Before Justices Cherry, Gibbons, and Pickering. Opinion by Justice Pickering.
In this appeal, the Court interpreted the notice terms of a claims-made-and-reported medical malpractice insurance policy (the “Policy”) to determine whether the insurer, Physicians Insurance Company of Wisconsin, Inc. d.b.a PIC Wisconsin (“PIC”), had timely notice of a claim made against the insured, Dr. Hamid Ahmadi, D.D.S. (“Dr. Ahmadi”), during the policy period. The Policy had a retroactive date of April 13, 1998 and, through renewals, its coverage extended to April 14, 2004. PIC was sued by a patient of Dr. Ahmadi seeking coverage under the Policy after Dr. Ahmadi used cocaine to anesthetize the patient, who then sideswiped a residential gas meter with his work cement truck, failed a drug test, and was fired from his employment. The District Court determined that “constructive” notice of a claim had been provided to PIC based on information that had been provided to PIC “anecdotally,” including through news reports, investigations into claims made on another PIC policy by Dr. Ahmadi relating to an alleged burglary, and an order suspending Dr. Ahmadi’s license. The Court reversed the District Court’s decision holding that the terms of the Policy required that the claim be reported to PIC within the policy period, and that without “actual” notice of the claim pursuant to such provision, there is no coverage for the claim under the Policy. The Court also rejected the interpretation that the Policy’s definition of “Claim” allowed for “constructive” notice of a claim, but rather PIC must be given “specific information about a specific wrongful act and consequent injury to a patient . . . more in the way of formal contact between the insurer and the insured.” Reversed and remanded. (David J. Stoft, Associate in the Las Vegas office of McDonald Carano Wilson.)
