January 4, 2013. Id. at 12. Dr. Aron contacted Catlin Specialty Insurance Co. on January 7, 2013 and notified it of Ms. Pfenninger's claim. Def. Mem. MPSJ 6. On February 1, 2013, Catlin Specialty Insurance denied Dr. Aron's claim. The denial notice stated that "[b]ecause you waited to report this claim past the expiration date of the applicable policy [i.e., December 31, 2012], Catlin has no obligation to defend or indemnify you in connection with this claim." Def. Mem. MPSJ 7 (quoting ECF No. 6-9) (additions in original).
Thereafter, on March 18, 2013, Catlin Specialty Insurance filed this action seeking a declaratory judgment that Catlin has no duty to defend or indemnify Dr. Aron and that it has no liability to any other party arising out of the Pfenninger surgery. Def. Mem. MPSJ 3. The Pfenningers then filed an action against Dr. Aron and his professional corporation, Barry I. Aron, M.D., P.C. alleging medical malpractice.
Rule 56 of the Federal Rules of Civil Procedure provides that a court "shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." FED. R. CIV. P. 56(c). A material fact is one that "might affect the outcome of the suit under the governing law." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). A genuine issue over a material fact exists "if the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Id. In considering a motion for summary judgment, a judge's function is limited to determining whether sufficient evidence exists on a claimed factual dispute to warrant submission of the matter to a jury for resolution at trial. Id. at 249, 106 S.Ct. 2505. In undertaking this inquiry, this Court must consider the facts and all reasonable inferences in the light most favorable to the nonmoving party. Scott v. Harris, 550 U.S. 372, 378, 127 S.Ct. 1769, 167 L.Ed.2d 686 (2007).
When both parties file motions for summary judgment, as here, the court applies the same standard of review to both motions, with this Court considering "each motion separately on its own merits to determine whether either [side] deserves judgment as a matter of law." Rossignol v. Voorhaar, 316 F.3d 516, 523 (4th Cir.2003), cert. denied, 540 U.S. 822, 124 S.Ct. 135, 157 L.Ed.2d 41 (2003); see also havePower, LLC v. Gen. Elec. Co., 256 F.Supp.2d 402, 406 (D.Md.2003) (citing 10A Charles A. Wright & Arthur R. Miller, Federal Practice & Procedure § 2720 (3d ed.1983)).
The two main issues raised by the parties' cross-motions for summary judgment are (1) whether § 19-110 of the Insurance Article of the Maryland Code applies to the insurance Policy in this case; and (2) whether Exclusion 11(ii) of the Policy excludes coverage for the claims in this case because the surgery on Ms. Pfenninger constituted an "incident" of which Dr. Aron was aware prior to the commencement of the 2012 policy period.
The Aron Defendants contend that § 19-110 of the Insurance Article of the Maryland Code applies to the Policy in this case and, therefore, requires Plaintiff Catlin Specialty Insurance to demonstrate that Dr. Aron's late reporting of Ms. Pfenninger's claim somehow prejudiced Catlin. Section 19-110 provides:
Md.Code, Ins. § 19-110. Thus, "if an insurer is to disclaim coverage based on failure to provide timely notice that is required under the terms of an insurance policy, the insurer must establish that the failure to provide notice caused actual prejudice to the insurer." McDowell Building, LLC v. Zurich American Insurance Co., Civ. A. No. RDB-12-2876, 2013 WL 5234250, at *4 (Sept. 17, 2013).
The Aron Defendants contend that Sherwood Brands, Inc. v. Great American Insurance
Because this Court has recently summarized the history and interpretation of § 19-110 in its McDowell Building decision, there is no need to do so again. See 2013 WL 5234250, at *5-8. Suffice it to say that this Court concluded in McDowell Building that § 19-110 could apply to claims-made-and-reported policies because Maryland law requires that timely notice provisions in insurance policies be construed as covenants rather than conditions precedent. See McDowell Building, 2013 WL 5234250, at *8 (citing Sherwood Brands, 418 Md. at 327 n. 21, 13 A.3d 1268). Notably, Judge Hollander of this Court has since cited favorably to McDowell Building and, after independently reviewing the relevant case law, came to the same conclusion. See Navigators Specialty Ins. Co. v. Medical Benefits Admins. of Md., Inc., Civ. A. No. ELH-12-2076, 2014 WL 768822, at *11-16 (D.Md. Feb. 21, 2014).
