Meinze v. Holmes

• Decision Date: 29 July 1987
• Docket Number: No. C-860459,C-860459
• Citation: 40 Ohio App.3d 143,532 N.E.2d 170
• Parties: MEINZE, Admx., Appellant, v. HOLMES et al.; Teachers Insurance and Annuity Association, Appellee.
• Court: Ohio Court of Appeals

Page 143

40 Ohio App.3d 143

532 N.E.2d 170

MEINZE, Admx., Appellant, v. HOLMES et al.; Teachers Insurance and Annuity Association, Appellee.

No. C-860459.

Court of Appeals of Ohio, First District, Hamilton County.

July 29, 1987.

Syllabus by the Court

1. A physician, employed by an insurer who examines an insured and thereby discovers a significant medical condition or information relating to treatment that is unknown to the insured has a duty to disclose such discovery to the insured where a reasonable physician of ordinary skill and diligence would disclose the information in question, even though a doctor-patient relationship does not exist. This duty is fulfilled by the insurer's transmittal of the pertinent medical information to the insured's attorney.

2. When the insured is examined at the insurer's behest to determine the extent of disability resulting from heart disease, and there is some difference of opinion among the insurer's doctors concerning the adequacy of the insured's ongoing medical treatment, the insurer's duty to disclose the opinions is satisfied by the delivery of the doctors' reports, at the insured's request, to the insured's attorney.

William C. Knapp, Cincinnati, for appellant.

Porter, Wright, Morris & Arthur and Louis J. Schneider, Jr., Cincinnati, for appellee.

BLACK, Presiding Judge.

The dispositive question in this case is whether the insurer of disability benefits fulfilled or violated a duty to disclose a medical opinion that the insured's medical treatment for heart disease was inadequate, when that opinion came to the insurer's attention by reason of medical examinations it arranged for the insured in connection with the payment of disability benefits. We hold that, under the circumstances revealed by the record, that duty was fulfilled.

I

William Meinze was employed as a maintenance pipefitter and plumber by Northern Kentucky University and suffered a heart attack on April 22, 1982. He was hospitalized by his treating physician, Dr. Glenn J. Bichlmeir. On June 11, 1982, a coronary arteriography was performed by a cardiologist, Dr. John C. Holmes, who initially concluded that Meinze had advanced three-vessel coronary artery disease with poor left ventricular function. However, the arteriography results were read by a radiologist, Dr. Harold Margolin, who concluded that Meinze did not have a serious coronary artery disease but a partial blockage. Holmes acceded to this opinion, did not recommend corrective surgery, and prescribed a relatively minor regime of treatment.

On August 5, 1982, Meinze applied for disability benefits from the Teachers Insurance and Annuity Association ("TIAA") claiming he was totally disabled. Under the disability policy covering the University's employees, TIAA required Meinze to apply for Social Security benefits because those payments would reduce the amounts contractually payable by TIAA. Meinze's applications to the Social Security Administration were twice rejected. After each rejection, TIAA arranged for Meinze to be examined by two independent medical consultants whom it engaged for this purpose. The first examination was performed by Dr. Allen Cornish who sent TIAA a report dated January 7, 1983, and the second examination was by Dr. Robert Adolph whose report was dated June 27, 1983. Each consultant stated in his respective report to TIAA that in his opinion the treatment prescribed was either questionable or inadequate, but each stated this only to TIAA because under the arrangement, the consulting physicians were required to deliver their reports only to TIAA and to no other person.

Cornish felt that Margolin's reading of the "cardiac catheterization" was inconsistent with the other indications, and he stated this in his report of January 7, 1983, as follows:

"There certainly is a discrepancy in the description of his cardiac catheterization results between the initial evaluation and the review of his cines. I think it would be of benefit to have the cathing doctor review the films again. Certainly the initial impression fits more with the EKG findings and Mr. Meinze's symptoms.

