Johnson v. Connecticut Ins. Guar. Ass'n
| Decision Date | 08 November 2011 |
| Docket Number | No. 18712.,18712. |
| Parties | Christopher E. JOHNSON et al. v. CONNECTICUT INSURANCE GUARANTY ASSOCIATION et al. |
| Court | Connecticut Supreme Court |
OPINION TEXT STARTS HERE
Mark D. Robins, pro hac vice, with whom was Charles W. Pieterse and, on the brief, Michael F. Cavolo and Thomas P. O'Connor, Greenwich, for the appellant (named defendant).
Sean K. McElligott, Bridgeport, for the appellees (plaintiffs).
ROGERS, C.J., and PALMER, ZARELLA, McLACHLAN, EVELEIGH, HARPER and VERTEFEUILLE, Js.
The plaintiffs, Christopher E. Johnson, individually and in his capacity as administrator of the estate of Debra L. Johnson, his deceased wife, brought the present declaratory judgment action seeking, inter alia, a determination that certain medical malpractice claims that they had asserted in an action against the defendant Middlesex Obstetrics and Gynecology Associates, P.C. (Middlesex), were covered under an insurance policy issued to Middlesex by Medical Inter–Insurance Exchange (Exchange). Due to Exchange's insolvency during the pendency of the malpractice action, the named defendant, Connecticut Insurance Guaranty Association (association), assumed liability for Exchange's obligations to the extent that claims were covered under the Connecticut Insurance Guaranty Act (guaranty act).1 Thereafter, the association filed a counterclaim for a declaratory judgment in the present action, contending that the claims against Middlesex were not covered because they were subject to a policy provision that excluded from corporate coverage liability based on “injury arising solely out of acts or omissions in the rendering or failure to render professional services ... by any paramedical for whom a premium charge is shown on the declarations page.” Following cross motions for summary judgment, the trial court rendered judgment in the plaintiffs' favor. The association appeals from that judgment,2 contending that the trial court improperly determined that the policy exclusion was inapplicable. We affirm the trial court's judgment.
The record reveals the following undisputed facts. Following the death of Debra Johnson, the plaintiffs brought a medical malpractice action against Middlesex and Sally J. Irons, an obstetrician, seeking damages for negligence and loss of consortium. Middlesex and Irons were insureds under the Exchange policy. The plaintiffs thereafter determined that their claims against Middlesex were predicated on the acts of one of its nurse practitioners, Kathy Hoffman. Hoffman was not named as a defendant in the malpractice action.3
After a dispute arose between the plaintiffs and the association as to Middlesex's coverage, these parties each sought a declaratory judgment. In subsequent cross motions for summary judgment, the limited issue before the trial court was whether Middlesex was covered under the Exchange policy for liability predicated on Hoffman's alleged negligence in light of the policy's paramedical exclusion to corporate coverage. The trial court rendered judgment in the plaintiffs' favor, apparently determining that the exclusion plainly did not apply. It underscored the fact that Hoffman was not a named insured, a dispositive fact in a question of coverage in Connecticut Medical Ins. Co. v. Kulikowski, 286 Conn. 1, 942 A.2d 334 (2008). Ultimately, the court concluded that the exception did not apply because “the premium charge for paramedicals under Coverage Part C was listed as ‘included’ and there were no paramedicals identified in or premium charges for paramedicals listed on [the] declaration pages....”
The association appeals from that judgment, claiming that Kulikowski does not support the trial court's conclusion and that the Exchange policy unambiguously indicates that the exclusion applies. Although we agree that Kulikowski does not control the present case,4 we conclude that the pertinent policy terms are ambiguous and, therefore, must be construed in favor of coverage. Accordingly, we affirm the trial court's judgment, but under different reasoning.
We undertake our task in the present case pursuant to well established principles. “[C]onstruction of a contract of insurance presents a question of law for the court which this court reviews de novo.... An insurance policy is to be interpreted by the same general rules that govern the construction of any written contract.... In accordance with those principles, [t]he determinative question is the intent of the parties, that is, what coverage the ... [insured] expected to receive and what the [insurer] was to provide, as disclosed by the provisions of the policy.... If the terms of the policy are clear and unambiguous, then the language, from which the intention of the parties is to be deduced, must be accorded its natural and ordinary meaning.... Under those circumstances, the policy is to be given effect according to its terms.... When interpreting [an insurance policy], we must look at the contract as a whole, consider all relevant portions together and, if possible, give operative effect to every provision in order to reach a reasonable overall result....
(Citations omitted; internal quotation marks omitted.) Connecticut Medical Ins. Co. v. Kulikowski, supra, 286 Conn. at 5–6, 942 A.2d 334.
Mindful of these principles, we turn to the Exchange policy at issue in the present case. That policy effectively consists of two parts: (1) the “Medical Group Practice, Professional Liability Insurance, Permanent Protection Policy,” a form contract; and (2) the declarations pages, which tailor coverage, effective dates and premiums to the individual insureds.5
Section I of the policy, “Coverage Agreements,” indicates that there are three types of coverage available: “Coverage A–Individual Professional Liability”; “Coverage B–Corporate/Partnership Liability”; and “Coverage C–Paramedical Employee Liability.” With respect to Coverage B, § I provides in relevant part: “The Exchange will pay on behalf of the insured all sums that the insured shall become legally obligated to pay as damages because of ... [i]njury arising out of the rendering of or failure to render ... professional services by any person for whose acts or omissions the corporation/partnership insured is legally responsible....” The association does not dispute that, but for any applicable exclusion, the plaintiffs' claims against Middlesex would be covered pursuant to § I.
Section III of the policy sets forth “Exclusions.” It provides in relevant part: “This insurance does not apply to liability of the insured ... (i) corporation/ partnership under Coverage Agreement B with respect to injury arising solely out of acts or omissions in the rendering or failure to render professional services by individual physicians or nurse anesthetists, or by any paramedical for whom a premium charge is shown on the declarations page.” (Emphasis added.) It is undisputed in the present case that Hoffman is a paramedical employee, that Hoffman's alleged acts constitute professional services 6 and that her acts alone are the claimed basis for Middlesex's liability. Thus, the issue in the present case turns on the meaning of the emphasized phrase in the relevant exclusion, in connection with the declarations page.
Although the exception refers to the declarations “page,” there are in fact several declarations pages. The “Common Policy Declarations” provide as follows: “Insurance is afforded only with respect to the Coverage Part(s) for which a premium charge or ‘no charge’ is indicated. This page of the declarations provides information for the policy in total. Refer to schedules on following pages of these declarations for information on individual insureds.
In addition to the Common Policy Declarations, the policy contains a “Coverage Part A Declarations, Schedule of Individual Insureds” and a “Coverage Part B Declarations, Schedule of Individual Corporation/Partnerships.” 7 There is no Coverage Part C Declarations, Schedule of Paramedical Insureds. In the Coverage Part A Declarations, the schedule reflects, inter alia: the names of 133 individuals covered, including Irons; their principal practice;...
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