Despite these recent decisions, Catlin Specialty Insurance nevertheless argues that the present case is distinguishable. Specifically, Catlin points to T.H.E. Insurance Co. v. P.T.P., Inc., 331 Md. 406, 628 A.2d 223 (1993) — an earlier case from the Court of Appeals of Maryland — which, in Plaintiff's view, held that that "the precursor to § 19-110 did not apply where a claims-made-and-reported policy had expired before the claim in issue was reported."
Id. (citations omitted).
While this Court agrees that the language of the 2012 Policy differs slightly from that in Sherwood Brands and McDowell Building, it does not find T.H.E. Insurance to be either analogous or dispositive of this case. In T.H.E. Insurance, P.T.P., Inc. had purchased a claims-made insurance policy from T.H.E. Insurance Co. for the period between April 2, 1987 and April 2, 1988 for its "go-kart track" business. Id. at 412, 628 A.2d 223. The policy required written notice of a claim "as soon as practicable" and provided a 60-day extended reporting period. Id. at
On August 27, 1987 — during the duration of the policy — one of P.T.P.'s customers was injured. Id. at 408, 628 A.2d 223. The policy expired on April 2, 1988, and a claim for damages was not made until June 6, 1988 — more than 60 days after the policy expired.
The Court of Appeals ruled that T.H.E. Insurance Co.'s denial was proper, finding that the policy had expired before any claim was made. Id. at 415, 628 A.2d 223. Because the making of a claim (as opposed to the reporting of a claim) was a condition precedent for coverage, the Court of Appeals refused to apply § 19-110's requirement for a showing of prejudice. See Sherwood, 418 Md. at 332 (explaining the Court of Appeal's conclusion in T.H.E. Insurance). Noting that the purpose of § 19-110 was to protect against denials of coverage based upon the insured's failure to comply with the agreement's notice terms where that failure had not prejudiced the insurer, the Court of Appeals found that the particular interests protected by the statute were not implicated in T.H.E. Insurance. See 331 Md. at 421, 628 A.2d 223. Accordingly, the Court of Appeals ruled that § 19-110 was not applicable and, therefore, that the insurer was not required to provide a showing of prejudice prior to denying the claim.
As should be apparent, the posture of this case is significantly different than that of T.H.E. Insurance. Specifically, Ms. Pfenninger's counsel first mailed Dr. Aron a demand letter on November 26, 2012. Pl.'s Mem. MSJ 11. Unlike in T.H.E. Insurance,
Catlin nevertheless attempts to blur this distinction by relying on the 2012 Policy's definition of a "claim," which requires (1) the filing of a lawsuit, written notice of intent to sue, written demand for money, or written notice of a loss event; and (2) written reporting to Catlin prior to the expiration date. Essentially, Catlin argues that, while the first factor of coverage is present, the second is not, and therefore, there is no coverage. Notably, however, this second element for coverage is merely a notice requirement. Thus, consistent with the Court of Appeals' interpretation in Sherwood Brands and this Court's conclusion in McDowell Building, the requirement of notice — even when appearing in the basic definition of a "claim" — must be construed as a covenant rather than a condition precedent.
The next issue is whether Exclusion 11(ii) of the 2012 Policy relieves Catlin Specialty Insurance of its duty to defend and indemnify Dr. Aron. Exclusion 11(ii) of the 2012 Policy states that "[t]his insurance does not provide coverage for or apply to ... any liability of an
What is disputed, however, is whether there was an "incident" that would trigger the applicability of Exclusion 11(ii). The term "incident" is not expressly defined by the Policy. Under Maryland law, insurance contracts are interpreted like other contracts, and undefined words "are given their `customary, ordinary, and accepted meaning,' unless there is an indication that the parties intended to use the words in a technical sense." Sullins v. Allstate Ins. Co., 340 Md. 503, 508, 667 A.2d 617 (Md.1995) (quoting Cheney v. Bell National Life, 315 Md. 761, 766, 556 A.2d 1135 (1989)). "If the language in an insurance policy suggests more than one meaning to a reasonably prudent lay person, [the language] is ambiguous." Id. If the policy language is ambiguous, then the language "will be construed liberally in favor of the insured and against the insurer as drafter of the instrument."
