Australasian Medical Insurance Ltd & Anor v CGU Insurance Ltd [2010] QCA 189 (2010) 271 ALR 142
SUPREME COURT OF QUEENSLAND
CITATION: Australasian Medical Insurance Ltd & Anor v CGU
Insurance Ltd [2010] QCA 189
PARTIES: AUSTRALASIAN MEDICAL INSURANCE LIMITED
ACN 003 707 471
(first plaintiff/first appellant)
QUEENSLAND MEDICAL LABORATORY
(A PARTNERSHIP)
(second plaintiff/second appellant)
v
CGU INSURANCE LIMITED
ACN 004 478 371
(defendant/respondent)
FILE NO/S: Appeal No 10459 of 2009
SC No 1426 of 2000
DIVISION: Court of Appeal
PROCEEDING: General Civil Appeal
ORIGINATING
COURT: Supreme Court at Brisbane
DELIVERED ON: 27 July 2010
DELIVERED AT: Brisbane
HEARING DATE: 29 April 2010
JUDGES: Muir and Chesterman JJA and Atkinson J
Separate reasons for judgment of each member of the Court,
each concurring as to the order made
ORDER: Appeal dismissed with costs
CATCHWORDS: INSURANCE – THE POLICY – THE INSURED – where
second appellant was a partnership of 15 pathologists – where
first appellant was the partners’ professional indemnity
insurer – where respondent insurer issued second appellant
with policy covering certain risks associated with the
pathology practice – where first appellant indemnified second
appellant in respect of a claim and sought contribution from
respondent – where first appellant had issued 15 separate
policies, one to each partner – where respondent’s policy did
not name each partner but referred to three practice
companies “T/AS Queensland Medical Laboratory
Partnership” – whether the insured under the policies issued
by the two insurers were different – whether the partners
were insured under the respondent’s policy
-- 1 of 25 --
2
INSURANCE – DOUBLE INSURANCE AND
CONTRIBUTION – GENERALLY – where first appellant
indemnified second appellant in respect of a claim and sought
contribution from respondent – where respondent’s policy
included a clause excluding liability where partners were
entitled to indemnity under another professional indemnity
insurance policy – where trial judge struck down the clause as
void under s 45(1) of the Insurance Contracts Act 1984 (Cth)
– where parties intended respondent’s policy to cover an
employee not indemnified by first appellant’s policy and to
cover a partner’s vicarious liability for the negligence of a
non-medical employee – where, notwithstanding this
intention, respondent had previously contributed to a similar
claim made by first appellant – where trial judge found
appellants were estopped from denying the risk covered by
respondent’s policy did not extend to the claim – whether the
policies of first appellant and respondent covered the same
risk – whether the respondent’s policy responded to the claim
Insurance Contracts Act 1984 (Cth), s 45(1)
Albion Insurance Co Ltd v Government Insurance Office
(NSW) (1969) 121 CLR 342; [1969] HCA 55, cited
Arrale v Costain Civil Engineering Ltd [1976] 1 Lloyd’s Rep
98, considered
CGU Insurance Ltd v Porthouse (2008) 235 CLR 103; [2008]
HCA 30, cited
Codelfa Constructions Pty Ltd v State Rail Authority of NSW
(1982) 149 CLR 337; [1982] HCA 24, applied
Devries v Australian National Railways Commission (1993)
177 CLR 472; [1993] HCA 78, cited
Equuscorp Pty Ltd v Glengallan Investments Pty Ltd (2004)
218 CLR 471; [2004] HCA 55, considered
Fox v Percy (2003) 214 CLR 118; [2003] HCA 22, cited
HIH Casualty and General Insurance Ltd v New Hampshire
Insurance Co [2001] 2 Lloyd’s Rep 161; [2001] EWCA Civ
735, considered
KPMG v Network Rail Infrastructure Ltd [2008] 1 P & CR
11; [2007] EWCA Civ 363, considered
Ladbroke Group plc v Bristol City Council [1988] 1 EGLR
126, considered
McCann v Switzerland Insurance Australia Limited (2000)
203 CLR 579; [2000] HCA 65, applied
National Bank of Australasia Ltd v J Falkingham & Sons
[1902] AC 585, cited
Pacific Carriers Ltd v BNP Paribas (2004) 218 CLR 451;
[2004] HCA 35, applied
Squarey v Harris-Smith [1981] 42 P & CR 118, considered
The Karen Oltmann [1976] 2 Lloyd’s Rep 708, considered
Toll (FGCT) Pty Ltd v Alphapharm Pty Ltd (2004) 219 CLR
165; [2004] HCA 52, applied
-- 2 of 25 --
3
COUNSEL: G W Diehm SC, with M Callaghan, for the appellants
L F Kelly QC, with D Pyle, for the respondent
SOLICITORS: Flower and Hart Lawyers for the appellants
Tynne & McCartney for the respondent
[1] MUIR JA: I agree that the appeal should be dismissed for the reasons given by
Chesterman JA.
[2] CHESTERMAN JA: The second appellant (“QML”) was at relevant times a
partnership of 15 pathologists. The first appellant (“AMIL”) was the partners’
professional indemnity insurer. The appellants were the plaintiffs in an action for
declarations and contribution which was dismissed by the Chief Justice on
26 August 2009.
[3] The respondent, the defendant in the action, (“CGU”) was an insurer which issued a
policy covering certain risks associated with the conduct of QML’s pathology
practice. The identity of the insured under CGU’s policy, and the exact risk covered
by it, were the subject of the dispute in the action and on appeal.
[4] In essence AMIL’s claim was for contribution as between co-insurers. It had
indemnified QML in respect of a claim made against the partners and alleged that
CGU’s policy covered the same risk. Accordingly it sought equal contribution in
the sum of $238,154.03.
[5] That being the nature of the claim QML would appear to have been a completely
unnecessary party. It suffered no loss having been indemnified by AMIL whose
claim was not brought by way of subrogation but in AMIL’s own right as co-
insurer. The unnecessary joinder excited no comment at trial or on appeal and I,
too, propose to ignore it.
[6] There was a dispute as to the extent of any contribution CGU should make in the
event that its policy covered the risk indemnified by AMIL. That insurer had issued
a separate policy to each partner. The appellants contended that there being two
insurers they should bear the loss equally. CGU contended that because there were
15 policies issued by AMIL which answered QML’s claim for indemnity the
contribution should be one sixteenth from CGU and fifteen sixteenths from AMIL.
(In the course of submissions we were told that there were 16 policies so that the
contributions should have been one seventeenth and sixteen seventeenths. However
only 15 pathologists are identified in paragraph 1(c) of the Further Further Further
Amended Statement of Claim. As well the AMIL policy schedules in evidence, one
for each partner, number 15, not 16). Because the Chief Justice dismissed the
action it was not necessary for his Honour to settle the controversy.
[7] The Chief Justice described the claim against CGU in these terms:
“[2] The claim for contribution relates to a claim pursued in
court proceedings brought by Tracey Leigh D’Arcy and
Scott John Vinnicombe against QML, for damages for
QML’s negligence, on the basis that QML failed properly to
interpret the results of a pap smear on 18 February 1993, a
failure which resulted in a lost opportunity to prevent the
development of the cervical cancer which subsequently
afflicted her. AMIL was obliged to indemnify QML in
-- 3 of 25 --
4
respect of QML’s liability under that claim, and AMIL did
so. AMIL accordingly paid the claimants $435,000 for
damages and $33,000 for costs, and itself incurred costs
amounting to $18,517.95. It was common ground that QML
was liable to those claimants, and that QML’s settlement
with them was reasonable.”
