Opinion ID: 2178255
Heading Depth: 1
Heading Rank: 3

Heading: coverage agreements

Text: The Exchange will pay on behalf of the insured all sums that the insured shall become legally obligated to pay as damages because of: Coverage AIndividual Professional Liability Injury arising out of the rendering of or failure to render, on or after the retroactive date, professional services by the individual insured, or by any person for whose acts or omissions such insured is legally responsible, except as a member of a partnership.... Appellant focuses on the language of Coverage A, which expressly creates coverage for injury arising out of the rendering of or failure to render, on or after the retroactive date, professional services by the individual insured.... She contends that the quoted language should be read to cover injuries that occurred on or after the retroactive date, rather than the services rendered or failed to be rendered after that date. We disagree. In interpreting a clause such as the one at issue, we find guidance in the Rule of the Last Antecedent, which is that `ordinarily, qualifying phrases are to be applied to the words or phrase immediately preceding them, and not to others more remote.' Perkins v. District of Columbia Bd. of Zoning Adjustment, 813 A.2d 206, 209 n. 5 (D.C.2002) (quoting District of Columbia v. Smith, 329 A.2d 128, 130 (D.C.1974)). While the rule is used most often to assist in statutory construction, we have used it in other contexts. In Perkins, for example, we used it to construe an occupancy permit. Id. at 211 et seq. The rule is not inflexible, and is not applied if the context in question suggests a different meaning. Id. (citing United States v. Pritchett, 152 U.S.App. D.C. 307, 311, 470 F.2d 455, 459 (1972)). But we find that is not the case here. We agree with the trial court that the language in question is not ambiguous, and find the trial court's reading of the provision straightforward and sensible. Application of the Rule of the Last Antecedent points us toward the conclusion that the phrase on or after the retroactive date modifies the immediately preceding words rendering or failure to render rather than injury as contended by Ms. Evans. Further support for this reading of the coverage exists within the language of the policy. The notice, quoted above, emphasizes that the policy does not provide coverage for medical incidents that took place before the retroactive date. The term medical incidents is defined in the policy to mean: a single act or omission or a series of related acts or omissions in the rendering of or failure to render professional services to any one person. The Limits of Liability section of the policy states in part (F) A medical incident shall be deemed to take place at the time of the first act or omission by any person in the rendering of or failure to render professional services to any person that: (I) gives rise to the claim or suit, and (ii) takes place during any period for which the insured was covered .... Appellant's reading would create coverage for incidents that took place before the retroactive date if the injury did not fully develop until some time after that date or, arguably, if the injury was still being experienced after the retroactive date. Reading the language of the coverage clause, the notice of the retroactive date and the definition section of the policy together, we conclude that the MIIX is responsible only for claims which arise out of the rendering or failure to render services on or after the retroactive date in the policyin this case January 1, 1995. Accordingly, MIIX was not responsible for any injuries arising out of the July 12, 1994, surgery performed by Dr. LeFlore. It is, however, liable for injuries, if any, arising out of services Dr. LeFlore rendered or failed to render after January 1, 1995. We turn, therefore, to the question of whether appellant presented evidence that raised a genuine issue of material fact regarding such rendering or failure to render services. Appellant argues that Dr. LeFlore did fail to render services after the retroactive date, that evidence of those failures was presented at the malpractice trial and that MIIX is responsible for coverage as relates to injuries she sustained as a result of those failures. She advances three items of evidence in support of this contention (1) the testimony of appellant's expert witness, Dr. Mausner, at the malpractice trial; (2) her own affidavit; and (3) an affidavit of Dr. Mausner. We will consider the testimony of Dr. Mausner presented at the malpractice trial, but will consider the affidavits only to the extent that they bear upon whether the factual and legal grounds on which the judgment was based gave rise to coverage. [3] The trial testimony of expert witness, Dr. Mark Mausner established his opinion that Dr. LeFlore's treatment of appellant fell below the standard of care in that he (1) did not address the excessive tissue remaining under Ms. Evans's armpit area; (2) did not offer Ms. Evans information on methods to reduce her scars; and (3) did not take postoperative photos at three-month, six-month, and one-year intervals to track progress. While this evidence could suggest that Dr. LeFlore was negligent after January 1, 1995, the record does not specifically so establish that for two reasons. The first is that Dr. Mausner's testimony dealt broadly with steps that should have been taken after the surgery, but the surgery was performed about five months before the retroactive date. Most important, indeed conclusive, is Ms. Evan's own malpractice trial testimony, which established that she was no longer a patient of Dr. LeFlore at the end of 1994. [4] Finally, the unrebutted testimony of Dr. LeFlore established that, on August 4, 1994, Ms. Evans told him that she would not return to his office, but would seek care from another physician, despite Dr. LeFlore's having scheduled a follow-up appointment ten days later which she declined to keep. In light of this evidence, Ms. Evans is unable to establish that she sustained injuries resulting from Dr. LeFlore's wrongful failure to render services after January 1, 1995, because she had removed herself from his care. Accordingly, she fails to meet her burden of showing that her judgment comes within the coverage of Dr. LeFlore's MIIX policy. Robinson, 288 A.2d at 238; Group Hospitalization, Inc., 255 A.2d at 500-01. [5]