Catlin originally contended that there were two "incidents" triggering the applicability of the policy exclusion — (1) the pathology report received by Dr. Aron on January 3, 2011; and (2) Dr. Aron's receipt of a document request from Ms. Pfenninger's attorney. See Pl.'s Am. Compl. ¶¶ 78, 80. In their Motion for Partial Summary Judgment, the Aron Defendants contend that the term "incident," which is not defined by the Policy documents, is ambiguous and, therefore, that Catlin cannot demonstrate that the policy exclusion is applicable in this case. In its cross-motion for summary judgment, Catlin Specialty Insurance does not dispute that the term is undefined by the Policy, but asserts that the reasonably prudent lay person would understand the term to mean "a distinct occurrence or event, esp. one that attracts general attention or is noteworthy in some way." Pl.'s Mem.
In determining the meaning of the term "incident," this Court must consider the contract as a whole. See Sullins v. Allstate Ins. Co., 340 Md. 503, 508, 667 A.2d 617 (Md.1995) ("In Maryland, insurance policies, like other contracts, are construed as a whole to determine the parties' intentions."). While the Policy fails to define what constitutes an "incident," it does define both "claims" and "loss events." As discussed above, a "claim" is defined in reference to four specific events: (1) the filing of a lawsuit; (2) written notice of intent to file a lawsuit or to arbitrate; (3) a written demand for money or services; or (4) a written notice of a loss event that describes, inter alia, the name of the patient and the circumstances under which the Insured became aware of an injury suffered by the patient.
In fact, as opposed to "damages," the Policy defines "injury" in terms of the actual negative effects experienced by patients. Id. ("[I]njury means bodily injury, sickness, disease, or other injury sustained by any patient, his or her spouse and or children, including mental anguish, loss of income or death, resulting from a rendering of or failure to render, an act or omission or series of acts or omissions of an Insured in the rendering of, or failing to render, medical professional services." (formatting omitted)). Significantly, Exclusion 11(ii) does not include the word "injury."
In light of the other language in the Policy, this Court must conclude that the term "incident" is ambiguous. On the one hand, the term could apply to some sort of claim or action against Dr. Aron by a patient, just as the other defined terms in Exclusion 11(ii) suggest.
In light of this ambiguity, this Court must construe the Policy against Catlin Specialty Insurance. See Dutta v. State Farm Ins. Co., 363 Md. 540, 556, 769 A.2d 948 (Md.2001). Considering that the other terms in Exclusion 11(ii) relate to claims (in the generic sense) against the insured rather than injuries to the insured's patients, this Court construes the term in a similar, claims-related fashion. This reading is buttressed by the fact that the Policy expressly defines "injury" in a way that significantly overlaps with the reading Catlin now offers for the undefined term "incident."
Under this reading of the term, there was no "incident" triggering the coverage exclusion. Specifically, Dr. Aron's receipt of the pathology report indicating that he had removed part of Ms. Pfenninger's ureter was merely an "injury" under the terms of the Policy. It was not the type of "incident" indicating an impending claim against Dr. Aron that was necessary to trigger Exclusion 11(ii).
For the reasons stated above, the Motion of Defendants Dr. Barry I. Aron and Barry I. Aron, M.D., P.C., for Partial Summary Judgment (ECF No. 26) is GRANTED and the Plaintiff's Motion for Summary Judgment (ECF No. 30) is DENIED.
A separate Order follows.
For the reasons stated in the foregoing Memorandum Opinion, it is this 6th day of August, 2014, ORDERED and ADJUDGED, that:
2012 Policy at 21-22.
2012 Policy at 22.