[8] The Chief Justice also described the manner in which QML operated its pathology
practice:
“[4] QML operated in tandem with three companies, Queensland
Medical Services Pty Ltd which, as is apparent from its
name, was a service company for the QML partnership, and
Renbond Pty Ltd and Samboor (sic) Pty Ltd. Dr David
Russell was the general manager of the broad trading group,
which included the partnership. Dr Russell’s evidence …
was that the trading name ‘QML’ was used for the group,
including the companies and the partnership, although it
could be used to refer to the partnership alone. Queensland
Medical Services Pty Ltd employed about 1,500 staff. Those
staff members included cytologists, who were employed by
that company … . The cytologists were scientists, not
medical practitioners or pathologists, and they were the
persons who screened the samples.
[5] Dr Russell was responsible for managing the insurance risks
of the trading group. He made sure the individual
pathologist partners kept up their professional indemnity
cover with AMIL. It was he who arranged, in addition, for
the involvement of a broker to look after QML’s cover. In
about 1991, that broker became Marsh and McLennan. The
CGU policies were issued by CGU through QML’s agent,
the broker Marsh and McLennan. At material times,
Ms Nicolson … was the relevant officer of Marsh and
McLennan, and she dealt with Mr Hansen of CGU … .”
[9] The nature of the right given to an insurer to recover contribution from another
where both have effected a policy of insurance was described in Albion Insurance
Co Ltd v Government Insurance Office of New South Wales (1969) 121 CLR 342 at
352:
“What attracts the right of contribution between insurers … is simply
the fact that each contract is a contract of indemnity and covers the
identical loss that the identical insured has sustained … .”
[10] CGU defended the action on three bases. It argued that the insured under the AMIL
policies were not insured under its policy. Secondly it submitted that the risk
covered by the policies, those issued by AMIL and CGU’s policy, was different.
Thirdly it contended that if the insured and the risk covered were identical AMIL
and QML were estopped from denying that the risk covered did not extend to the
D’Arcy claim. The estoppel was identified as being based on the convention the
parties had adopted in their dealings with each other with respect to the issue of the
CGU policy.
[11] The Chief Justice held in favour of the appellants on the first two grounds but for
the respondent on the third.
-- 4 of 25 --
5
[12] The CGU policy which the appellant contended indemnified the second appellant
against the D’Arcy claim covered claims made in the year 1 July 1997 to 30 June
1998 (“the 1998 Policy”). It was the third such policy and was, in effect, a renewal
of the policies issued in the two preceding years.
[13] The convention which CGU advanced as giving rise to the estoppel, and which the
Chief Justice accepted, was described by his Honour:
“[65] It applied to each of the policies for the years ended 1996,
1997 and 1998. The assumption was that the policy did not
provide cover for QML partners for negligence in their own
right, although it would cover a partner’s vicarious liability
for the negligence of a non-medical employee … . It was
not an overlapping or duplicate insurance to that which the
partners already had from AMIL. It provided cover for the
employees of the partnership, or of the insured companies,
in the event those employees were sued. And it provided
cover where a claim against the partnership arose solely
from the conduct of a non-medical employee, but excluded a
situation where a partner failed properly to supervise the
employee. Ms Nicolson … and Mr Hansen … were in
agreement that the CGU policy would not cover the D’Arcy
claim.”
[14] The appellants support the rejection of the respondent’s defences based upon the
CGU policy but attack the findings of fact which led to the acceptance of the
estoppel by convention. The respondent by notice of contention argued that it
should be found that the CGU policy did not respond to the claim by Ms D’Arcy
against QML.
[15] I propose to deal firstly with the arguments raised by the notice of contention
because I have concluded that the respondent’s second point should be accepted: the
1998 Policy did not extend to indemnify QML against the D’Arcy claim. In my
opinion the facts which led the Chief Justice to find the estoppel by convention led,
as well, to that construction of the 1998 Policy.
Identity of Insured
[16] As I mentioned AMIL issued polices to each of the pathologists who were partners
in QML. CGU’s first point, that the insured under the policies issued by the two
insurers were different, depends upon whether the partners were included among the
insured promised indemnity by the 1998 Policy.
[17] Item 1 in the schedule to the 1998 Policy identified the insured as:
“Queensland Medical Services Pty Ltd
Samdoor Pty Ltd
Renbond Pty Ltd
T/AS Queensland Medical Laboratory Partnership.”
The policy defined “Insured” as the persons named in the schedule.
[18] The insuring clause in the policy promised that CGU would, in consideration of the
payment of $29,000 by way of premium:
“… to the extent and in the manner … provided …
-- 5 of 25 --
6
1.1 Indemnify the Insured against any Claim … for
which the Insured shall become legally liable to the
Claimant up to but not exceeding in the aggregate …
the Total Sum Insured being a Claim:
(1) made against the Insured during the Period of
Insurance; and
(2) as soon as reasonably practicable, notified in
writing to (CGU) … ; and
(3) arising from any actual or alleged act, error,
omission or conduct wherever the same
occurred subsequent to the Retroactive Date
specified in Item 6.4 of the Schedule.”
The monetary limit of indemnity appeared in the schedule. It was $2 million.
[19] Item 11 in the schedule to the policy contained a special condition. It was:
“Notwithstanding anything contained herein to the contrary, this
policy does NOT indemnify the Insured in respect of a claim or
claims made arising from the activities of Pathologists and/or
Medical Practitioners providing services for or on behalf of the
Insured, where such Pathologist or Practitioner is entitled to
indemnity under a Medical Defence Union or Protection Society or
other Professional Indemnity Insurance. This exclusion shall apply
whether or not indemnity has been granted by the Defence Society,
Association or relevant Insurer.”
[20] The CGU policy defined “Proposal” to mean:
“… the written Proposal form bearing the date stated … made by the
Insured to (CGU) containing particulars and statement which,
together with any attachments thereto, are considered to be
incorporated into this Policy.”
The proposal for the 1998 Policy was made on 6 May 1997. It identified the
“natural persons & incorporated bodies currently comprising the proponent” as:
“Queensland Medical Laboratory Partnership – List of names
attached
Queensland Medical Services Pty Ltd
Samdoor Pty Ltd.”
The attached list set out the names of 14 persons described as “partners/directors”.
[21] There were, as I mentioned, 15 separate policies issued by AMIL to the partners.
Fourteen of the policies had a limit of liability of $5 million each. The fifteenth
policy had a limit of $1 million. The aggregate cover was therefore $71 million.
There was no evidence of the amount of premium paid by the individual partners for
their policies. Each policy promised that AMIL would pay up to the insured
amount:
“All sums which You become legally liable to pay as compensation
for any civil liability in respect of claim(s) against You which:
…
arise directly in connection with Your Profession. …”
“Profession” was defined to mean “the provision by You of medical treatment,
advice and services to patients in the course of Your medical practice.”
-- 6 of 25 --
7
[22] CGU’s argument was that the insured under its policy were the three companies,
Queensland Medical Services Pty Ltd, Samdoor Pty Ltd and Renbond Pty Ltd
(“practice companies”) which together traded under the name “Queensland Medical
Laboratory Partnership”. The abbreviation “T/AS” was said to indicate that the
three companies constituted a particular partnership, the three corporate members of
which were the only insured, so that “Queensland Medical Laboratory Partnership”
did not designate QML the second appellant or the pathologists who were members
of that partnership. As the pathologists were the only insured under the AMIL
policies there was no double insurance. CGU relied as well on Dr Russell’s
evidence that “QML” was a convenient designation which had no defined object. It
could refer to the partnership of pathologists, or that partnership and the company
Queensland Medical Services Pty Ltd, or “the entire group” which consisted of the
partnership and the practice companies.
[23] The appellants had initially sought relief by way of rectification of the 1998 Policy
to amend the designation of insured to include the 15 partners. That claim was
abandoned. The respondent submits that without such relief the CGU policy must
be read literally and therefore to the effect that the partners of “QML”, the second
appellant, were not included among the insured covered by CGU’s policy.
