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First Professionals Insurance Co.10/5/2005
Sitting: Catherine Stone, Justice, Karen Angelini, Justice, Rebecca Simmons, Justice.
REVERSED AND RENDERED IN PART; REVERSED AND REMANDED IN PART
The issue presented in this appeal is whether under a claims-made policy, timely notice of separate claims made against two physicians practicing in the same medical group constituted timely notice of a claim against the group when: (1) the notice of claim forms identified the group as the insured; (2) the letters containing the claims against the two physicians were attached to the notice of claim forms; and (3) the letters stated that the claims were made for the medical care of the same decedent whose care was the basis of the claims against the two physicians and the group in a subsequent lawsuit. The trial court determined that the notice of the claims made against the physicians was sufficient notice of a claim against the group. We reverse the trial court's judgment, render judgment that Heart & Vascular Institute of Texas take nothing against First Professionals Insurance Company, Inc., and remand the cause to the trial court for further proceedings consistent with this opinion.
Background
Heart & Vascular purchased a claims-made policy from First Professionals covering the policy period from April 1, 2002 to April 1, 2003. Heart & Vascular is listed as the first named insured, and various physicians were listed as additional insureds. The policy provided that a claim is made "on the date we receive, at our home office, your first written report to us of your receipt of written notice of a liability claim or intent to sue." In order for a claim to be covered, the claim "must be made for the first time during the policy period." In the definitions section of the policy, the term "you and your" are defined as referring to "the named individual or group." Coleman Company was designated as the sole agent to act on behalf of the insureds under the policy. The policy was serviced on behalf of First Professionals by American Physicians Management Consulting Insurance Services f/k/a American Physician Insurance Services ("APMC").
On March 3, 2003, Coleman received a claim from Heart & Vascular in the form of a 4590i letter dated February 27, 2003, notifying Dr. Stephen C. Carey of a health care liability insurance claim against him for the medical care of Kenneth MacIntyre, Deceased. On March 4, 2003, Coleman forwarded a notice of claim form to APMC listing Heart & Vascular as the insured and attaching a copy of the letter. Dr. Carey is listed as an additional insured under the policy.
On March 6, 2003, Coleman received an additional claim from Heart & Vascular in the form of a 4590i letter dated February 27, 2003, notifying Dr. Richard Wilks of a health care liability insurance claim against him for his medical care of the same decedent, Kenneth MacIntyre. On March 6, 2003, Coleman forwarded another notice of claim form to APMC, again listing Heart & Vascular as the insured and attaching a copy of the letter. Dr. Wilks is also listed as an additional insured under the policy. In this second notice of claim form, Coleman included the following in the description of the occurrence: "THIS TIME THEY ARE NAMING A DIFF. DOCT (DR. RICHARD WILKS, M.D.)." Also, in the remarks, Coleman included the following: "THIS IS SECOND NOTICE FOR DIFF DOCTOR ON SAME DECEASED."
On March 19, 2003, Jan Jonas, an agent with Coleman, sent an e-mail to Barbara Kounelias, a representative of APMC, noting that Heart & Vascular wanted to know "if the Institute has been implicated by this claim in any way." Later that same day, Jonas forwarded the same e-mail request to
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