KAREN KING MITCHELL, Presiding Judge.
Drs. Stanley Brand and Bradley Freilich, along with Dr. Freilich's practice, Kansas City Gastroenterology & Hepatology, LLC (KCGH), appeal the grant of summary judgment in favor of Travelers Indemnity Company of America (Travelers) on a collection action, filed pursuant to section 379.200
Dr. Brand is a medical doctor, specializing in gastroenterology and liver disease. Dr. Freilich is also a medical doctor, specializing in gastroenterology and hepatology. Dr. Freilich was the sole owner and director of Bradley L. Freilich, M.D., LLC, which later became KCGH.
In July 2003, Dr. Freilich approached Dr. Brand about joining KCGH. Dr. Brand, who had a heart condition and previously suffered a heart attack, informed Dr. Freilich of both his heart condition and the fact that he was receiving time-consuming and expensive blood-cleansing treatments. As a condition of his employment, Dr. Brand requested and received assurances that he would be eligible to participate in KCGH's group health insurance plan, including coverage for his treatments. Dr. Brand subsequently began his employment with KCGH on September 1, 2003.
On February 8, 2006, Dr. Freilich presented Dr. Brand with an ultimatum: either he sign a proposed independent contractor agreement or leave KCGH. The proposed independent contractor agreement contained most of the same control provisions as Dr. Brand's original employment contract, but the terms of the proposed independent contractor agreement precluded Dr. Brand from participating in KCGH's benefits, including its group health insurance. Dr. Brand rejected the proposed independent contractor arrangement, and, thereafter, on September 14, 2006, Dr. Freilich sent Dr. Brand a letter, terminating his employment.
Following the termination, Dr. Brand filed a timely charge of discrimination with the Missouri Commission on Human Rights and, following an investigation, received notice of his right to sue. On July
At the time Dr. Brand filed his petition, Dr. Freilich and KCGH carried a Commercial General Liability (CGL) insurance policy provided by Travelers.
The policy defined "administration" to include "[e]ffecting or terminating any employee's participation in a plan included in the `employee benefit program.'" And "employee benefit program" was defined to include "group accident or health insurance."
After Dr. Brand filed his lawsuit in 2007, Dr. Freilich and his counsel contacted Travelers and requested coverage. Travelers reviewed the allegations in Dr. Brand's lawsuit, compared those allegations to the CGL policy, and determined that there was no coverage under the CGL policy for Dr. Brand's claims, because (among other reasons) they did not fall within the coverage provided under the EBL provision in that the allegations did not allege a "negligent act, error, or omission" and did not result from the "administration" of Dr. Freilich's "employee benefit program." Travelers requested that if Dr. Freilich was "aware of any facts or theories that would support a duty to reimburse you, please contact us so that we may consider that information." Dr. Freilich's counsel responded to Travelers that "one of the claims in this case is specifically pleaded as a `negligence' claim and, further, the basis for the claimant's claims in this case is his allegation that he should not have been terminated from participation in the insured's health insurance plan." Travelers relied upon its review of this information that, "it does not appear that the act of terminating an employee would constitute a `negligent act, error or omission' as set forth in the insuring agreement of the EBL coverage" and again declined to provide defense or indemnity for Dr. Brand's lawsuit "as it is presently stated." Before the jury trial, Dr. Brand's allegations relating to Dr. Freilich's allegedly intentional misconduct were not amended to substitute allegations of inadvertence or mistake and Dr. Freilich did not provide any further information to Travelers that his ultimatum to Dr. Brand was the product of anything other than Dr. Freilich's intentional conduct.
The case proceeded to a jury trial. During the trial, Dr. Brand voluntarily dismissed
The jury rejected the claim of disability discrimination (Count I) but found in favor of Dr. Brand on his claims of wrongful discharge (Count II) and negligence per se (Count VI). The jury awarded damages in the amount of $406,074 for wrongful discharge and $300,000 for negligence per se. Dr. Brand filed a motion asking the trial court to enter a judgment of $706,074, the sum of the two verdicts, and on March 5, 2009, the trial court entered judgment in that amount.