[24] CGU relied upon the High Court’s emphatic affirmation that parties who sign a
written contract are bound by its terms. The court (Gleeson CJ, McHugh, Kirby,
Hayne and Callinan JJ) said in Equuscorp Pty Ltd v Glengallan Investments Pty Ltd
(2004) 218 CLR 471 at 483:
“The respondents each having executed a loan agreement, each is
bound by it. Having executed the document, and not having been
induced to do so by fraud, mistake, or misrepresentation, the
respondents cannot now be heard to say that they are not bound by
the agreement recorded in it. The parol evidence rule, the limited
operation of the defence of non est factum and the development of
the equitable remedy of rectification, all proceed from the premise
that a party executing a written agreement is bound by it. …
There are reasons why the law adopts this position. First, it accords
with the ‘general test of objectivity [that] is of pervasive influence in
the law of contract’. The legal rights and obligations of the parties
turn upon what their words and conduct would be reasonably
understood to convey, not upon actual beliefs or intentions.
Secondly, … oral agreements will sometimes be disputable. …
Where parties enter into a written agreement, the Court will
generally hold them to the obligations which they have assumed by
that agreement. At least, it will do so unless relief is afforded by the
operation of statute or some other legal or equitable principle
applicable to the case.” (footnotes omitted)
[25] The Chief Justice dealt with the point. His Honour said:
“[33] Ms Nicolson explained how the problem arose. The 1997/8
policy was the successor to the previous year’s policy,
which had named the partners in the Schedule … . In the
instant policy, the wording changed, so that the term
‘insured’ extended to the members of a named partnership,
with the consequence that there was no need to list the
-- 7 of 25 --
8
names of the partners in the Schedule … . On that basis, one
may infer that the retention of the letters ‘T/AS’ may have
been a mistake. Ms Nicolson and Mr Hansen gave their
evidence on the assumption that the partners were included
as ‘insured parties’ … .
[34] Counsel for the defendant submitted that the plaintiffs
cannot have the pathologist partners brought within the
CGU policy as “insured” persons without having the policy
rectified. The plaintiffs abandoned a claim for rectification
shortly before the commencement of the trial last year.
Counsel for the defendant relied on Equuscorp … . On the
other hand, the plaintiffs contend that the partners are
brought in as ‘insured’ persons by a proper process of
construction of the policy.
[35] A possible explanation for the exclusion of the partners
from the scope of the ‘insured’ under the CGU policy may
have rested in the view that because their insurance was
provided by the AMIL policies, there was no need for them
to be covered by the CGU policy as well; the CGU policy
was intended to provide cover for employees, and they
were employed by Queensland Medical Services Pty Ltd,
which was named as an insured party.
[36] Notwithstanding that consideration, the conjunction of the
incorporated ‘proposal’, naming the partners of
‘Queensland Medical Laboratory Partnership’ as
proponents of the policy on the one hand, and on the other
hand, the inclusion of the descriptor ‘T/AS’ before the
reference in the Schedule to that partnership, does to my
mind raise an ambiguity. On the one hand, the partners
were seeking their inclusion, as proponents, and the policy
acknowledged that. Yet when we come to the Schedule, the
reference to the partnership is preceded by ‘T/AS’ (which
we know was a remnant of the predecessor policy and
should have been deleted). Dr Russell’s evidence was that
‘QML’ was the trading name used by the companies and
the partnership as a group … . But the reference in the
Schedule is not to that trading name (QML), but to ‘T/AS
Queensland Medical Laboratory Partnership’, that is, with
the word ‘partnership’ included. The ambiguity is simply
resolved, by ignoring the letters ‘T/AS’ .”
[26] The reasons cannot, I think, be criticised. The ambiguity in the identity of the
insured under the CGU policy is best resolved by notionally omitting the description
“trading as” (“T/AS”) so that the partnership, QML, is included as a named insured.
This approach, and the conclusion to which it leads, is inevitable given the
uncontroversial facts. The proposal, which became incorporated into the policy,
was made inter alia by the members of the partnership. The omission of the
individual partners as designated insured was explained by Ms Nicolson’s evidence
concerning the change in policy wording from the previous year which obviated the
-- 8 of 25 --
9
need to list the partner separately by name in the schedule. As well Mr Hansen for
CGU prepared a quote with respect to the proposal for the 1998 Policy which
identified the partners individually. The parties obviously intended to include the
partners of QML as insured.
[27] The respondent’s first argument on its notice of contention should be rejected.
Scope of CGU Cover
[28] It will be helpful when considering the arguments for and against the contention that
the 1998 Policy did not respond to the claim against QML by Ms D’Arcy and
Mr Vinnicombe to know a little more about their claim. It was succinctly described
by the Chief Justice:
“[20] Ms D’Arcy alleged that on 18 February 1993, she provided
QML with a pap smear. The QML report on that incorrectly
said that the sample was free of any cancerous cell … . That
report, prepared by a cytologist (unidentified), was not
signed by a pathologist. There was no evidence a pathologist
checked it.
[21] The QML report on a second pap smear provided by
Ms D’Arcy on 2 March 1995 noted the presence of
abnormal cells, leading to the diagnosis of cervical cancer.
[22] Ms D’Arcy and Mr Vinnicombe (claiming for loss of
consortium etc) brought their proceeding against the QML
partnership. They did not join any non-medical employee,
such as a cytologist. … They did not contain any allegation
of negligence on the part of any cytologist. The allegations
were of breach by the partners. …
[23] The statement of agreed facts in this instant proceeding …
summarizes the D’Arcy proceeding in this way:
“3. That Tracey Leigh D’Arcy and Scott John
Vinnicombe instituted proceedings against
the Second Plaintiff [QML, a partnership]
claiming damages for personal injuries
caused by the Second Plaintiff’s negligence
regarding a failure to properly interpret the
results of a pap smear performed on
18 February 1993, resulting in a lost
opportunity to prevent the development of a
cervical cancer which subsequently emerged.
…
5. The First Plaintiff [AMIL] was obliged to
indemnify the Second Plaintiff [QML, a
partnership] with respect to the said claims.
…
8. The Second Plaintiff was liable for
negligence to the Claimants.”
-- 9 of 25 --
10
[29] The respondent’s argument that its policy did not respond to Ms D’Arcy’s claim
foundered at trial on the terms of Special Condition 11. Again it is convenient to
turn to the explanation of the point given by the Chief Justice to gain an
understanding of the arguments. His Honour said:
“[39] Prima facie, CGU would have been obliged to indemnify the
partners in relation to the D’Arcy claim, item 11 aside. That
emerges from the natural application of the terms in which
the right to indemnity is expressed. But item 11 would
exclude that cover, because the claim arose from the
partners’ activities as pathologists providing services on
behalf of the insured, attracting cover under the AMIL
policy.
[40] The plaintiffs submitted, however, that s 45(1) of the
Insurance Contracts Act 1984 (Cth) avoided item 11. …
[41] Counsel for the defendant submitted that s 45 does not apply
‘because the insured is different and the risk covered is
different in the case of the AMIL policy and the CGU
policy’. There is some difference in the ‘insured’: under the
AMIL policies, the insured parties are the respective
partners; under the CGU policy, they are the aggregation of
the partners and the service companies. I consider, however,
that applying s 45, one looks at the insured under the CGU
contract in a distributive way: have the pathologist partners
(being the objects of the claim) entered into another
applicable indemnity policy? They have. The other question
is whether the respective policies cover the same risk.
Subject to another question to which I will come shortly, in
my view they do.
[42] Counsel then submitted that item 11 is not a provision
‘limiting or excluding’ liability, but ‘merely assists in
defining’ the risk covered by the CGU policy: ‘special
condition 11 must be read with the remainder of the policy as
defining the nature of the risk covered and not as an isolated
exclusion clause of the type which section 45 is aimed at’.
