Violation of primary key

Violation of PRIMARY KEY constraint 'PK_CUSTOM2'. Cannot insert
duplicate key in object 'MHGROUP.Custom2'

Is there ANY other reason this violation of the primary key would
happen OTHER than a trying to insert a duplicate record?

This sql statement false due to the primary key violation:

Insert Into MHGROUP.Custom2
Select
ClientNumber,
MatterNumber,
MatterDescription,
'Y'
From MG_EliteMatters EM
Left Outer Join MHGROUP.Custom2 C2
On C2.CPARENT_ALIAS = EM.ClientNumber
And C2.Custom_ALIAS = EM.MatterNumber
Where CPARENT_ALIAS Is Null And Custom_ALIAS Is Null

---Custom2
CREATE TABLE [MHGROUP].[CUSTOM2](
[CPARENT_ALIAS] [varchar](32) COLLATE SQL_Latin1_General_CP1_CI_AS
NOT NULL,
[CUSTOM_ALIAS] [varchar](32) COLLATE SQL_Latin1_General_CP1_CI_AS NOT
NULL,
[C_DESCRIPT] [varchar](254) COLLATE SQL_Latin1_General_CP1_CI_AS
NULL,
[ENABLED] [char](1) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
CONSTRAINT [PK_CUSTOM2] PRIMARY KEY CLUSTERED
(
[CPARENT_ALIAS] ASC,
[CUSTOM_ALIAS] ASC
)WITH (IGNORE_DUP_KEY = OFF) ON [PRIMARY]
) ON [PRIMARY]

--MG_EliteMatters
CREATE TABLE [dbo].[MG_EliteMatters](
[Matters] [varchar](16) COLLATE SQL_Latin1_General_CP1_CI_AS NULL,
[ClientNumber] [varchar](32) COLLATE SQL_Latin1_General_CP1_CI_AS
NULL,
[ClientDescription] [varchar](254) COLLATE
SQL_Latin1_General_CP1_CI_AS NULL,
[MatterNumber] [varchar](32) COLLATE SQL_Latin1_General_CP1_CI_AS
NULL,
[MatterDescription] [varchar](254) COLLATE
SQL_Latin1_General_CP1_CI_AS NULL,
[LastDateModified] [datetime] NULL,
[PracticeArea] [varchar](50) COLLATE SQL_Latin1_General_CP1_CI_AS
NULL
) ON [PRIMARY]
.

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