AIG DOMESTIC CLAIMS, INC., ET AL. VS. TUSSEY (TAMMY), ET AL.
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RENDERED: SEPTEMBER 17, 2010; 10:00 A.M.
NOT TO BE PUBLISHED
OPINION OF AUGUST 28, 2009, WITHDRAWN
Commonwealth of Kentucky
Court of Appeals
NO. 2008-CA-001248-MR
AIG DOMESTIC CLAIMS, INC. AND
NATIONAL UNION FIRE INSURANCE COMPANY
v.
APPELLANTS
APPEAL FROM PIKE CIRCUIT COURT
HONORABLE EDDY COLEMAN, JUDGE
ACTION NO. 06-CI-00231
TAMMY TUSSEY; PIKE COUNTY BOARD OF
EDUCATION; AND EDDIE MCCOY
APPELLEES
OPINION
AFFIRMING
** ** ** ** **
BEFORE: CAPERTON, THOMPSON, AND WINE, JUDGES.
CAPERTON, JUDGE: National Union Fire Ins. Co. and AIG Domestic Claims,
Inc. appeal a decision of the Pike Circuit Court extending coverage under the terms
of a “claims-made” insurance policy. They argue on appeal that the Pike Circuit
Court erred in its interpretation of the policy when it granted summary judgment in
favor of the Appellees, Tammy Tussey and the Pike County Board of Education.
Upon a review of the policy in question, we are in agreement with the Circuit
Court insofar as it found that the Board was continually covered under the policy
from July 1, 2005, to July 1, 2007. Accordingly, we affirm.
On February 20, 2006, Tammy Tussey, a gym teacher for Pike County
High School, filed a claim against the Pike County Board of Education (the Board)
for gender discrimination related to her employment. The Board filed its answer
on April 24, 2006. At the time the action was filed, the Board had an insurance
policy issued by National Union Fire Insurance Company, whose parent company
is AIG Domestic Claims (hereinafter “National Union”). The policy at the time
was effective from July 1, 2005, to July 1, 2006. At the end of that term, the policy
was renewed with an effective period from July 1, 2006, to July 1, 2007. It is
undisputed that the Board was continuously covered through National Union at all
times relevant herein. It is likewise undisputed that the Board’s claim was not
reported until the “second” policy period.
On April 23, 2007, nearly a year after filing its answer, the Board
made a claim under the “first” policy. The Board avers that the delay in time was
due primarily to a change in administration that took place around the time the
complaint was filed. National Union denied coverage under the first policy. On
January 8, 2008, Tussey filed an Amended Complaint alleging that the acts
complained of in her complaint were covered under the second policy. Likewise,
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on January 22, 2008, the Board filed a cross-claim against National Union,
similarly alleging that the second policy covered the claim.
National Union again denied coverage and moved the Pike Circuit
Court for summary judgment thereafter. Specifically, National Union contended
that the insurance policies in question were “claims-based” policies, and that
claims not reported within the policy period were not covered under the policy.
Tussey and the Board filed cross-motions for summary judgment contending that
the claim was covered under the policy. The Pike Circuit Court denied National
Union’s motion for summary judgment and granted judgment in favor of Tussey
and the Board, prompting the present appeal. As the denial of a motion for
summary judgment is treated as an interlocutory order which is not appealable, we
will only address the order granting summary judgment in favor of Tussey and the
Board.
In reviewing the arguments of the parties, we recognize that summary
judgment is improper unless it appears “impossible for the respondent to produce
evidence at the trial warranting a judgment in his favor and against the movant.”
Steelvest, Inc. v. Scansteel Service Center, Inc., 807 S.W.2d 476, 483 (Ky. 1991),
citing Paintsville Hospital v. Rose, 683 S.W.2d 255 (Ky. 1985). Upon appellate
review of a denied motion for summary judgment, the relevant inquiry is whether
the trial court correctly found that there were no genuine issues of material fact and
that the moving party was entitled to judgment as a matter of law. Kentucky Rules
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of Civil Procedure (CR) 56.03; and Scifres v. Kraft, 916 S.W.2d 779, 781 (Ky.App.
1996).
The construction and interpretation of insurance contracts are
questions of law for the court. Kemper National Insurance Companies v. Heaven
Hill Distilleries, Inc., 82 S.W.3d 869 (Ky. 2002). As such, we give no deference to
the trial court. Blevins v. Moran, 12 S.W.3d 698, 700 (Ky.App. 2000).