[43] I do not accept that submission. Because a right to indemnity
in respect of the D’Arcy claim would arise under the
provision in the policy according the indemnity, Item 11
must be read as ‘limiting or excluding’ that right to
indemnity in the specified circumstances. That would mean
that item 11 is void.”
[30] The appellants argued that Special Condition 11 fell within the ambit of s 45(1) of
the Insurance Contracts Act 1984 (Cth) (“IC Act”) and was therefore void, leaving
the full extent of the insuring clause to operate. The contrary submission, advanced
unsuccessfully by the respondent, was that Special Condition 11 did not take away
what the insuring clause gave, but should instead be read with it to define and
confine the risk which was covered by the CGU policy, which did not extend to
those risks covered by the AMIL policies. Properly construed, CGU submitted, its
policy never extended to cover a risk of the type represented by the D’Arcy claim.
-- 10 of 25 --
11
On that construction Special Condition 11 did not exclude liability “by reason that”
the second appellant had affected the AMIL policies. The CGU policy, the
argument ran, never extended to the subject matter covered by the AMIL policies.
[31] The Chief Justice accepted the appellants’ submission. His Honour regarded
Special Condition 11 as a provision excluding the obligation to indemnify which
would otherwise arise pursuant to the insuring clauses, by reason that QML had
entered into other contracts of insurance, with AMIL, which covered the same risk.
The claim brought by Ms D’Arcy and Mr Vinnicombe arose from an “act, error,
omission or conduct” of the insured, which included the partners of QML, and was
therefore within the insuring clause. Special Condition 11 excluded the obligation
of indemnity by providing the CGU policy did not
“indemnify the (partners) in respect of a claim … arising from the
activities of Pathologists … providing services for or on behalf of the
Insured, where such Pathologist … is entitled to indemnity under
(the AMIL) … Insurance.”
and was therefore struck down by s 45.
[32] Section 45 provides:
“(1) Where a provision included in a contract of general
insurance has the effect of limiting or excluding the liability
of the insurer under the contract by reason that the insured
has entered into some other contract of insurance, not being
a contract required to be effected by or under a law,
including a law of a State or Territory, the provision is
void.”
[33] Put succinctly CGU submitted that the insuring clause and Special Condition 11
should be read compositely as together defining the risk which was the subject of
the 1998 Policy. So read the scope of the policy did not extend to indemnifying the
insured (the partners of QML) against any claim for which they became legally
liable arising from the activities of pathologists and/or medical practitioners
providing services for the insured, where such pathologist or practitioner was
entitled to indemnity under professional indemnity insurance. This left as the scope
of the 1998 Policy liability for the (negligent) acts of others.
[34] Section 45 invalidates terms of insurance contracts which have the effect of
excluding liability “by reason that” the insured has entered into another insurance
contract. CGU’s argument is that its policy did not operate to exclude liability to
the partners of QML (“pathologists/medical practitioners providing services for or
on behalf of the insured”) because (“by reason that”) they took out policies with
AMIL. Its argument is that its policy did not exclude liability for that reason but
because it never extended to such persons, and a reference to their having effected
other professional indemnity insurance was only a means of identifying a risk to
which the CGU policy did not attach.
[35] The appellants’ argument is that one looks separately at the insuring clause and
Special Condition 11. So regarded the insuring clause extended to indemnify
pathologists and/or medical practitioners who were insured under the policy against
any claim arising from any act, error, omission or conduct. The clause obviously
extended to provide indemnity against the D’Arcy claim. However, Special
-- 11 of 25 --
12
Condition 11 purported to remove the indemnity where the pathologist or
practitioner had other professional indemnity insurance. The condition therefore
fell squarely within the prohibition of such terms contained in s 45, and was void.
[36] The Chief Justice preferred the appellants’ construction. In my opinion the
respondent’s construction is to be preferred and the facts which led the Chief Justice
to find the convention which gave rise to the estoppel should have led to the
construction of the CGU policy for which it contends. To repeat, the convention
which was found to exist between the second appellant and the respondent was that
the 1998 Policy:
“… did not provide cover for QML partners for negligence in their
own right, although it would cover a partner’s vicarious liability for
the negligence of a non-medical employee … . It was not an
overlapping or duplicate insurance to that which the partners already
had from AMIL. It provided cover for the employees of the
partnership, or of the insured companies, in the event those
employees were sued. And it provided cover where a claim against
the partnership arose solely from the conduct of a non-medical
employee, but excluded a situation where a partner failed properly to
supervise the employee.”
Fact I
[37] This is Mr Hansen’s account of a meeting he had with Mr Russell of QML and
Ms Nicolson and Mr Kirkwood from QML’s insurance brokers in August or
September 1996. Mr Hansen testified that:
“(a) Dr Russell told me that the tests conducted at the QML
pathology laboratory were not 100% accurate, but rather
they were considered ‘screenings’ … because not every
blood cell is tested, only a small sample(.)
(b) We discussed the extent of cover under the policy with
(CGU). The intention of the policy was discussed and Mr
Russell agreed with me that the policy was intended to
protect only employees. Also discussed was the extent of
cover to the entity that employed the staff. I stated, and Mr
Russell agreed, that if the partnership was sued due to an
error by an employee other than a medical practitioner, the
policy would respond. In this way, it was agreed the policy
was a ‘back-up’ if the corporate entities (the partnership)
were named in an action, provided that the claim against the
partnership arose solely from the activities of an employee
rather than those of a medical practitioner. It was a ‘sleep
easy’ policy which was highly unlikely to be called upon as
it would be rare for an employee to be sued directly.”
Fact II
[38] In July 1995 Dr Russell prepared a memorandum to be circulated to the cytology
screeners employed by QML, or one of the practice companies. Before issuing the
memorandum Dr Russell sought and obtained the approval of CGU to its contents.
It read:
-- 12 of 25 --
13
“Recent litigation and threatened litigation against pathology firms
… has heightened the awareness of all pathology professionals
including staff directly responsible for screening … .
It is … more important than ever to ensure that all staff use
professional care in all things that they do. For the information of
those who may be more concerned about their level of duty of care
than in the past, please bear in mind that before any QML employee
will be personally liable for any mistakes which they … may make,
the following systems have to be satisfied.
1. The employee must firstly be actually negligent.
2. The negligence must be capable of proof in a court of law
… (which) can be very time consuming and difficult.
3. Even if negligence is proven in a court, that negligence has
to be attached to an identified individual. Under common
law employer/employee arrangements, the employer is
liable for the actions of the employee. … In practice most
plaintiffs will seek only to recover from the employer.
4. Even if the above are all satisfied and QML is unable … to
indemnify the employee, all QML pathologists are members
of a medical defence organisation.
5. If all of the above mechanisms fail, QML has arranged a
professional indemnity insurance policy with an
independent underwriting insurance company to cover its
employees in the unlikely event that any liability could be
attached to them.
While no absolute guarantees can be given … that there could never
… be negligence which attaches back to the individual, the above
‘net’ should ensure that no QML employee would ever be liable
personally for any acts they commit whilst employed at QML.”
The insurer referred to in paragraph 5 was CGU.
[39] Dr Russell explained that his purpose in writing the memorandum was to:
“give … comfort to employees who nationally were at risk … and
convince the employees that the chance of them personally losing
their house was as low as (QML) as a business could make it.”
He agreed that in writing paragraph 5 he meant to convey that if for some reason
AMIL did not cover a claim under its polices:
“then the employees had the knowledge or … comfort that in the
unlikely event that they were sued … there was professional
indemnity insurance separately that had been arranged for them.”
Mr Hansen gave evidence confirming that paragraph 5 of the memorandum
accurately reflected his own understanding of what the CGU policy covered.
[40] The point is, as the Chief Justice noted in his reasons, that by his memorandum, and
in particular paragraph 5, Dr Russell for QML confirmed its intention that the CGU
policy would only respond to a claim to indemnify an employee not covered by the
AMIL policies.
