COMMONWEALTH OF VIRGINIA, DIVISION OF RISK MANAGEMENT v. VIRGINIA ASSOCIATION OF COUNTIES GROUP SELF INSURANCE RISK POOL, f/k/а VIRGINIA ASSOCIATION OF COUNTIES RISK POOL
Record No. 150930
Supreme Court of Virginia
June 23, 2016
OPINION BY JUSTICE D. ARTHUR KELSEY
PRESENT: All
FROM THE CIRCUIT COURT FOR NEW KENT COUNTY
Thomas B. Hoover, Judge
This appeal involves a dispute between two sources of insurance coverage for claims asserted by a pretrial detainee against guards and nurses at a regional jail. The circuit court held that, as a matter of law, one insurance source provided primary coverage and the other offered only excess coverage. We hold that both provided concurrent primary coverage. We thus reverse and remand for the circuit court to determine the proper contributions of each to the costs of defense and indemnification associated with settlement of the underlying liability suit.
I.
A. TWO INSURANCE SOURCES
The Northwestern Regional Jail Authority operates the Northwestern Regional Adult Detention Center. During the relevant time frame, the jail authority purchased a general liability insurance policy (“VaCorp Policy”) from the Virginia Association of Counties Group Self Insurance Risk Pool (“Risk Pool Association”). See generally
The jail authority also elected to participate in a government-sponsored insurance program, the VaRISK Plan, managed by the Division of Risk Management (“DRM”), a division of the Virginia Departmеnt of the Treasury. See
Both the VaCorp Policy and the VaRISK Plan addressed the possibility of multiple sources of applicable insurance. The VaCorp Policy included an other-coverage clause stating that the policy provided “primary coverage” except when another clause stated otherwise. Id. at 141.2
“When this coverage is primary and the Participant has other coverage, which is stated to be applicable to the loss on an excess or contingent basis, the amount of the Fund’s liability shall not be reduced by the existence of such other coverage.” Id. (emphasis added and clerical error omitted). The clause went on to apply a liability contribution formula in the event of concurrent coverage. Id. at 141-42.
The VaRISK Plan included a very different other-coverage clause. In pertinent part, that clause provided, “if, at that time of loss, there is any other coverage or insurance available to a Covered Party which covers such loss or which could have covered such loss, VaRISK shall not have any liability for such loss.” Id. at 150 (emphasis added). The forfeiture of coverage, however, did not apply in two situations:
This condition shall not apply if the Director of DRM approves in writing, in advance, of the issuance of such other coverage or insurance designating the Plan as primary. Further, this condition will not apply unless the Director of DRM gives written authorization for the Plan to provide the underlying coverage for any excess or umbrella coverage purchased by a Constitutional Officer or Regional Jail Authority that has paid a contribution to the Plan for this primary coverage and that otherwise meets the terms and conditions for VaRISK primary endorsement.
Id. at 150-51.
Both the Risk Pool Association and DRM issued what they considered to be primary coverages to the jail authority. Id. at 141, 159, 280, 285, 451. Neither described their coverage as excess, rather than primary.3 The jail authority, as the insured, had the same understanding. See id. at 402 (circuit court’s final order noting that “both coverages have been contracted for by [the jail authority] for primary coverage”).4
B. THE UNDERLYING LAWSUIT
In 2013, a pretrial detainee in the custody of the jail filed a federal suit under
The detainee alleged that he had been placed in the jail on a charge of public intoxication. While there, he allegedly suffered from seizures resulting from alcohol withdrawal. The detainee claimed that the jail nurses and guards were deliberately indifferent to his need for prompt medical care, causing him to suffer multiple untreated seizures due to “severe metabolic acidosis.” J.A. at 19. He alleged that these seizures left him permanently disabled.
While the federal suit was pending, the detainee filed a declaratory judgment action in circuit court against DRM and the Risk Pool Association, seeking a determination of their respective liabilities for insuring the jail defendants. The Risk Pool Association filed a third-party claim against DRM, seeking a declaration that, pursuant to
While both the federal and state proceedings were pending, the detainee entered into a settlement with the jail defendants for an undisclosed amount. DRM and the Risk Pool Association agreed to fund the settlement contingent upon the final judicial resolution of their respective liabilities. In the proceeding for declaratory judgment, the circuit court dismissed the detainee and jail defendаnts based upon their settlement, leaving only DRM and the Risk Pool Association’s opposing claims for declaratory relief. Id. at 398-99. Both filed motions for summary judgment based upon undisputed facts.