Consequently, our review is de novo. K.M.R. v. Foremost Insurance Group, 171
S.W.3d 751 (Ky.App. 2005). Having so stated, we do note that it is a fundamental
rule of construction in the Commonwealth that insurance policies are to be
liberally construed, with any doubts resolved in favor of the insured. Kentucky
Revised Statute (“KRS”) 446.080; and State Farm Mutual Auto Ins. Co. v. Shelton,
413 S.W.2d 344, 347 (Ky. 1967). Limitations or exclusions of coverage must be
clearly stated in an insurance policy so as to apprise the insured of such limitations.
St. Paul Fire & Marine Ins. Co., 870 S.W.2d at 227. Further, where the terms of
an insurance policy are clear and unambiguous, the policy will be enforced as
written. Kemper, 82 S.W.3d at 873. However, ambiguous exclusions of coverage
are to be strictly construed so as to make insurance effective. Id.
The policy at issue between the parties states as follows:
NOTICE: THIS IS A CLAIMS-MADE FORM:
EXCEPT TO SUCH EXTENT AS MAY OTHERWISE
BE PROVIDED HEREIN, THE COVERAGE OF THIS
POLICY IS LIMITED GENERALLY TO LIABILITY
FOR ONLY THOSE CLAIMS THAT ARE FIRST
MADE AGAINST THE INSURED AND REPORTED
IN WRITING TO THE COMPANY WHILE THE
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POLICY IS IN FORCE. PLEASE REVIEW THE
POLICY CAREFULLY AND DISCUSS THE
COVERAGE WITH YOUR INSURANCE AGENT OR
BROKER.
In addition, the policy specifies that:
[National Union agrees t]o pay on behalf of the Insured
all sums which the Insured shall become legally
obligated to pay as Damages resulting from any Claim
first made against the insured and reported to the
company during the Policy Period for any Wrongful Act
of the Insured in the performance of duties for the School
Entity.
(Emphasis added). Furthermore, the “Special Provisions” section on page 4 of the
policy includes a provision entitled “Discovery Period,” which reads as follows:
If [National Union] or the School Entity shall cancel or
refuse to renew this policy, the School Entity shall have
the right, upon payment of an additional premium ... to a
period of twelve (12) months following the effective date
of such cancellation or non-renewal in which to give
written notice to the Company of any Claim made against
the Insured during the said twelve (12) month period for
any Wrongful Act before the end of the Policy Period.
It is the above “Discovery Period” provision, in particular, which is
central to the arguments of both parties. The Board contends that the provision
implies that the only circumstance where an insured would need to purchase an
additional twelve-month reporting period would be in the case of cancellation or
non-renewal. Thus, upon the Board’s argument, renewal implies an extended
reporting period where coverage remains continuous. National Union, however,
argues that it means exactly the opposite. National Union contends that the
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reporting period ends when the effective policy ends, and that an insured is only
entitled to an extended period of reporting if the insured purchases an extension for
an additional premium.
As National Union correctly notes, there are two primary types of
errors and omissions policies:1 “occurrence” policies and “claims-based” policies.
A claims-based policy, they argue, is often offered at a lower premium to an
insured because such a policy is limited to claims made and reported during the
policy period. An occurrence policy, on the other hand, is typically offered at a
higher premium because of the insurer’s exposure to indefinite future liability.
Thus, on appeal, National Union argues that the Board’s claim is not
covered because it was made after the reporting period for the claims-based policy
(hereinafter, “the policy”). National Union contends that the policy is
unambiguous in its requirement that the claim be made within the policy period in
which the claim arose. Accordingly, it asserts that to extend coverage to the
Board’s claim here would be tantamount to giving the Board a benefit for which it
did not bargain.
Having reviewed the arguments of the parties and the applicable law,
we note that claims-made policies are designed to provide coverage for claims
made against the insured during the policy period regardless of when the incident
1
Errors and omissions policies protect against liability based upon the failure of an insured, in
their professional capacity, to comply with the standard of care for that profession. 1 Couch on
Insurance 3d § 131:38 (3d ed. 2008). Such policies are designed to protect an insured against
liability arising from special risks such as negligence, omissions, or mistakes inherent in the
practice or profession. 9A Couch on Insurance 3d §131:38 (3d ed. 2008)
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giving rise to the claim occurred. In this case, the alleged incident and the claim
occurred under the first policy period; thus if the policy had expired and no
additional premium was paid for an extension of coverage, we would agree that
National Union must prevail. Nevertheless, we have difficulty reaching the same
result where, as here, the policy was renewed and there was no lapse in coverage.
Accordingly, this Court is of the opinion that when the Board renewed its claimsbased policy at the precise time the earlier policy expired, its coverage was
continuous.