-- 13 of 25 --
14
Fact III
[41] Next there is the point that early in 1997 Dr Russell became concerned with the
scope of the AMIL policies. His concern arose from a newsletter circulated by the
Medical Defence Society of Queensland from which Dr Russell surmised “Medical
Defence are continuing to try to limit their liability … .” He asked Ms Nicolson to
confirm that QML was covered against liability arising from the acts of employees.
The newsletter had also suggested the possibility that AMIL might seek to cap the
monetary extent of its indemnity. Ms Nicolson sent the inquiry onto Mr Hansen
who replied to her on 4 February 1997:
“… coverage provided by the (CGU) policy as it stands is not
affected by this suggestion of limitation or capping of liability, nor is
it affected by the comments relating to indemnity to employee
practitioners.
Non employee practitioners are not within the scope of the policy, so
any capping of liability under (the AMIL policies) shall not impose
any liability upon (CGU). It may be worth considering, should
capping be imposed, recommending to your client that excess cover
should be purchased if they feel the capped amount will not
sufficiently allow for possible future litigation costs and awards.
As you are aware, Practitioners who are employees are covered
within the scope of the policy. …
… the (CGU) policy does indemnify the Insured for actions taken
against them arising from the acts of staff, either qualified or not. In
addition though, we also, with the agreement of the Insured,
indemnify the employee if they are named personally in any action.”
(emphasis in original)
[42] On 5 February 1997 Ms Nicolson relayed this information by facsimile transmission
to Dr Russell. He did not contest the assertions contained in Mr Hansen’s
communications. Four months later, on 6 May 1997, Dr Russell submitted the
proposal to renew the CGU policy for a further 12 months.
[43] The Chief Justice found that the exchange of facsimile transmissions, setting out the
shared understanding of CGU and QML’s broker as to the risk covered by the CGU
policy was agreed to by Dr Russell. The finding is supported by the evidence and
should be accepted.
Fact IV
[44] Next there is the point that Dr Russell was anxious to avoid any duplication of
insurance cover between the AMIL policies and CGU’s policy which would involve
paying to CGU an additional premium for the cover that the AMIL policies already
provided. Mr Hansen paraphrased what was said between them at their 1996
meeting:
“It was agreed that the function of this policy is primarily an
employee cover, but also a back up policy if the corporate entities
were named in an action, provided of course that the claim against
the corporation arises from the activities of an employee rather than
those of a partner. No cover for partners was understood to be
included, as this is what they pay the MDS so much money for.”
-- 14 of 25 --
15
[45] Ms Nicolson told Dr Russell that there was:
“… no cover for medical practitioners under (the CGU) policy, but
that was covered under the Medical Defence policy … . So, I didn’t
feel that there was actually any overlap, because you had one policy
that was for the medical practitioners that were covered by the
Medical Defence policy, and then the employees that … weren’t
qualified Medical Defence employees … were picked up under this
(CGU) policy.”
[46] She also said that:
“The intention of (the CGU) policy wasn’t to cover (pathologists or
medical practitioners if they were entitled to indemnity from
(AMIL)).”
“(A)t around the time of renewing the … 1998 policy”, she explained to Mr Russell
Special Condition 11 “meant that no one with medical qualifications … no medical
practitioners, were covered under (the CGU) policy.” Mr Russell replied that he
was “not worried” because he did not want QML to pay for cover already provided
by AMIL.
[47] Mr Hansen gave similar evidence. He said that the CGU policy was not intended to
“cover the risk of partners of QML as pathologists.” Had that been intended he
would have required “a full claims history in respect of any allegation of negligence
in respect of each partner to be disclosed.” No such disclosure was made or
requested.
Fact V
[48] The premium payable under the CGU policy was significantly below what would
have been charged had the risk to be covered included the liability of the partners of
QML and employed medical practitioners. The premium charged, $29,000,
extended cover to 1,500 persons employed by the practice companies.
Fact VI
[49] This concerns what was called “the Fraser claim”. Late in 1995 Ms Fraser brought
proceeding against QML in New South Wales. The circumstances of her claim are
indistinguishable from Ms D’Arcy’s. AMIL conducted QML’s defence and sought
contribution from CGU with respect to Ms Fraser’s claims which was eventually
settled. CGU contributed equally with AMIL to the agreed compensation. The
relevant CGU policy was that issued for the 1995-1996 year. The claim for
contribution was made by AMIL’s solicitors without consulting Dr Russell the
partner at QML responsible for its insurance business.
[50] The claim for contribution came as a surprise both to CGU and QML both of whom
were, to use the description of the Chief Justice, “highly disturbed”. His Honour
continued:
“[68] This claim relates to the 1996 CGU policy. When AMIL
sought contribution from CGU, both CGU and QML were
highly disturbed. The policy then contained a medical
practitioner exclusion endorsement (cl 8). In drafting item
11 for the 1998 policy, Mr Hansen, aware of that Fraser
claim, sought to shore up the convention, agreed in by
-- 15 of 25 --
16
Dr Russell and him, which they considered had been
breached by AMIL in the Fraser case … . The claim had put
Mr Hansen on a state of “high alert” … .
[69] Far from suggesting acquiescence on the part of CGU in the
claim for contribution brought against it, CGU’s reaction to
the claim was one of alarm, on the basis the making of the
claim subverted an established understanding. While there
was a settlement to which CGU contributed, that occurred in
Sydney without involvement on the part of Mr Moore.”
[51] The Fraser claim is relied upon by the appellants as being inconsistent with, and
destructive of, the convention between QML and CGU as to the basis on which they
effected the CGU policy. The Chief Justice said, with respect to this contention:
“the claim against CGU was driven, not by QML (with which it had
the common assumption) but by the medical defence insurer with
which it had no communications and which had been cold and
extremely secretive in its dealings with QML itself.”
His Honour therefore considered that CGU’s contribution to the Fraser settlement
did not detract from “the strength of the mutual assumption or understanding
otherwise established by the evidence.”
Fact VII
[52] Item 8 in the CGU policy issued for the year preceding the period of insurance
covered by the 1998 Policy was in these terms:
“It is hereby declared and agreed that under the terms, conditions and
exclusions of this policy that no indemnity extends to members of a
Medical Defence Organisation who
(a) provide professional services to third parties
within/at or on premises owned or under the control
of the insured and
(b) are not employees of the insured or any company
associated with the insured.
Further, it is a condition of the indemnity provided by this policy that
any such health care professional/s using/occupying the insureds’
premises is/are a current financial member of a representative
Medical Defence Organisation that provides Malpractice protection
and/or Professional Indemnity protection for their members.”
In response to AMIL’s claim for contribution with respect to the Fraser claim
Mr Hansen altered Item 8 to take the form of Special Condition 11.
[53] These facts which I have numbered I to VII are taken, more or less verbatim, from
the findings made by the Chief Justice. His Honour expressly accepted as honest
and reliable Mr Hansen’s account which is the basis for fact I. His Honour thought
there was little conflict between the testimony of Mr Hansen and Ms Nicolson on
the one hand and Dr Russell on the other. Notwithstanding that observation his
Honour accepted what was said by CGU’s witnesses. There was a body of more or
less contemporaneous documents supporting what they said.
-- 16 of 25 --
17
Construction of the CGU Policy
[54] The copious references to what representatives of the insurer, insured and broker
said and thought should not obscure the fact that the 1998 Policy is to be construed
objectively, by reference to what the reasonable observer would have concluded
was meant by the words chosen by the parties to reflect and record their bargain in
the light of the relevant “matrix of facts” known to them both. The subjective
intentions or beliefs of one or both parties to a contract as to what they had agreed
is, of course, inadmissible. The High Court (Gleeson CJ, Gummow, Hayne,
Callinan and Heydon JJ) said in Toll (FGCT) Pty Ltd v Alphapharm Pty Ltd (2004)
219 CLR 165 at 179:
“This Court, in Pacific Carriers Ltd v BNP Paribas, has recently
reaffirmed the principle of objectivity by which the rights and
liabilities of the parties to a contract are determined. It is not the
subjective beliefs or understandings of the parties about their rights
and liabilities that govern their contractual relations. What matters is
what each party by words and conduct would have led a reasonable
person in the position of the other party to believe. References to the
common intention of the parties to a contract are to be understood as
referring to what a reasonable person would understand by the
language in which the parties have expressed their agreement. The
meaning of the terms of a contractual document is to be determined
by what a reasonable person would have understood them to mean.