DRM argued that the VaCorp policy provided sole primary coverage for the detainee’s claims in the federal suit and that the VaRISK Plan’s other-coverage clause extinguished any DRM liability as a matter of law. DRM also contended that its $1,000,000 policy limit, not the expanded $2,000,000 limit applicable to medical malpractice claims, should cap any coverage liability that the VaRISK Plan might otherwise have with respect to the detainee’s civil rights claims. In response, the Risk Pool Association claimed that the VaRISK Plan was the sоle primary policy as a matter of law and that the VaCorp policy provided, at best, excess coverage.
The circuit court found that “both coverages have been contracted for by [the jail authority] for primary coverage.” Id. at 402.6 However, the court interpreted
In addition, the circuit court found that the VaRISK Plan’s $2,000,000 coverage extension for medical malpractice claims applied to all of the detainee’s claims (whether based on state tort law, federal § 1983 law, or state constitutional law) against “the named defendant healthcare providers,” i.e., the jail nurses. See id. Turning to the VaCorp Policy, the court held that it would be converted by operation of law into an excess policy. In that capacity, the court further concluded, the Risk Pool Association had no duty to contribute toward the defense costs incurred by the jail defendants in the federal suit.
II.
DRM argues on appeal that the circuit court misinterpreted
A. THE VARISK PLAN
DRM proposed, and the Governor apрroved, the Constitutional Officer and Regional Jail Risk Management Plan, known simply as the VaRISK Plan.8 The VaRISK Plan provided primary liability coverage for plan participants, unless DRM specifically agreed to extend only excess liability coverage to a particular plan participant. The statute makes clear that “[p]articipation in the risk management plan shall be voluntary,”
The circuit court held that the statute forbids a VaRISK plan participant from purchasing additional primary coverage from another source. The court apparently drew that inference from
The circuit court read too much into subsection G. The General Assembly added subsection G to
In this case, however, the jail authority did not purchase an excess coverage policy from another source of insurance. It purchased a primary coverage policy — the VaCorp Policy issued by the Risk Pool Association. Nothing in
Our common-law tradition counsels that courts “are nоt lightly to interfere” with lawful exercises of the “freedom of contract.” Atlantic Greyhound Lines v. Skinner, 172 Va. 428, 439, 2 S.E.2d 441, 446 (1939) (citation omitted); accord 7 Steven Plitt et al., Couch
B. THE OTHER-COVERAGE CLAUSES
Because the jail authority secured two primary sources of coverage, the VaCorp Policy and the VaRISK Plan, we must referee between their competing other-coverage clauses.
The VaCorp Policy included an other-coverage clause that secured its primary position even in the event that other insurance sources were concurrently applicable. See J.A. at 141. “When this coverage is primary,” the clause provided, “and the Participant has other coverage, which is stated to be applicable to the loss on an excess or contingent basis, the amount of the Fund’s liability . . . shall not be reduced by the existence of such other coverage.” Id. (emphasis added and clerical punctuation error omitted). In circumstances where “both this coverage and other coverage apply to the loss on the same basis, whether primary, excess or contingent,” the other-coverage clause employed a liability “contribution” formula to determine the specific liability of the concurrent coverages. Id. at 141-42.
The VaRISK Plan’s other-coverage clause, on the other hand, stated, “if, at that time of loss, there is any other coverage or insurance available to a Covered Party which covers such loss or which could have covered such loss, VaRISK shall not have any liability for such loss.” Id. at 150 (emphasis added). The circuit court deemed this clause unenforceable because
The original purpose of other-coverage clauses in insurance policies appears to have been to cut off duplicative recoveries against different insurers, perhaps unaware of each other, for exactly the same loss. See generally 15 Lee R. Russ & Thomas F. Segalla, Couch on Insurance 3d § 219:1, at 219-7 (2005). There are three basic types of such clauses. Id. § 219:5, at 219-12. One category permits concurrent coverage subject to pro-rata-contribution formulas, in a similar manner as the VaCorp Policy. See id. § 219:27, at 219-32; 2 Allan D. Windt, Insurancе Claims and Disputes § 7:1, at 7-2 (6th ed. 2013).11 A second type of clause “purports to make an
otherwise primary policy excess insurance should another primary policy cover the loss in question.” Russ & Segalla, supra, § 219:33, at 219-36. The third category seeks to absolve the insurer of any and all liability — co-primary or excess — in the event that the insured obtains duplicative coverage elsewhere. See id. § 219:36, at 219-42; 2 Windt, supra, § 7:1, at 7-2.