The policy was in force from July 1, 2005, through July 1, 2007,
during which time the terms of the policy remained identical, creating seamless
coverage over the two-year period. It is difficult to fathom that a claim accruing
during the two policy periods would not be covered by either policy. See Cast
Steel Products, Inc. v. Admiral Ins. Co., 348 F.3d 1298 (11th Cir. 2003).
We believe the policy evidences that it was the expectation of the
parties that renewal of the policy carried with it a continuation of coverage. The
“discovery period” provision in the policy states that only if the policy is cancelled
or National Union refuses to renew the policy, can coverage be extended by the
payment of an additional premium. Thus, following the logic argued by National
Union, renewal of the policy leaves the insured with no means of protecting
against claims made after the first policy expired. This conclusion is both illogical
and inequitable. Id.
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A more sensible interpretation of the contract is that because the
discovery provision sets forth only two circumstances when the purchase of an
extension is necessary to maintain coverage, the renewal of the policy provides a
continuation of coverage and the purchase of an extension is unnecessary. We are
in agreement with the Court in Helberg v. National Union Fire Ins. Co., 102 Ohio
App. 3d 679, 683, 657 N.E.2d 832, 835 (Ohio App. 6 Dist. 1995), when it stated:
Applying the time-honored maxim of construction,
expressio unius est exclusio alterius, the inclusion of
specific things implies the exclusion of those not
mentioned, this court can only conclude that the inclusion
of “nonrenewal” of the policy as one of those
circumstances demanding the purchase of an extended
reporting endorsement excludes a “renewal” as a
circumstance which demands such a purchase. Since
appellant’s position here was a renewal rather than
“nonrenewal” or “cancellation,” this court concludes that
the language of the contract does not deny coverage in
this context.
Accordingly, we are of the opinion that the renewal of the policy provided
continual and seamless coverage to the Board. Accordingly, we affirm.
In affirming, we briefly note the issue which has come to the attention
of this Court on appeal concerning the timeliness of the Board’s notice of its claim,
particularly, the provision in the policy at issue which provides that the Board shall
“give written notice as soon as practicable” to National Union of any claim made
against the Board. One issue presented upon appeal centered upon whether the
fourteen-month delay on the part of the Board in giving notice was unreasonable.
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Having reviewed the record, we find that this issue was neither raised
before, nor addressed by, the court below. As we have repeatedly held, errors to be
reviewed by the appellate court must be precisely preserved and identified in the
lower court. See Skaggs v. Assad, 712 S.W.2d 947, 950 (Ky. 1986). Essentially,
appellants are not permitted to feed one can of worms to the trial judge and another
to the appellate court. Kennedy v. Commonwealth, 544 S.W.2d 219, 222 (Ky.
1976). Accordingly, as this issue was neither raised nor addressed below, we
decline to address it now for the first time on appeal.
Wherefore, for the foregoing reasons, we hereby affirm the summary
judgment of the Pike Circuit Court, extending coverage under the claims made
policy.
THOMPSON, JUDGE, CONCURS.
WINE, JUDGE, DISSENTS AND FILES SEPARATE OPINION.
WINE, JUDGE, DISSENTING: I must respectfully dissent from the
majority. This case involves an errors and omissions policy which is “claimsbased” in nature, and thus would preclude a finding in favor of Tussey and the Pike
County Board of Education for an after-reported claim.
As the majority correctly notes, errors and omissions policies are a
type of professional liability policy designed to protect an insured against liability
associated with their particular profession --namely failure to comply with the
standard of care for that profession. 1 Couch on Insurance 3d §1:35 (2008).
Again, as the majority aptly notes, such policies are designed to insulate an insured
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from professional negligence or other special liability arising from the risks
inherent in their profession. 9A Couch on Insurance 3d §131:38 (3d ed. 2008).
However, errors and omissions policies are of two primary types:
“occurrence-based” and “claims-based.” Although the majority recognizes this
distinction, it fails to see its significance. Occurrence-based policies are typically
offered at much higher premiums and cover all occurrences that take place during
the policy period. Claims-based policies, on the other hand, are typically offered at
lower premiums and only cover occurrences which accrue and are reported during
that same policy period. Claims-based policies are often offered at lower
premiums to an insured precisely because of the lower burden of risk carried by the
insurer. Conversely, occurrence-based policies are typically offered at much
higher premiums because the insurer is exposed to indefinite future liability. It is
through this lens that we must view the present case.
At first blush, the majority’s argument may have intuitive appeal, as it
seems that situations could arise where occurrences accrue close to the end of a
policy period and cannot reasonably be known or reported until after the policy
period has lapsed. However, it is important to note that this is not such a case. The
school board had over four months left in their policy period in which to make a
claim after Tussey filed her suit in the Pike Circuit Court. Instead, the Board
waited more than a year before finally deciding to make a claim under the policy.