On March 13, 2009, Dr. Freilich and KCGH filed a motion for judgment notwithstanding the verdict (JNOV), and Dr. Brand filed his motion for a new trial on the disability discrimination claim and the request for punitive damages. The trial court denied Dr. Brand's motions, but granted Dr. Freilich and KCGH's request for remittitur on the negligence per se claim, reducing the verdict from $300,000 to $24,672. The trial court then entered a final judgment, awarding damages to Dr. Brand in the amount of $430,746.
Both parties appealed the judgment to this Court. Brand v. Kansas City Gastroenterology & Hepatology, LLC, Nos. WD71061, WD71078, 2011 WL 135010, *2 (Mo.App.W.D. Jan. 18, 2011). Dr. Brand challenged: (1) the trial court's order of remittitur; (2) the trial court's instructions regarding his disability discrimination claim; and (3) the trial court's decision to grant a directed verdict on the issue of punitive damages. Id. Dr. Freilich and KCGH challenged: (1) the trial court's denial of their motion for directed verdict on the wrongful discharge claim; (2) the trial court's denial of their motion for directed verdict on the negligence per se claim; and (3) the trial court's judgment for the sum of the jury's two damage awards. Id.
On appeal, this Court affirmed the verdict on wrongful discharge, reversed the verdict on negligence per se due to the lack of a requisite statutory violation,
Pursuant to the settlement agreement, Dr. Freilich and KCGH agreed to pay $365,000 to Dr. Brand's attorneys for Dr. Brand's discrimination claim and $65,000 to Dr. Brand "for damages sustained as a result of Defendant KCG[H] and/or its agent's negligent administration of an employee benefit plan." The parties further agreed to either dismiss the pending suit without prejudice or to:
The parties further agreed to refrain from both filing any post-trial motions following entry of the judgment and appealing the judgment. The parties then agreed to take action against Travelers based upon its allegedly wrongful refusal to both defend Dr. Freilich and KCGH and provide coverage under the policy.
The parties then provided a stipulation to the Missouri Supreme Court indicating that they had agreed to settle on the condition that the pending transfer application was granted and the case remanded to the trial court for further actions "to effect the settlement." The Missouri Supreme Court, in accordance with the stipulation, ordered the case transferred and immediately remanded to the trial court "for approval of the settlement of the parties."
On remand, the trial court entered a new judgment reflecting dismissal of all claims in the petition except for Count VI (negligence per se). As to the negligence per se claim, the trial court made factual findings that appear to be premised upon a claim of general negligence — a claim that does not appear in any pleading before the trial court.
Drs. Brand and Freilich then filed a separate lawsuit against KCGH and Travelers on the underlying judgment pursuant to both section 379.200 and a claim of bad faith refusal to defend and indemnify. Travelers moved for summary judgment on the ground that it had no duty to defend because Dr. Brand's lawsuit did not arise out of any negligent act, error, or omission by the insured. The circuit court granted Travelers's motion, finding that the underlying lawsuit was based upon intentional and deliberate, rather than negligent, conduct and, therefore, did not fall within the coverage of the EBL provision.
"`The trial court makes its decision to grant summary judgment based on the pleadings, record submitted, and the law; therefore, this Court need not defer to the trial court's determination and reviews the grant of summary judgment de novo.'" Clark v. Progressive Preferred Ins. Co., 390 S.W.3d 208, 211 (Mo.App.W.D.2012) (quoting Bank of America, N.A. v. Reynolds, 348 S.W.3d 858, 860 (Mo.App.W.D. 2011)). "In reviewing the decision to grant summary judgment, this Court applies the same criteria as the trial court in determining whether summary judgment was proper." Id. Summary judgment is appropriate "if the moving party establishes that there is no genuine issue as to the material facts and that the movant is entitled to judgment as a matter of law." Id.
Appellants raise two points on appeal. First, they argue that the circuit court erred in granting Travelers's motion for summary judgment on the ground that Travelers had no duty to defend. Second, they argue that the circuit court erred in denying their motion for partial summary judgment on the issue of whether Travelers had a duty to indemnify following entry of the underlying judgment that found negligence in the administration of an employee benefit plan. We find the first point dispositive and, therefore, need not address the merits of the second point.