As we observed earlier, DRM is not a private insurance company. It is a division of the Virginia Department of the Treasury. See
We need not examine this hypothesis in any detail, however, because DRM does not advocate for it. DRM does not contend on appeal that its other-coverage provision triggered a total forfeiture of coverage. Appellant’s Br. at 22 (“DRM is not attempting to escape its coverage obligations, but is attempting to order competing coverage obligations to best preserve state funds.”); see also J.A. at 423 (DRM counsel’s disavowal of the “none at all” interpretation); id. at 475 (DRM’s affirmation that it has not “invoked” the other-coverage clause to say “we don’t owe a penny in this case”).
Instead, DRM contends that its other-coverage clause merely converted the VaRISK Plan into excess coverage that would be effective only after the sole primary coverage, the VaCorp Pоlicy, had been exhausted. See Appellant’s Br. at 22-28; Oral Argument Audio at 2:07 to 2:17 (contending that DRM is simply “last in line” to pay any coverage). Interpreting its other-coverage clause this way, DRM concedes, “does not excuse DRM’s duty to provide coverage, but merely states that it is a source of coverage of last resort when all other coverage sources are exhausted.” Id. at 25. Like many other courts,12 we have approved other-coverage clauses that
prioritize coverage in this manner. See State Farm Mut. Auto. Ins. v. United Servs. Auto. Ass’n, 211 Va. 133, 136-38, 176 S.E.2d 327, 330-31 (1970).13
Our problem with DRM’s argument is more basic: The VaRISK Plan’s other-insurance clause never mentions the possibility of shifting primary coverage to a mere excess
bonds of any description, policies of insurance or programs of self-insurance purchased or established by or on behalf of a Covered Party to insure against liability arising from the activities of such persons, regardless of whether or not the policy or program provides primary, excess, excess over excess, umbrella, or contingent coverage and regardless of the deductible of any other insurance or self-insured retention plan.
Id. (emphasis added).
This wording can only be interpreted as an escape clause, not an excess clause. See Butler, supra, § 140.2 (providing an example escаpe clause stating that “[t]he insurance . . . shall not apply to any liability or loss against which the insured has other collectible insurance applicable thereto in whole or in part”); Russ & Segalla, supra, § 219:36, at 219-43 (setting forth a sample “super escape clause” as one “stat[ing] that the insurance will not apply to any liability for a loss that is covered on a primary, contributory, excess, or any other basis by insurance in another insurance company”); cf. State Farm Mut. Auto. Ins., 211 Va. at 137, 176 S.E.2d at 331 (noting that the “other coverage” clause at issue was distinguishable from that analyzed in Bryant, because the language of the Bryant policy “permit[ted] [the] insurance company to escape all or a portion of its liability to the insured” (emphasis added)).
We thus leave the words of the VaRISK Plan’s other-coverage clause as we found them. Read literally, they extinguish coverage altogether when other insurance is applicable. Though DRM disclaims this interpretation, the alternative interpretation offered by DRM cannot be harmonized with the plain meaning of the clause. See generally School Bd. of Newport News v. Commonwealth, 279 Va. 460, 467-68, 689 S.E.2d 731, 735 (2010) (applying “[f]amiliar principles” governing the “interpretation of a contract” to DRM’s VaRISK 2 Plan). Nothing in the other-coverage clause gives the VaRISK Plan, in the event of other applicable insurance, the ability to abandon its primary coverage status and to retreat to the position of excess coverage.
Our reasoning leads to two conclusions: (i) The VaRISK Plan’s other-coverage clause does not, as DRM contends, operate as an excess clause, and (ii) DRM does not contend it operates as an escape clause. The debate over the other-coverage clause in the VaRISK Plan thus collapses under its own weight. The VaRISK Plan provided primary coverage, and no argument presented to us concerning the Plan’s other-coverage clause changes that fact.
