National Fire Ins., National Fire Insurance Company, Plaintiff-Counter-Defendant-Appellant v. Napoleon A. Bartolazo, M.D., Defendant-Counter-Claimant-Appellee

Citations: 27 F.3d 518; 29 Fed. R. Serv. 3d 872; 1994 U.S. App. LEXIS 19678Docket: 93-2448

Court: Court of Appeals for the Eleventh Circuit; August 1, 1994; Federal Appellate Court

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In the case of National Fire Insurance Company v. Napoleon A. Bartolazo, M.D., the Eleventh Circuit Court of Appeals addressed a dispute regarding the timely reporting of a medical malpractice claim under a "claims-made" insurance policy. The central issue was whether Bartolazo reported the claim within the required timeframe for coverage. National Fire Insurance Company appealed the district court's summary judgment in favor of Bartolazo, citing a procedural flaw in the judgment's granting.

Bartolazo had successive policies with National Fire Insurance that required him to notify the insurer of any claims made within the year they were reported, with a grace period for claims after policy termination. The court considered two key events: a letter from a former patient, Helen Marsico, dated April 18, 1990, requesting medical records for a malpractice claim, and a formal Notice of Intent to Initiate Litigation served on January 24, 1991. Bartolazo reported the claim to National on January 27, 1991.

National argued that the 1990 letter constituted a claim, which Bartolazo failed to report within the required timeframe, thus denying him coverage. Bartolazo countered that only the 1991 Notice constituted a claim, which he reported on time, or that if the 1990 letter was considered a claim, he was still covered under an extended reporting clause in his 1990 policy.

The appellate court, while acknowledging that typically orders denying motions for summary judgment are unappealable, exercised its pendent appellate jurisdiction due to the interrelated nature of the issues. The court ultimately reversed the district court's summary judgment in favor of Bartolazo and emphasized that National's motion for summary judgment was based on Exclusion "Q" of the policy, which allows denial of coverage if the insured knew of a potential claim at the policy's inception.

The 1991 policy defines a "claim" as a request for money or services that names the insured and alleges a medical incident. National's assertion that a 1990 letter from Marsico's attorney qualifies as a "claim" is incorrect, as the letter only requested medical records and hinted at a malpractice claim without demanding money or services. The district court's affirmation of this point is upheld, and National’s motion for summary judgment was rightfully denied. 

Bartolazo claimed coverage under the extended reporting period of the 1990 policy, but this point is irrelevant due to the determination that the claim was valid under the 1991 policy. Bartolazo's attorney made an oral motion for summary judgment during a hearing, asserting that if judgment were granted, it should favor the defendant. The court accepted this oral motion without a written request, which contradicts Circuit rules requiring that Rule 56 motions be submitted in writing and served at least 10 days before the hearing to ensure proper notice and preparation.

The district court’s acceptance of the oral motion compromised National's ability to address the full range of its defenses against coverage denial. National alleged four bases for denying coverage under the 1991 policy, but the hearing focused only on the fourth ground. The court’s premature ruling prevented National from fully presenting its case, which could have led to a summary judgment in its favor without needing to consider the other grounds. For Bartolazo to succeed, he needed to prove that his claim constituted a medical incident and that Exclusions "F" and "N" were inapplicable.

National acknowledged that Bartolazo referred to additional issues during the summary judgment hearing but did not address them in its arguments, and the court did not consider them in its ruling. National was unprepared for the court to decide its entire complaint based solely on the issue discussed at the hearing, indicating that the unresolved issues likely required factual determinations that were not yet established. Consequently, the appellate court reversed the summary judgment in favor of Bartolazo and remanded the case for further proceedings on these outstanding matters. Additionally, Bartolazo’s award of attorney's fees and costs under Section 627.428 of the Florida Statutes was also reversed, and his request for appellate attorney's fees was denied. The decision concluded with an affirmation of some parts of the ruling, a reversal of others, and a remand for further consideration. A letter from Marsico's attorney requested Bartolazo to provide all medical records related to Helen Marsico within ten business days, including an enclosed authorization for the release of medical information and a commitment to reimburse reasonable copying costs.