" * * *

"It certainly would be difficult to predict how well his symptoms would respond to more aggressive medical management, however, I think he will need to avoid heavy physical exertion in the future. This certainly may limit his ability to perform his duties as power plant operator since climbing and heavy lifting are involved.

"In summary, I feel that Mr. Meinze's [sic ] must be assumed to have class III angina pectoris. His physical activity should be significantly restricted at this time. He may improve with more aggressive medical therapy, but still would need to be under restrictions from heavy lifting and vigorous physical exercise. There is a discrepancy in his cardiac catheterization report and I feel that a review of his films would be helpful in assessing his overall prognosis."

Dr. Adolph stated in his report of June 27, 1983:

"His medical management is inadequate insofaras [sic ] he is not taking either nitrates and/or a calcium channel blocker. He has hypertension, which is poorly controlled on the beta-blocker alone. He is at considerable risk for developing another acute myocardial infarction. In view of the finding of three-vessel disease and because of the persistence of his symptoms of angina. [Sic.] His is a candidate for coronary artery bypass grafting by usual criteria.

" * * *

"I believe that his symptoms are real and that he is totally disabled by virtue of the disease mentioned above. His physical activities should be significantly restricted and rehabilitation to gainful employment could only be considered following more aggressive medical management and coronary artery bypass surgery." (Emphasis sic.)

TIAA's medical director, Dr. Oscar Garfein, thought that Holmes's angiogram should be reviewed, that Meinze's condition was "rather serious," but that he was not at considerable risk.

At Meinze's written request, a copy of Cornish's report was delivered to Meinze's attorney, Deborah F. Webb, on April 18, 1983, and a copy of Adolph's report was delivered to her on September 13, 1983. These deliveries are uncontroverted. Webb used these copies to pursue Meinze's reapplications for Social Security benefits, and they were entered in the record of these proceedings. Webb talked to Bichlmeier for an hour on May 6, 1983, about the Cornish report. Meinze's family had a copy of Adolph's report when he was admitted to Park West Hospital in Knoxville, Tennessee, on January 1, 1984. The family was traveling through that city between Cincinnati and Florida when Meinze suffered another heart attack. This one was fatal, and he died in the hospital on January 5, 1984.

II

Meinze's administratrix brought suit against the cardiologist, the radiologist and TIAA, claiming malpractice by the physicians and both a negligent violation and an intentional violation by TIAA of a duty to disclose the inadequacy of Meinze's treatment. The malpractice and the failure to disclose were alleged to have caused Meinze's death. The two physicians settled the respective claims against them and were dismissed from the case. TIAA filed a motion for summary judgment that was supported by affidavits, answers to interrogatories and depositions. The trial court granted TIAA's motion without filing an opinion, and the administratrix appealed.

In the first of two assignments of error, appellant asserts that the trial court erred in ruling that as a matter of law TIAA had no duty to inform Meinze about his serious medical condition, and in the second, that the trial court erred in holding that the furnishing of the Cornish and Adolph reports fulfilled TIAA's duty to inform. We find no merit in either assignment of error.

III

The first assignment of error has no merit because the record fails to substantiate it. The record does not demonstrate that the court made a specific holding that an insurer has no duty whatsoever to disclose significant medical information. The trial court's entry granting TIAA's motion for summary judgment states no more than that there were no genuine issues of material fact and that TIAA was entitled to a judgment as a matter of law. The court did not state its reasons for granting the motion, and as will be explained below, there are two other possible reasons for its judgment in addition to the absence of a duty to disclose.

IV

The second assignment of error has no merit, in our judgment, for two reasons. The first is that on the basis that a disability insurer has, under some circumstances, a duty to inform the insured about significant medical information it acquires by reason of examination of the insured's person and his medical files (see Part A below), that duty was fulfilled in this case when the insurer sent copies of the pertinent reports to the insured's attorney. The second reason is that the appellant failed to establish another essential element of her claim for damages; that is, she failed to establish the causal connection between the failure to disclose (if any) and the death.

A

Returning to the first reason, we examine appellant's arguments that because TIAA constrained Cornish and Adolph to...