That, normally, requires consideration not only of the text, but also
of the surrounding circumstances known to the parties, and the
purpose and object of the transaction.” (footnotes omitted)
[55] In Pacific Carriers the same court had said (2004) 218 CLR 451 at 462:
“The construction of the letters of indemnity is to be determined by
what a reasonable person in the position of Pacific would have
understood them to mean. That requires consideration, not only of
the text of the documents, but also the surrounding circumstances
known to Pacific and BNP, and the purpose and object of the
transaction. In Codelfa Constructions Pty Ltd v State Rail Authority
of NSW ((1982) 149 CLR 337), Mason J set out with evident
approval the statement by Lord Wilberforce in Reardon Smith Line
Ltd v Hansen-Tangen:
‘In a commercial contract it is certainly right that the court
should know the commercial purpose of the contract and
this in turn presupposes knowledge of the genesis of the
transaction, the background, the context, the market in
which the parties are operating.’”
[56] The same approach is taken in the construction of policies of insurance. Gleeson CJ
explained in McCann v Switzerland Insurance Australia Limited (2000) 203 CLR
579 at 589:
“A policy of insurance, even one required by statute, is a commercial
contract and should be given a businesslike interpretation.
Interpreting a commercial document requires attention to the
language used by the parties, the commercial circumstances which
the document addresses, and the objects which it is intended to
secure.” (footnotes omitted)
-- 17 of 25 --
18
That explanation was recently reaffirmed by Gummow, Kirby, Heydon, Crennan
and Kiefel JJ in CGU Insurance Ltd v Porthouse (2008) 235 CLR 103 at 116.
[57] Evidence of negotiations between the parties in the course of arriving at their
ultimate contract are inadmissible, except to the extent that they:
“… establish objective background facts which were known to both
parties and the subject matter of the contract. … But in so far as
they consist of statements and actions of the parties which are
reflective of their actual intentions and expectations they are not
receivable”:
Codelfa at 352 per Mason J. See also Prenn v Simmonds [1971] 1 WLR 1381;
Secured Income Real Estate (Australia) Limited v St Martins Investments Pty Ltd
(1979) 144 CLR 596. Likewise prior drafts of a contract discarded and amended
in the process of recording the final contract are inadmissible: National Bank of
Australasia Ltd v J Falkingham & Sons [1902] AC 585 at 591.
[58] There are, however, exceptions to the prohibition. The first exception arises where
the words in a contract are capable of more than one meaning. In that case
“extrinsic evidence is admissible to show the facts which the negotiating parties had
in their mind”: Codelfa at 350 per Mason J. The point was made at greater length
by Kerr J in The Karen Oltmann [1976] 2 Lloyd’s Rep 708. The case concerned the
construction of a charter party for two years’ duration which gave the charterer a
right to terminate “after 12 months trading”. The dispute was whether the right to
terminate arose at the expiration of 12 months or at any time thereafter. Kerr J
looked at the telexes exchanged in the negotiations for the charter party. He said (at
712):
“If a contract contains words which, in their context, are fairly
capable of bearing more than one meaning, and if it is alleged that
the parties have in effect negotiated on an agreed basis that the words
bore only one of the two possible meanings, then it is permissible for
the Court to examine the extrinsic evidence … to see whether the
parties have in fact used the words in question in one sense only, so
that they have in effect given their own dictionary meaning to the
words as the result of their common intention.”
[59] A very brief recognition of the exception appears in the judgment of Stephenson LJ
in Arrale v Costain Civil Engineering Ltd [1976] 1 Lloyd’s Rep 98 at 104:
“Even if the ‘genesis’ of a written contract includes negotiations and
its ‘aim’ includes intentions, they are alike admissible only to clarify
ambiguity or to support rectification.”
[60] Lewison in his book The Interpretation of Contracts (2nd Ed p 37-38) regards the
principle, at least that espoused in Karen Oltmann, as “akin to the formulation of an
estoppel by convention … .” The opinion supports my conclusion that the
convention found by the Chief Justice, the basis on which CGU and QML made
their contract, is available as an admissible relevant fact to aid in construing the
1998 Policy.
[61] This exception to the prohibition against receiving evidence of negotiations is, I
think, the same as that described by Mason J in Codelfa at 352-3. His Honour said:
“There may perhaps be one situation in which evidence of the actual
intention of the parties should be allowed to prevail over their
-- 18 of 25 --
19
presumed intention. If it transpires that the parties have refused to
include in the contract a provision which would give effect to the
presumed intention of persons in their position it may be proper to
receive evidence of that refusal. After all, the court is interpreting
the contract which the parties have made and in that exercise the
court takes into account what reasonable men in that situation would
have intended to convey by the words chosen. But is it right to carry
that exercise to the point of placing on the words of the contract a
meaning which the parties have united in rejecting? It is possible
that evidence of mutual intention, if amounting to concurrence, is
receivable so as to negative an inference sought to be drawn from
surrounding circumstances.”
[62] The English cases, in particular Karen Oltmann, suggest that where the parties in
negotiation have concurred on a meaning as to a word or phrase and share a mutual
intention with respect to it, evidence of the concurrence and the intention is
admissible, on the question of what the word or phrase means.
[63] The second exception to the rejection of evidence of negotiations arises where the
negotiations have resulted in an actual agreement which antedates the documented
form of the contract the construction of which is in dispute. Lewison puts it this
way (at 35-36):
“This objection (to evidence of negotiations) is not open in the case
of reference to an antecedent agreement. In (Reardon Smith) it was
said that the court should be placed in thought in the same factual
matrix as that in which the parties were when they made their
agreement. If they had already reached an agreement, that would
have been one objective fact which would have been known to both
of them, and ought therefore to be admissible in evidence.”
[64] The case principally relied upon for the proposition is Ladbroke Group plc v Bristol
City Council [1988] 1 EGLR 126. The case concerned the construction of a rent
review clause in a very long lease. The date on which the first review was to occur
was ambiguously stated. The lease had been executed consequent upon a building
contract between the parties which provided that the property to be built pursuant to
the agreement would then be leased. A draft lease was annexed. The court had
regard to the rent review clause in the draft to elucidate what the parties meant by
the date of the first review in the executed lease. The Court of Appeal said (129):
“In our judgment it is therefore permissible and relevant to look at
the draft lease for the purpose of discovering the parties’ intentions
in including the reference to March 31 1973 in clause 2(a) of the
lease as executed. In our judgment, a study of clause 2(a) of the draft
lease in its context makes reasonably clear the parties’
intentions … .”
[65] Ladbroke was followed in KPMG v Network Rail Infrastructure Ltd [2008] 1 P &
CR 11. Twenty years after the execution of the lease a dispute arose between lessor
and lessee as to the terms in which the latter might quit. In this case, too, a draft
lease was attached to the agreement for lease. The primary judge had concluded
that the draft lease was “of little … assistance” in construing the executed lease in
dispute. The argument on appeal in support of that view was dismissed as being
“inconsistent … with the decision of this court in Ladbroke Group … .”
Accordingly the earlier agreement:
-- 19 of 25 --
20
“… including the form and content of the draft lease attached to it,
was an important part of the background and is a permissible aid in
the construction of the lease in its final form.”
