St. Paul Fire and Marine Ins. Co. v. Roche,
No. 549 M.D. 2001 (Pa. Commw. Oct. 21, 2002)
St. Paul Fire and Marine Insurance Company asked a court to determine whether an insurance claim was first made in 1997 or 1998. If the claim was first made in 1997, St. Paul's liability would be greater, while, if the claim was first made in 1998, its liability would be less.
The insurance policy in question stated that a claim was "first made" when the insured hospital "first gives written notice of a potential claim and such notice is received" by the insurance company. The policy went on to state that the insurance company would be deemed to have received notice at the same time that the insured hospital's Office of General Counsel received notice. Thus, the court had to determine when the Office of General Counsel of the insured hospital first received notice.
The court found that, on September 24, 1997, the Director of Risk Management of the hospital had received written notice about the claim. The court noted that risk management was a function of the Office of General Counsel and that the Director's job description stated that he worked in "Risk Management/Legal Affairs." Moreover, the Director's job responsibilities included "acting as the primary contact for receipt of appropriate documents presented by a process server." Given these factors, the court concluded that the Office of General Counsel (and thus the insurance company) first received notice of the claim in September 1997, when the Director of Risk Management received notice of the claim. Thus, the claim was "first made" in 1997.