An insurer's duty to defend an insured "`arises whenever there is a potential or possible liability to pay based on the facts at the outset of the case and is not depend[e]nt on the probable liability to pay based on the facts ascertained through trial.'" McCormack Baron Mgmt. Servs., Inc. v. Am. Guarantee & Liab. Ins. Co., 989 S.W.2d 168, 170 (Mo. banc 1999) (emphasis added) (quoting 13 JOHN A. APPLEMAN & JEAN APPLEMAN, INSURANCE LAW AND PRACTICE, § 4684 (rev. vol. 1976)). "The duty to defend is determined by comparing the language of the insurance policy with the allegations in the complaint." Id. "If the complaint ... alleges facts that give rise to a claim potentially within the policy's coverage, the insurer has a duty to defend." Id. at 170-71.
"An insurer does not have a duty to defend a suit where the petition `upon its face alleges a state of facts which fail to bring the case within the coverage of the policy.'" Trainwreck West Inc. v. Burlington Ins. Co., 235 S.W.3d 33, 42 (Mo.App. E.D.2007) (citation omitted). "`The insurer owes no duty of defense where ... the allegations of claimant's petition and the
Here, Appellants argue that the EBL provision provided coverage and triggered Travelers's duty to defend. The EBL provision provided coverage for "negligent acts, errors, or omissions" in the "administration" of an "employee benefit plan." Appellants argue that Dr. Freilich's act of offering Dr. Brand employment without group health insurance coverage constituted a negligent act in the administration of an employee benefit plan. Appellants further argue that the potential for coverage under the EBL provision was readily apparent in Dr. Brand's petition — more specifically, in Count VI alleging negligence per se — and, therefore, Travelers had a duty to defend Dr. Freilich and KCGH against Dr. Brand's petition. We disagree.
A petition's mere mention of the word, "negligence," does not trigger a duty to defend where the factual allegations forming the "negligence" claim demonstrate intentional conduct. See Allen v. Continental W. Ins. Co., No. ED99111, 2013 WL 1803476, *6 (Mo.App.E.D. Apr. 30, 2013) (finding that insurer had no duty to defend under liability policy where petition against insured alleged negligence premised upon intentional conduct).
Dr. Brand's petition presented six counts, all of which were premised upon intentional conduct by Dr. Freilich and KCGH. Even Count VI, alleging negligence per se, was premised upon Dr. Freilich's intentional act of attempting to change Dr. Brand's status from employee to independent contractor for the purpose of removing him from the group health insurance plan; Dr. Brand alleged that this intentional act violated section 376.421, "which prohibits, among other things, the delivery of a group health insurance policy in the State of Missouri unless all employees of the employer are eligible for insurance under the policy." Brand, 2011 WL 135010 at *3. The petition specifically averred that the conduct underlying the negligence per se claim "was knowingly undertaken with the intention of depriving Plaintiff of his legal rights and otherwise causing injury to Plaintiff, and/or was undertaken with reckless disregard for the consequences to Plaintiff." Under neither scenario (knowingly undertaken or undertaken with reckless disregard) did Dr. Brand allege negligent conduct. And, in fact, in their briefing to this Court, Appellants have admitted that "Dr. Freilich and KCGH intended to exclude Dr. Brand from participation in the group health insurance plan." Thus, at the commencement of Dr. Brand's lawsuit and upon Travelers's request for any other facts, information, or theories that would support coverage under the CGL policy, the only information provided by Dr. Freilich was that, at all times, Dr. Freilich's conduct was not the product of inadvertence or mistake, but rather, was the product of his intentional conduct — or intentional misconduct as it were.
Despite their admission of intent to exclude Dr. Brand, Appellants nevertheless claim that the actions they took to accomplish their misguided goal "involved a `negligent act o[r] error' ... in effecting or terminating his participation in the group health insurance plan" and were, therefore, covered by the EBL provision. (Emphasis added.) There are two flaws in this argument. First, the EBL provision covers only those damages caused by negligent acts, errors, or omissions; it does not cover damages that merely involve negligent acts, errors, or omissions. And, the petition claims that Dr. Brand's damages were caused by Dr. Freilich and KCGH's admittedly wrongful act of forcing Dr. Brand to choose between termination and losing health insurance coverage. And, although the language in the independent contractor agreement, rendering Dr. Brand an employee, rather than an independent contractor, may have been involved in his harm, it was not the cause of it. This is especially evident by the fact that Dr. Brand refused to execute the agreement; thus, the language it contained never had any operable effect. In reality, Dr. Brand's damages were caused by the decision to terminate his employment.