This was not an occurrence happening in the “eleventh hour,” so to speak.2
2
Moreover, the Board is a sophisticated entity which was represented by counsel, who clearly
should have been aware of the nature of the insurance policy under which it was covered.
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Further, it is important to remember that the reporting period is what
defines coverage under “claims-made” policies of insurance. It is this very
requirement which distinguishes claims-made policies from occurrence-based
policies. Indeed, “[t]o read an ‘inherent’ extended reporting period into a renewal
policy [for claims-based policies] would ‘creat[e] a long [and unbargained-for] tail
of liability exposure, the avoidance of which forms the conceptual framework’” for
claims-based coverage in the first place. CheckRite Limited v. Illinois National
Insurance Co., 95 F.Supp.2d 180, 194 (S.D.N.Y. 2000), quoting Nat’l Union Fire
Ins. Co. v. Bauman, No. 90 C. 0340, 1992 WL 1738, at 10 (N.D.Ill. Jan. 2, 1992).
By ignoring this fact, this Court is giving the insured that for which they did not
bargain, and is breaking rank with the overwhelming majority of jurisdictions all
over this country who have repeatedly held that failure to notify an insurer within
the policy period in a claims-based policy defeats coverage under the policy. See,
e.g., CheckRite, supra; Nat’l Union, supra; Ehrgood v. Coregis Insurance Co., 59
F.Supp.2d 438, 446 (M.D.Pa 1998); Pantropic Power Prods v. Fireman’s Fund
Ins. Co., 141 F.Supp.2d 1366 (S.D.Fla. 2001); Gulf Ins. Co. v. Dolan Fertig &
Curtis, 433 So.2d 512 (Fla. 1983); U.S. v. A.C. Strip, 868 F.2d 181 (6thCir. 1989).3
3
Further, it is important to note that the two cases the majority cites to: Cast Steel, supra and
Helberg, supra, are the only two cases I could find, nationwide, to have been decided in the
manner in which the Court decides today’s case. Moreover, Cast Steel presents an “eleventh
hour” situation, which we clearly do not have presented before us today. Cast Steel presented a
situation where the entity’s agent failed to file the claim at the time it was instructed to do so by
the company. Id. Even so, Cast Steel also presented a situation where the claim was filed within
mere hours of the policy’s lapse. Helberg involved a circumstance where the claim accrued only
two months before the policy’s end and was reported only six weeks after the initial policy
period had lapsed. Id. I cannot find where Cast Steel has ever been cited to by another court.
Moreover, the only three courts which have cited Helberg saw fit to distinguish it. Regardless,
Helberg and Cast Steel clearly represent a distinct minority position.
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In fact, today’s decision is directly contrary to the position taken by
our own circuit and our own district courts. See, U.S. v. A.C. Strip, 868 F.2d 181
(6thCir. 1989); Trek Bicycle Corp. v. Mitsui Sumitomo Ins. Co., Ltd., 2006 WL
1642298 (W.D.Ky. 2006).4 Indeed, the Western District of Kentucky has stated:
If a court were to allow an extension of reporting time
after the end of the policy period [in a claims-based
policy of insurance], such [would be] tantamount to an
extension of coverage to the insured gratis, something
for which the insure[d] has not bargained. This extension
of coverage, by the court, so very different from a mere
condition of the policy, in effect [would rewrite] the
contract between the two parties. This we cannot and
will not do.
(Emphasis added). Trek Bicycle Corp., supra.
This case does not present a situation where the occurrence happens
on the eve of the policy period’s lapse and cannot reasonably be reported until after
the policy has ended. In such a case, certainly, a workable exception could be
adopted by our courts, allowing the insured a reasonable time in which to report.
Instead, today’s decision jumps wildly afield, allowing occurrence-based coverage
for all claims-based policy holders in the Commonwealth. Such a leap will surely
have ramifications in insurance premium costs to professionals and professional
organizations all over this great Commonwealth.
4
It should be noted that the proscription against citing unpublished cases in CR 76.28(4)(c) does
not apply to federal cases. Nonetheless, even unpublished state cases may be viewed as
persuasive, and this case certainly outlines the Western District’s clear stance on claims-based
professional liability policies.
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BRIEF FOR APPELLANT:
Robert S. Walker, III
Lexington, Kentucky
BRIEF FOR APPELLEE TAMMY
TUSSEY:
Lawrence R. Webster
Pikeville, Kentucky
BRIEF FOR APPELLEE PIKE
COUNTY BOARD OF
EDUCATION:
Neal Smith
Pikeville, Kentucky
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