[66] The court also noted the judgment of Rix LJ in HIH Casualty and General
Insurance Ltd v New Hampshire Insurance Co [2001] 2 Lloyd’s Rep 161 at [83]:
“In principle, it would seem to me that it is always admissible to look
at prior contracts as part of the matrix or surrounding circumstances
of a later contract. I do not see how the parol evidence rule can
exclude prior contracts, as distinct from mere negotiations. The
difficulty of course is that, where the later contract is intended to
supersede the prior contract, it may in the generality of cases simply
be useless to try to construe the later contract by reference to the
earlier one. … a cautious and sceptical approach to finding any
assistance in the earlier contract seems … a sound principle. What I
doubt, however, is that such a principle can be elevated into a
conclusive rule of law.”
[67] Another example is Squarey v Harris-Smith [1981] 42 P & CR 118 in which a claim
that the conveyance of a lease carried with it an implied easement of way over other
adjoining land of the lessor was defeated by reference to the contract between the
predecessors in title pursuant to which the lease was agreed to be conveyed. A term
of the contract excluded the implication.
[68] The principle also appears to have been endorsed by Mason J in Codelfa though his
Honour expressed himself in terms of common assumptions rather than agreement
or antecedent contract. I apprehend that the point made by his Honour is the same
as that expressed in the cases just discussed. Relevantly Codelfa was concerned
with the implication of a term in a building contract. The implication was said to
arrive as a matter of construction of the contract. Relevant to the construction were
background facts. Mason J said (353-4):
“The implication of the term … rests on findings made by the
Arbitrator based on circumstances surrounding the making of the
contract, including evidence of the discussions between the parties
which preceded entry into the contract. Thus the Arbitrator found
that there was a common understanding … that the works would be
carried out on a three shift … basis … . He also found that the
Authority had represented to Codelfa, and that it had accepted, that
no injunction would be granted … . …
The first question is whether, in the light of the principles …
explained … it was legitimate to look to this material on the issue of
implication of a term. I think it was. The discussions which
generated these findings were not negotiations about the terms of the
contract. … The relevant discussions were … directed to the
question of price. Their object was to enable Codelfa to inform itself
of what was involved in the work and to cost it… . … the evidence
revealed a matter which was in the common contemplation of the
parties yet was not a contractual provision actually agreed upon for
the simple reason that it was a matter of common assumption.”
[69] The present case seems to fall more naturally within the second exception rather
than the first. The facts found by the Chief Justice, which I have repeated and
-- 20 of 25 --
21
numbered, establish an agreement between the parties as to the scope of the
indemnity to be offered by the 1998 Policy. The case differs from those discussed
in that there is no written record by way of a draft of the agreement. That point goes
only to the confidence with which a court might find the terms of an earlier
agreement. It does not affect the principle described in those cases. In this case the
evidence allowed a definite finding of the parties’ agreement, though it was oral.
[70] Even if the case be within the first exception the result is the same. In the course of
their negotiations the parties concurred on what they meant by “pathologists and/or
medical practitioners providing services for or on behalf of the Insured … .” It was
pathologists who had policies with AMIL who were not covered for their own
negligence. That left cover for employees and employers who were vicariously
liable for the employees’ negligence. The concurrence is a fact which may be used
in the construction of the 1998 Policy.
[71] The facts which the Chief Justice found, and which I have set out, with the
exception of fact VI, the Fraser claim, show unequivocally that CGU and QML had
reached agreement prior to the issue of the 1998 Policy as to the commercial benefit
QML accepted from it (i.e. the scope of the cover). They had, at the very least, a
common understanding of what the policy was to achieve for them both. That
common understanding, or agreement, was admissible and relevant in the
construction of the policy and, in particular, the relationship between Special
Condition 11 and the insuring clause.
[72] It is plain from the parties’ agreement, and their common understanding, that the
1998 Policy was not to cover the partners of QML for their own negligence (using
that word generally to include all bases on which a partner might be liable to
compensate a patient arising out of the practice of pathology). The 1998 Policy was
intended to indemnify the practice companies and/or the partners in QML, who
might be liable to pay damages arising out of the negligence of an employee. As
well the policy would indemnify an individual employee who might be sued for his
or her own negligence. The parties’ common understanding was that the 1998
Policy would not indemnify the partners of QML who had their own professional
indemnity insurance with, as it turned out, AMIL. Special Condition 11 did not
exclude liability to indemnify the partners of QML in circumstances where they
took out professional indemnity insurance. The condition did not operate “by
reason that” the partners had effected insurance with AMIL. Accordingly s 45 of
the Insurance Contracts Act had no application.
[73] The results would be the same if one did not regard the facts as establishing an
antecedent agreement, or common understanding, as to what the parties meant by
the particular phrase they chose to record their contract. That is, if the two
exceptions I have discussed were disregarded as not being a proper departure from
the rule rejecting evidence of negotiations, the facts would nevertheless establish the
same construction of the policy I have advanced.
[74] The facts are admissible to aid in the construction of the 1998 Policy. They fall
squarely within the designation of admissible facts identified in the judgments in
Pacific Carriers, Codelfa and McCann. All of the facts are of “surrounding
circumstances” attending the making of the 1998 Policy, and/or show its
commercial purpose, and/or its origin or genesis. They show what the parties set
out to achieve by their policy and, more particularly, the risk against which QML
-- 21 of 25 --
22
sought protection from CGU. When one has regard to the origin and aim of the
transaction as revealed by the facts, the scope of the policy and the risk it covered, is
readily apparent.
[75] I do not wish to ignore fact VI, the Fraser claim, on which the appellants relied so
heavily. It is true that CGU’s payment by way of contribution is inconsistent with
its construction of its policy and the convention found by the Chief Justice. The
short answer is that it was an aberration and payment was made over the objections
of CGU in Brisbane and its solicitor. There may have been reasons for it other than
an acceptance that the convention, or the common understanding, did not exist.
Fact VI is overwhelmed by the other facts.
[76] The AMIL policies and the 1998 Policy did not cover the same risk. With one
exception there was no “double insurance”, and no basis on which AMIL could
claim contribution against CGU in respect of the D’Arcy claim. The exception
would occur where the basis of a claim against QML was the vicarious liability of a
partner or partners for the negligence of an employee. In that case where the
partners were not themselves negligent the 1998 Policy would indemnify the partner
(and the employee if sued). The AMIL policies would also indemnify the partners
(but not the employee).
[77] It is therefore necessary to consider whether the D’Arcy claim was one against
QML for its vicarious liability for the negligence of the employed cytologist or
whether it was a claim against QML for the partners’ own negligence.
[78] Before turning to that consideration it is necessary to digress to mention a
concession made by counsel for the appellants which appears only obliquely in their
written submissions. The concession was that the 1998 Policy did not indemnify
the partners of QML for their own negligence where they acted independently of
employees, but indemnified them against any liability for their own negligence if it
was connected with anything done or omitted by an employee, whether or not the
act or omission constituted negligence. The concession is curious because it
appears an impossible construction of the 1998 Policy if Special Condition 11 is
given the meaning advanced by the appellants. If Special Condition 11 has that
effect, which the Chief Justice accepted, then s 45 did operate to strike it down,
leaving the insuring clause to operate according to its terms which extend to
covering the partners for their own negligence. If one ignores Special Condition 11,
as s 45 requires, if it applies, the policy cannot be read to produce the result now
said by the appellants to be what the policy achieves.
[79] It is only if Special Condition 11 remains an operative term of the 1998 Policy that
the policy can have the meaning which the appellants now adopt. That involves an
abandonment of the submissions made at trial and on appeal that the condition
operated as an exclusion of liability to indemnify the insured because it had taken
out other insurance. The appellants’ concession involves accepting CGU’s
contention that s 45 of the IC Act did not apply, and the condition operated to define
the risk covered which did not extend to the liabilities of QML’s partners for their
own negligence for which they were insured by AMIL.
