Medforce Inc v. Reliance Ins Co ( 2001 )

UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
No. 01-30229
Summary Calendar
MEDFORCE, INC.,
Plaintiff-Appellant,
versus
RELIANCE INSURANCE COMPANY; CAMPANIA MANAGEMENT COMPANY, INC.,
Defendants-Appellees.
Appeal from the United States District Court
for the Eastern District of Louisiana
(99-CV-3898-F)
July 20, 2001
Before HIGGINBOTHAM, WIENER, and BARKSDALE, Circuit Judges.
PER CURIAM:*
Medforce, Inc., appeals the summary judgment granted Reliance
Insurance Company and Campania Management Company. Medforce
asserts primarily that the district court erred by concluding that
a formal claim was not made against Medforce within the policy
period. Because we conclude that Smith’s claims were not made
before the policy was terminated, we need not address the remaining
issues regarding Reliance’s alternative grounds for summary
judgment.
*
Pursuant to 5TH CIR. R. 47.5, the court has determined that
this opinion should not be published and is not precedent except
under the limited circumstances set forth in 5TH CIR. R. 47.5.4.
I.
This action by Medforce seeks indemnification for its costs in
defending an action filed by its former employee, Mona Lisa Smith.
During her employment with Medforce, Smith was covered under a
group health insurance policy provided by Great West Insurance
Company. In September 1997, Smith ended her employment with
Medforce. When Smith returned to Medforce the next month, she was
told she was still covered under the group health plan.
In January 1998, Smith contacted Great West to report a
medical claim, and was informed that Medforce’s group health plan
had been terminated in July 1997, due to non-payment of premiums.
In October 1998, Smith filed the above-referenced action against
Medforce, asserting: Medforce never informed her the policy was
canceled; it breached its contract to provide health insurance
coverage; and it was negligent in advising her she would be covered
by the group policy when she returned to work. Smith’s action was
settled.
Medforce sought coverage from Reliance under the Commercial
General Liability Coverage Policy it issued to Medforce through
Campania. Reliance denied coverage, asserting, inter alia, that
Smith’s claims against Medforce were not made until after its
policy had been terminated on 5 September 1998, for non-payment of
premiums.
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II.
A summary judgment is reviewed de novo. E.g., Resolution
Trust Corp. v. Ayo, 31 F.3d 285, 289 (5th Cir. 1994). Such
judgment is appropriate when the evidence, viewed in the light most
favorable to the non-movant, reveals no genuine issues of material
fact. FED. R. CIV. P. 56(c); Ayo, 31 F.3d at 289.
It is undisputed that the Reliance policy is a claims made
policy in which, as in the policy in Federal Deposit Ins. Corp. v.
Barham, 995 F.2d 600 (5th Cir. 1993), “claims” refer to demands
which could result in legal obligations to pay damages. As it did
in the district court, Medforce contends the requisite notice of
claim was given Reliance on 6 August 1998, pursuant to a 3 August
letter from Smith’s attorney.
Upon review of the letter from Smith’s attorney, however, we
agree with the district court that it does not constitute a claim
against Medforce. Although referencing the “Claims of Mona Lisa
Smith”, the letter states it is “one last attempt to have [Smith’s]
bills paid”, and requests “a copy of the summary plan description
and ... any appeal process ... necessary to have those bills paid”;
it seeks to “resolve this matter informally to Ms. Smith’s
satisfaction or in two weeks, [Smith] will have to pursue it
judicially”. The letter merely requests payment of outstanding
medical bills from Great West and information regarding the process
for appealing a denial of coverage; at most, it was a potential
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claim against Medforce. See Federal Deposit Ins. Corp. v. Booth,
82 F.3d 670, 677 (5th Cir. 1996) (letter suggesting charges may be
filed in future too tenuous to constitute claim).
III.
For the foregoing reasons, the judgment is
AFFIRMED.
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