Case Name: FOUR SEASONS HEALTHCARE, INC. et al. v. WILLIS INSURANCE SERVICES OF GEORGIA, INC.
Court: Court of Appeals of Georgia
Jurisdiction: Georgia
Decision Date: 2009-07-15
Citations: 299 Ga. App. 183
Docket Number: A09A0785
Parties: FOUR SEASONS HEALTHCARE, INC. et al. v. WILLIS INSURANCE SERVICES OF GEORGIA, INC.
Judges: Johnson, P J., Blackburn, P. J., and Mikell, J., concur. Miller, C. J., Barnes and Ellington, JJ., dissent.
Reporter: Georgia Appeals Reports
Volume: 299
Pages: 183–192

Head Matter:
A09A0785.
FOUR SEASONS HEALTHCARE, INC. et al. v. WILLIS INSURANCE SERVICES OF GEORGIA, INC.
(682 SE2d 316)

Opinion:
ANDREWS, Presiding Judge.
Four Seasons Healthcare, Inc., Healthfield Holdings, Inc., Healthfield, Inc., and Rodney Windley sued their insurance broker, Willis Insurance Services of Georgia, Inc., alleging that they hired Willis to procure directors and officers (D & O) liability insurance sufficient to cover any claim that might arise out of a pending business transaction, and that Willis negligently failed to procure insurance sufficient to cover the claim that later arose. All four insureds appeal from the trial court's grant of summary judgment in favor of Willis. For the following reasons, we affirm.
The suit involved two AIG insurance policies procured by Willis. One was a new policy that provided D & O coverage for Four Seasons effective March 9, 2001, and the second was an existing D & O policy for Healthfield Holdings (which also named Healthfield, Inc. and Windley as additional insureds) that was extended for three years to provide additional D & O coverage. After the insureds' pending business transaction was finalized, a claim arose out of the transaction, and the insureds called on AIG to provide D & O coverage for the claim under both policies.
The business transaction and the resulting claim involved all four insureds. Windley was the chief executive officer of Healthfield Holdings and the chief executive officer and chairman of the board of directors of Healthfield, Inc. Healthfield Holdings' only substantial asset was ownership of all of Healthfield, Inc.'s stock, which was in foreclosure after Healthfield Holdings defaulted on a note for which the stock was collateral. Windley incorporated Four Seasons for the purpose of buying Healthfield, Inc.'s stock at foreclosure. After Four Seasons bought the stock at the foreclosure sale on March 9, 2001, a group of Healthfield Holdings shareholders (owning more than 5 percent of the voting stock) filed suit on November 21, 2001, against Four Seasons, Healthfield Holdings, Healthfield, Inc., and Windley, alleging that they were wrongfully frozen out by the stock purchase and transfer of corporate assets to Four Seasons. See APA Excelsior III, L.P v. Windley, 329 FSupp.2d 1328 (N.D. Ga. 2004).
AIG denied D & O coverage under both policies for the claim asserted in the shareholders' suit. As to the policy insuring Four Seasons, AIG relied on the fact that the policy excluded coverage for prior acts (acts occurring prior to the March 9, 2001 effective date of the policy). As to the policy insuring Healthfield Holdings (and naming Healthfield, Inc. and Windley as additional insureds), AIG relied on the fact that the policy excluded coverage for claims brought by shareholders owning more than 5 percent of the insured's voting stock (the 5 percent major shareholder exclusion). None of the insureds challenged AIG's denial of coverage, and it is undisputed that the policies excluded coverage for the shareholders' claim. The negligence suit brought by the insureds against Willis sought damages for amounts paid to the shareholders to settle the uncovered claim plus attorney fees paid to defend the claim.
Willis moved for summary judgment on various grounds, and the trial court summarily granted the motion without setting forth reasons. The record shows that Willis was entitled to summary judgment on at least two of the grounds asserted in its motion. First, even assuming that Willis was negligent because it failed to procure the requested insurance coverage or to adequately explain the coverage, recovery was barred because Four Seasons knew about and requested the prior acts exclusion in its policy, and Healthfield Holdings, Healthfield, Inc., and Windley failed in their duty to read and discover the plain and unambiguous 5 percent major shareholder exclusion in their policy. Second, because there is no evidence in the record that Willis could have procured the Healthfield Holdings D & O policy without the 5 percent major shareholder exclusion, there is an absence of evidence to prove an essential element of the negligence claim — that Willis' alleged negligence proximately caused the lack of coverage.
Despite specific recommendations by Willis that Four Seasons include "prior acts" coverage in its D & O policy, Four Seasons rejected this advice and refused "prior acts" coverage because it concluded that there was no need for the coverage. Accordingly, Four Seasons was well aware that its D & O policy excluded coverage for claims based on acts that the shareholders' suit alleged occurred prior to the March 9, 2001 effective date of the policy. The other D & O policy insuring Healthfield Holdings (and naming Healthfield, Inc. and Windley as additional insureds) included a "5% major share holder exclusion," which provided:
In consideration of the premium charged, it is hereby understood and agreed that the Insurer shall not be liable for any Loss in connection with any Claim(s) made against any Insured(s) which are. brought by any individual(s) or entity(ies) that own or control (whether beneficially, directly or indirectly) 5% or more of the outstanding voting stock (hereinafter "Major Shareholder"); or by any security holder of the Company whether directly or derivatively, unless such security holder's Claim(s) is instigated and continued totally independent of, and totally without the solicitation of, or assistance of any Major Shareholder.