The second flaw in Appellants' argument is that the motivation prompting allegedly negligent conduct is "crucial" to the determination of whether that conduct is covered by an errors or omissions provision. Katz Drug Co., 647 S.W.2d at 837. And here, Appellants have admitted that tendering the independent contractor agreement was motivated by Dr. Freilich's unlawful desire to remove Dr. Brand from group health insurance coverage.
In Katz, the insured failed to notify an employee regarding an impending lapse in life insurance coverage absent affirmative action by the employee to extend coverage. Id. at 833. Upon learning of the lapse, the insured's spouse contacted the employer, whom she had been advised could reauthorize the life insurance coverage, but the employer refused to do so. Id. at 833-34. After the insured passed away, his wife sued the employer for breach of contract to provide group life insurance coverage. Id. at 834. The employer maintained a commercial general liability policy containing an EBL provision much like the provision at issue in this case. Id. at 836-37. But when the employer tendered the wife's
On appeal, this Court rejected the trial court's determination that a subsequent intentional act could relieve an insurer from its duty to defend against potentially negligent acts causing harm. Id. at 838. In reaching our holding, we examined the potential preclusive effect of the underlying judgment, wherein the jury determined that the employer failed to provide timely notice before his life insurance coverage lapsed. Id. at 837. The employer-insured argued that the jury's finding was tantamount to a finding that the employer committed a negligent act, error, or omission in the administration of its employee benefit program. Id. We disagreed, noting that "[t]he jury was not required to determine the reason for the failure to notify, and therefore made no finding as to whether it resulted from an honest mistake, an oversight, negligence, an intentional act, or malicious motivation." Id. (emphasis added). We indicated that "[s]uch a finding is crucial to the question of whether the failure to notify was covered by [the] policy...." Id. (emphasis added). We then examined the evidence presented at trial demonstrating that, despite good faith efforts by the employer, the employee never received notice; consequently, we determined that the failure to notify appeared to result from an error of some kind, rather than any intentional conduct, which brought it within the coverage of the EBL provision and placed a duty to defend upon the insurer. Id. at 838.
Here, unlike the failure to notify in Katz, we know the reason that Dr. Brand was offered the allegedly faulty independent contractor agreement: Dr. Freilich no longer wished to pay for Dr. Brand's health insurance. The agreement was offered with the intent of depriving Dr. Brand of health insurance coverage, and that is exactly the effect it would have had if Dr. Brand had agreed to it. The concepts of negligence and intentional conduct "are contradictory and mutually exclusive." Gallatin v. W.E.B. Rests. Corp., 764 S.W.2d 104, 105 (Mo.App.W.D.1988). Thus, Dr. Freilich's actions simply cannot be characterized as negligent. And, in the absence of a negligent act, error, or omission, Travelers had no duty to defend.
Point I is denied.
In their second point, Appellants argue that, because Travelers wrongfully refused to defend, it is now bound by the underlying judgment, which clearly reflects a claim falling within the coverage of the EBL provision. While we agree that the underlying judgment reflects general negligence factual findings that may fall within the coverage language of the EBL provision, we disagree that Travelers has a duty to indemnify.
As discussed above, an insurer's duty to defend is examined at the outset of the case, or upon notice of an amended pleading, based upon facts known or reasonably ascertained through a review of
Point II is denied.
The allegations of Dr. Brand's petition were all premised upon intentional conduct engaged in by Dr. Freilich and KCGH. Thus, they did not fall within the coverage of the errors and omissions clause of the EBL provision, and Travelers had no duty to defend. And because Travelers had no duty to defend, it has no duty to indemnify Dr. Freilich and KCGH on the underlying judgment. The trial court's grant of summary judgment in favor of Travelers is affirmed.
CYNTHIA L. MARTIN and GARY D. WITT, Judges, concur.