Opinion ID: 2806293
Heading Depth: 1
Heading Rank: 8

Heading: a paid claim

Text: J.A. 644. As FirstPro points out, this provision is a “prior knowledge provision” which is designed to ensure that insurers do not “contract to cover preexisting risks and liabilities known by the insured.” Bryan Bros. Inc. v. Continental Cas. Co., 419 F. App’x 422, 425 (4th Cir. 2011) (unpublished). “Thus, it is generally the insured’s duty to provide truthful 35 and complete information so the insurer can fairly evaluate the risk it is contracting to cover.” Id. “Medical incident,” as defined by the FirstPro policy, means “any act, error or omission in the providing of or failure to provide professional services to a patient by [the doctor] or by persons described in the Individual Professional Liability Coverage Part for whom [the doctor is] determined to be legally responsible.” J.A. 636. Of particular importance to this case is that the policy treats “all bodily injury(ies) caused by a course of treatment(s) of a patient or of a mother and fetus (or fetuses) from conception through postpartum care” as a single medical incident. J.A. 637. The term “report” or “reported” is not defined by FirstPro’s policy in the same manner as “medical incident.” Because the FirstPro policy does not define the term “reported,” we look to its “commonly accepted meaning.” Bardsley v. GEICO, 747 S.E.2d 436, 440 (S.C. 2013). According to the Oxford English Dictionary, the verb “to report” is commonly defined as “to give an account of (a fact, event, etc.),” “to describe,” or “to convey, impart, pass on (something said, a message, etc.) to a person as knowledge or information.” Oxford English Dictionary Online (last visited April 17, 2015) (saved as ECF opinion attachment). As FirstPro points out in its brief, it is therefore commonly understood as communicating or conveying information to someone, synonymous with the term 36 “to inform.” Against this background, when Dr. Sutton called MedPro to convey the contents of the St. Francis letter, she “reported” the information in the letter. But she did not necessarily report a “medical incident” as defined by the FirstPro policy. Beyond reporting the contents of the St. Francis letter, which merely identified Amy Moore as a patient who visited Dr. Sutton on June 22, 2004, Dr. Sutton did not report to MedPro any details about the acts she performed, any treatment she provided, or any potential errors or omissions that arose during her interactions with Amy Moore. The sparse information provided, detailing merely the fact that Amy Moore was a patient of Dr. Sutton’s, can hardly be said to describe a medical incident. Because the policy defines “medical incident” as “any act, error, or omission in the providing of . . . professional services,” it contemplates the reporting of acts, errors, or omissions beyond the mere fact of a doctor’s provision of professional services. We therefore decline to adopt FirstPro’s argument that reporting the mere fact of having seen a patient can qualify as a “medical incident” when that report includes no description of any acts, errors, or omissions that took place during the provision of services. Thus, Dr. Sutton’s call to MedPro to report the contents of the St. Francis letter does not trigger the exclusion in 11(b) of the FirstPro policy. 37 Although the exclusion in 11(b) is not applicable, we remand to the district court to determine (if the case is not otherwise resolved) whether the exclusion in 11(c) of the FirstPro policy applies, an issue the district court did not reach. That exclusion states that FirstPro will not defend or pay for any injury or damages “arising out of a medical incident or committee incident disclosed or which should have been disclosed on our applications, renewal applications, or during the application or renewal process.” FirstPro argues that Dr. Sutton should have disclosed the Moore medical incident in response to two questions in the application for insurance. Question 5(a) of the Application states: “Do you know or is it reasonably foreseeable from the facts, reasonable inferences or circumstances that any of the following circumstances might reasonably lead to a claim or suit being brought against you, even if you believe the claim will not have merit: a request for records from a patient and or attorney related to an adverse outcome.” J.A. 597. Relatedly, Question 7 of the application states: “Do you know or is it reasonably foreseeable from the facts, reasonable inferences or circumstances that there are outstanding incidents, claims, or suits (even if you believe the outstanding claim or suit would be without merit) that have not been reported to your current or prior professional liability carrier.” J.A. 597. Dr. Sutton responded “no” to these 38 questions. J.A. 597. We remand to the district court to determine whether it was reasonably foreseeable that the St. Francis medical records request letter might reasonably lead to a claim or suit being brought against Dr. Sutton and whether the claim arising from the birth of Nathan Moore was reasonably foreseeable, thereby triggering the exclusion in 11(c).