This provision plainly excluded coverage for any "Loss" (defined under the policy to include damages from judgments, settlements, and defense costs) connected with a claim against an insured brought by shareholders owning 5 percent or more of the voting stock, or by any security holder of the "Company." Under the policy, the term "Company" referred to the named insured, Healthfield Holdings and additional subsidiary insureds. The provision clearly excluded coverage for any loss connected with the suit brought by over 5 percent of Healthfield Holding's shareholders. The' policy insureds do not contest the plain effect of this exclusion. In fact, they virtually conceded this point by making no challenge to AIG's denial of coverage. Rather, they claim that they were unaware of the exclusion and that Willis negligently failed to obtain a policy without the exclusion or to adequately advise them about the contents of the policy.
The general rule applicable to the insureds' claims is set forth in this Court's whole court decision in Atlanta Women's Club v. Washburne, 207 Ga. App. 3, 4 (427 SE2d 18) (1992). "[Wjhere the agent does procure the requested policy and the insured fails to read it to determine which particular risks are covered and which are excluded, the agent is thereby insulated from liability, even though he may have undertaken to obtain 'full coverage.' " Washburne, 207 Ga. App. at 4 (citation and punctuation omitted). The rule is based on the requirement that
[an insured] who has the policy in his possession prior to the uninsured loss is charged with the knowledge of the terms and conditions of the policy, namely and in particular that the policy coverage was not as contracted for between the parties. Consequently the [insured] being, under the law, charged with knowing the terms and conditions of the policy, any negligence, if any, on the part of the defendant in failing to procure the amount or type of insurance coverage contracted for could have been avoided by the [insured] and therefore a finding for the defendant is demanded.
England v. Georgia-Florida Co., 198 Ga. App. 704-705 (402 SE2d 783) (1991) (citations and punctuation omitted). On May 7, 2001, prior to the shareholders' November 21, 2001 suit, a copy of the updated Healthfield Holdings policy was provided to the insureds, and an insurance binder was provided to Four Seasons evidencing the new policy that Four Seasons already knew excluded the prior acts coverage it had specifically rejected. Accordingly, the three insureds under the Healthfield Holdings policy were charged with knowledge of the exclusion in the policy in their possession, and Four Seasons was either charged with knowledge of or actually knew about the policy exclusion in its policy. Under the general rule, the insureds' knowledge insulated Willis from liability on the negligence claims and entitled Willis to summary judgment. Washburne, 207 Ga. App. at 4; England, 198 Ga. App. at 704-705; Lau's Corp. v. Haskins, 261 Ga. 491 (405 SE2d 474) (1991).
The Washburne decision, however, recognizes an exception to the general rule in circumstances
where the agent, acting in a fiduciary relationship with the insured, holds himself out as an expert in the field of insurance and performs expert services on behalf of the insured under circumstances in which the insured must rely upon the expertise of the agent to identify and procure the correct amount or type of insurance.
Washburne, 207 Ga. App. at 4; Wright Body Works v. Columbus Interstate Ins. Agency, 233 Ga. 268, 271 (210 SE2d 801) (1974). Under these circumstances, the insured is not required to minutely examine the policy. Washburne, 207 Ga. App. at 4; Wright Body Works, 233 Ga. at 271. But Washburne makes clear that, even in these circumstances, the insured is not relieved of all responsibility to examine the policy. If an examination of the policy would have made it "readily apparent" that the requested coverage was not contained in the policy, then the exception does not apply, and the agent who acted in a fiduciary capacity and gave expert advice relied upon by the insured remains insulated from liability under the general rule. Washburne, 207 Ga. App. at 4-5; Turner, Wood & Smith v. Reed, 169 Ga. App. 213, 214-215 (311 SE2d 859) (1983). A policy provision is "readily apparent" upon examination if it is "plain and unambiguous." MacIntyre & Edwards v. Rich, 267 Ga. App. 78, 81 (599 SE2d 15) (2004). We conclude that, even assuming Willis acted in a fiduciary relationship with the insureds and held itself out as an expert upon which the insureds relied to identify and procure the requested insurance, the exception to the general rule does not apply. Because Four Seasons had actual knowledge of the "prior acts" exclusion it requested in its policy, and the "5% major shareholder" exclusion in the other policy was plain and unambiguous, both exclusions were "readily apparent." Therefore, the insureds were charged with knowledge of the exclusions and barred from recovery under the general rule. Washburne, 207 Ga. App. at 4-5.
Willis was entitled to summary judgment for an additional reason on the claim that it negligently failed to procure coverage without the 5 percent major shareholder exclusion under the Health-field Holdings D & O policy. An insured cannot recover on a negligence cause of action against an insurer without evidence sufficient to support an essential element of the action — that the insurer's negligence was the proximate cause of the loss for which the insured seeks recovery. Peagler & Manley Ins. Agency v. Studebaker, 156 Ga. App. 786 (275 SE2d 385) (1980). To establish that an insurer's negligent failure to procure requested coverage was the proximate cause of an uncovered loss, the insured must produce evidence that the requested coverage was available and could have been procured. See Tri-Town Marine v. J. C. Milliken Agency, 924 A2d 1066, 1069-1070 (Me. 2007); Bayly, Martin & Fay v. Pete's Satire, 739 P2d 239, 242-244 (Colo. 1987). Because there is an absence of any evidence in the record sufficient to support a finding that the requested D & O coverage could have been procured without the 5 percent major shareholder exclusion, the insureds cannot survive summary judgment against their claim that Willis negligently failed to procure insurance without the exclusion. Lau's Corp., 261 Ga. at 495.
Judgment affirmed.
Johnson, P J., Blackburn, P. J., and Mikell, J., concur. Miller, C. J., Barnes and Ellington, JJ., dissent.
The Four Seasons D & O policy contained the same 5 percent major shareholder exclusion contained in the Healthfield Holdings policy.