For these reasons, we hold that the VaCorp Policy and the VaRISK Plan provided concurrent primary coverage. Each had an independent duty to defend and to indemnify its insured jail defendants.14 The circuit court’s contrary holding did not require it to determine
whether and, if so, how to apportion their respective contributions toward the costs of defense and the settlement proceeds paid to the pretrial detainee. We will not do so in the first instance on appeal.
On remand, we direct the circuit court to resolve any contest between the parties over the appropriate pro-rata allocation of costs of defense and indemnity payments, taking into account any applicable contribution agreement
C. MEDICAL MALPRACTICE COVERAGE
On appeal, DRM also challenges the circuit court’s holding that the medical malpractice coverage limit of $2,000,000 applied to all “claims asserted against the named defendant healthcare providers in the Underlying Suit, including the claims alleging violations of
The pretrial detainee’s complaint in the federal lawsuit advanced several counts against the jail’s nurse defendants. Count II asserted medical negligence solely against the nurses. See id. at 24-26. Count III, however, claimed that both jail guards and nurses had deprived the detainee of his federal civil rights in violation of
The VaRISK Plan established a maximum coverage limit of $1,000,000. However, “[f]or a claim аgainst a health provider as defined in
The pretrial detainee’s complaint carefully distinguished between his claim for medical malpractice under state tort law (Count II) and his claims for civil rights violations under federal constitutional law (Count III). To equate the two for the purpose of applying the medical malpractice coverage limit requires a similitude too attenuated for us to accept.
The United States Supreme Court held in Estelle v. Gamble, 429 U.S. 97, 104 (1976), that a prison official’s deliberate indifference to an inmate’s serious medical needs constitutes cruel and unusual punishment under the Eighth Amendment. It is true that this type of civil rights claim involves some aspects of the inmate’s medical condition, as do medical malpractice claims under state tort law. The analogy begins and ends there, however. Estelle “carefully distinguished between a claim for ‘deliberate indifference’ and a claim for medical malpractice.” Sosebee v. Murphy, 797 F.2d 179, 181 (4th Cir. 1986). Estelle claims can be asserted, as they were here, against medical providers and non-medical providers. They are not limited to, or calibrated in their application against, only those in the jail who provide health care.
The standards of liability are also dissimilar. “Medical malpractice does not become a constitutional violation merely because the victim is a prisoner.” Estelle, 429 U.S. at 106; see also Loe v. Armistead, 582 F.2d 1291, 1296 (4th Cir. 1978). A § 1983 claim turns on proof of deliberate indifference, and thus, the relevant question does “not demand that the jury consider probing, complex questions concerning medical diagnosis and judgment. The test for deliberate indifference is not as involved as that for medical malpractice, an objective inquiry that delves into reasonable standards of medical care.” Ledford v. Sullivan, 105 F.3d 354, 359 (7th Cir. 1997); see also Farmer v. Brennan, 511 U.S. 825, 838-42 (1994) (observing that “deliberate indifference” is, at least in part, a “subjective” standard (emphasis added)).17
The anаlogy breaks down even more clearly when pressed to its logical conclusion. Suppose the detainee had filed Count II (medical malpractice under state tort law) and Count III (federal civil rights claims under § 1983) against the jail defendants in state court rather than federal court. Would the jail defendants be able to limit any recovery under the federal § 1983 claim to the maximum allowed under the Medical Malpractice Act applicable to state torts?
Clearly not. The statutory cap on damages applies only to state tort or contract claims alleging medical malpractice, not federal civil rights claims alleging constitutional violations. See
Consequently, the federal § 1983 claim cannot be equated with medical malpractice principles governed by state tort law. Nor is it sufficiently analogous to be treated as such for purposes of the VaRISK Plan’s $2,000,000 coverage extension for medical malpractice claims.19 The circuit court, therefore, erred to the extent that it concluded otherwise.
III.
In sum, we hold that the VaCorp Policy and VaRISK Plan provided co-primary liability coverage to the regional jail defendants. We also conclude that the VaRISK Plan’s $2,000,000 coverage extension applicable to medical malpractice claims did not apply to Count III’s § 1983 civil rights claim alleging violations of federal constitutional law. We thus reverse in part and affirm in part the circuit court’s final order. We remand this case for the court to determine, in the first instance, the appropriate pro-rata contributions of the VaCorp Policy and the VaRISK
Affirmed in part,
reversed in part,
and remanded.