[80] The debate then becomes quite narrow and focuses upon what is meant by a claim
“arising from the activities of the pathologists and/or medical practitioners
providing services for or on behalf of the Insured.” The respondent’s contention is,
-- 22 of 25 --
23
as I have set out at some length, that such a claim is one for negligence of the
partners themselves. This leaves as the subject matter of the CGU policy claims
against an employee, or a practice company or QML as employer. That is to say
claims arising out of an employee’s negligence for which the employer is
vicariously liable.
[81] The appellants’ submission was that the claims excluded by the special condition
were those arising out of acts or omissions of the partners of QML without any
involvement at all of an employee with respect to the activity which gave rise to the
claim. This rather clumsy expression is not how the appellants expressed their
submission but it is what it comes down to.
[82] The appellants approached the question of construction from the insuring clause, not
the special condition. They emphasise the promise of indemnity against “any Claim
… arising from any actual or alleged act, error, omission or conduct … .” They
accept that (despite the inconsistency with their position that the condition is void)
Special Condition 11 exempts from the promise of indemnity the partners’ own
negligent conduct but submits that if there was any causal connection between an
act, error or omission of an employee and the partners’ negligence then the 1998
Policy responds to the claim. It is not necessary, the appellants emphasise, that the
act, error or omission amounted to negligence.
[83] The appellants’ submission should be rejected. It would achieve a strained and
unnatural result, and one at odds with the common understanding pursuant to which
QML effected the 1998 Policy, particularly the memorandum which was the basis
of fact II. The policy was to indemnify an employee who was sued, and
incidentally the employer. It was not to cover the QML partners for their own
negligence. The appellants’ contention would nullify the common understanding
and extend indemnity to the partners for their own negligence as long as their
negligent conduct was somehow connected with an act or omission of an employee.
[84] The insuring clause of the 1998 Policy is concerned with legal liability. It
indemnifies QML against any claim for which it became legally liable arising out of
any act, error or omission. The words naturally import some negligent act, error or
omission. In context that means such an act or omission of an employee.
[85] One then returns to the question whether the D’Arcy claim was against QML for the
negligence of the partners themselves, or whether it was based upon the negligence
of an employee for which the partners were vicariously liable. The 1998 Policy
would respond to the latter claim but not the former. The Chief Justice concluded
the claim was in the former category. His Honour said:
“[25] That assumes significance because of the basis on which
AMIL contends CGU’s liability arose. In paras 18-19 of the
statement of claim, AMIL alleges that each of the
pathologist partners fell within the definition of “insured”
under the CGU policy, and that Ms D’Arcy’s claim arose
from the act or omission of a cytologist who was not a
pathologist or medical practitioner and not entitled to
indemnity under a medical defence union policy etc. The
last reservation refers to item 11 in the schedule to the
policy. The claim was presented in that way to distinguish it
from the sort of claim for which a pathologist partner would
-- 23 of 25 --
24
be primarily liable, such a claim as would activate the AMIL
coverage.
[26] In this context the following circumstances are significant:
that Ms D’Arcy alleged a breach by the partners of their
primary duty to exercise care and skill as pathologists; that
the “agreed facts” include the statement that Ms D’Arcy’s
proceeding alleged negligence on the part of the partnership
as the cause of her loss; that there was no proof in this
instant proceeding that a cytologist was negligent,
notwithstanding QML’s capacity to establish that if it was
indeed the case. Dr Russell, QML’s general manager, gave
evidence, and he said that he would be surprised if any
QML doctor had supervised the interpretation of the
screening … but Dr Russell was unaware of the
circumstances and could do no more than speculate as to
what occurred … . I regard that assessment from Dr Russell
as no more than speculative, and therefore unhelpful.
[27] I infer that the claim was accepted and processed on the
basis on which it was advanced, that is, as alleging
negligence on the part of the QML partners for their failure
properly to check the analysis of the pap smear. Consistently
with that, after the incorrect reading in 1993, and at the time
of other proceedings instituted against the QML partners in
New South Wales in 1995 by Ms Fraser (to which I will
come), QML put into place more rigorous systems to
improve the screening process … .”
[86] The finding is, with respect, plainly right. The only allegation of negligence made
by Ms D’Arcy and Mr Vinnicombe was against the partners of QML for their own
failures. Paragraph 9 of the D’Arcy statement of claim pleaded:
“In relation to the 1993 pap smear and, in particular, the Defendant’s
examination and report on that … smear, the Defendant breached its
duty to the First Plaintiff and was negligent.
Particulars of Negligence
(a) The Defendant failed to ensure that due care and skill was
exercised in the performance of examinations on the 1993
pap smear;
(b) The Defendant failed to ensure that examinations on the
1993 pap smear were performed with such professional care
and skill as could reasonably be expected of a pathology
specialist;
(c) The Defendant failed to ensure that the 1993 pap smear was
examined in such a way as to detect the presence of any
abnormal or cancerous cells … ;
(d) The Defendant failed to perform sufficient tests to detect
any and all abnormalities in the … smear;
(e) The Defendant failed to ensure that any and all
abnormalities in the … smear were detected;
-- 24 of 25 --
25
(f) The Defendant failed to detect the presence of abnormal or
cancerous cells … in the … smear;
(g) The Defendant failed to ensure that the presence of any and
all abnormalities … in the … smear was reported to the First
Plaintiff or (her) treating doctor; and/or
(h) The Defendant failed to inform the First Plaintiff or (her)
treating doctor of the presence of abnormal or cancerous
cells … in the … smear.”
[87] The “defendant’ was said to be:
“Queensland Medical Laboratory … a company duly incorporated …
(which) carried on a business under the name … QML … as a
pathology specialist … .”
[88] That would appear to be factually incorrect but no point was taken about the error.
Clearly enough the allegation of negligence was made against the pathologists who
constituted QML, the partnership. The statement of claim contains no allegation of
a negligent act or omission by a cytologist or any other employee. There is no
pleading of liability arising from an act or omission of employees. The case
advanced against QML was one of a deficient system of supervision and
examination by the pathologists, not their employees.
[89] The 1998 Policy did not respond to the claim actually made by Ms D’Arcy and
Mr Vinnicombe.
[90] One last matter should be mentioned. There is a trace of confusion in some of the
evidence as to whether the employees protected by the 1998 Policy included
medical practitioners. The Chief Justice seems to have thought such persons were
not covered in his Honour’s statement of the convention. On the other hand there
are several contemporaneous documents which refer to the cover extending to
employees whether medically qualified or not. I expect that was the position but
nothing turns on it for the present appeal. The cytologist in question was not a
medical practitioner. Nor was she said to have been negligent.
[91] The basis on which the appeal should be dismissed makes it unnecessary to discuss
the appellants’ challenge to the finding of estoppel by convention, or their
arguments that it could not arise by reason of pre-contract statements, or operate
against s 45. To the extent that the appellants’ attack on the estoppel depended
upon criticisms of fact the critical findings were all supported by evidence which
the Chief Justice indicated he accepted. There was ample support for them in the
oral testimony and the supporting documents. Devries v Australian National
Railways Commission (1993) 177 CLR 472 and Fox v Percy (2003) 214 CLR 118
show the difficulty in the path of such an attack. The appellants, as I understood
their arguments, did not seek to bring the case within the narrow limits within which
an appellate court might interfere with findings of fact. I mention this because the
criticisms of the facts relevant to the estoppel would, if made out, apply to the facts
on which I have relied to construe the policy, or some of them. The appellants
relied also upon what they saw as discrepancies between the convention as pleaded
and as proved. Even if made out the point goes only to the credit of the
respondent’s witnesses, and they were believed.
[92] The appeal should be dismissed with costs.
[93] ATKINSON J: I agree with the order proposed by Chesterman JA and with his
Honour’s reasons.
-- 25 of 25 --
Official source: https://www.sclqld.org.au/caselaw/QCA/2010/189