Articles Posted in Insurance Dispute

hieroglyph-1226853-715x1024The death of a loved one is always an emotionally difficult time. But the loved one’s death also creates many obligations and legal requirements that the deceased successors must accomplish. Often, these processes can be complex and may lead to litigation, especially when money is involved. A recent court case out of the Third Circuit Court of Appeal for Louisiana illustrates these problems.

The case surrounds the life insurance policy of Triston Knoll. Mr. Knoll obtained a life insurance agreement and named his then-wife, Tina Knoll, and their minor child, Andree Knoll, as the primary beneficiaries (the individuals who would receive the payment made upon the death of Mr. Knoll pursuant to the life insurance agreement). The life insurance agreement was designed to pay Andree two-thirds and Ms. Knoll one-third of the total life insurance policy amount. Years after Mr. Knoll obtained the life insurance policy, Ms. Knoll and himself filed and were granted, a divorce. Mr. Knoll passed two years after the divorce.

Upon the death of Mr. Knoll, Ms. Knoll and Andree were supposed to receive the insurance policy payment because both were still both named primary beneficiaries. Andree’s biological mother, Andrienne Theriot, contested the insurance policy payment, arguing that prior to Mr. Knoll’s death he intended to name Ms. Theriot as a beneficiary and therefore Ms. Theriot was entitled to some of the life insurance proceeds. This controversy was brought before a federal district court where the court ruled that Ms. Knoll and Andree were entitled to all of the proceeds from the life insurance policy. While fighting the litigation in federal district court, Ms. Knoll and Andree entered into an agreement where Andree would receive the all of the life insurance proceeds and that those proceeds would be placed in a trust. However, after their success in the federal district court, Ms. Knoll argued that she did not intend to give up her right to some of the life insurance proceeds. Ms. Knoll then decided to file a claim in Louisiana district court.

bad-weather-1398005-1024x683What happens if an insurer fails to pay a claim on time to the insured? In Louisiana, an insurer could be subject to a penalty for failing to pay. This case out of Ascension Parish demonstrates how an insurer can be guilty of bad faith when their actions are arbitrary, capricious or without probable cause.

On October 6, 2010, Mr. Beau Schexnaildre was involved in a motor vehicle accident caused by the negligence of Mr. Nathan Spicer. On March 14, 2012, Mr. Schexnaildre sought recovery under a policy of uninsured/underinsured motorist coverage (“UM”) issued to him by State Farm Mutual Automobile Insurance Company (“State Farm”). Mr. Schexnaildre provided State Farm with copies of the accident report, medical reports, medical bills and Mr. Spicer’s insurance policy. Mr. Schexnaildre’s attorney received a $25,000 check in the mail from State Farm on April 16, 2012, 33 days after State Farm received the demand.

Mr. Schexnaildre filed a lawsuit against State Farm claiming it failed to tender benefits under the UM policy within 30 days of receipt of satisfactory proof of loss and that such failure was arbitrary, capricious and without probable cause. State Farm filed a motion for summary judgment arguing that Mr. Schexnaildre did not provide sufficient proof of loss under La. R.S. 22:1892 because the UM demand did not show that Mr. Spicer was uninsured and only included some medical bills. A motion for summary judgment will be granted if the pleadings, depositions, answers, and admissions, show that there is no genuine issue as to material fact. State Farm also asserted that the claim was timely paid under the statute because the payment was mailed within 30 days of receiving the UM demand. In opposition to the motion, Mr. Schexnaildre argued the statute requires that payment must be received by the insured within 30 days.

piggy-bank-1-1241054-1024x764Life insurance benefits can provide beneficiaries with the monetary needs they require. What is a life insurance policy? An insurance company agrees by contract to provide a lump-sum payment, called a death benefit, to the beneficiaries upon the insured’s death in exchange for premium payments. But what happens when the insured dies and the beneficiary encounter problems in getting paid? This case out of Concordia Parish explains entitlement to life insurance proceeds in Louisiana.

On October 16, 2012, Michael Burley and his brother William each purchased life insurance policies from New York Life Insurance Company (“New York Life”) and named the other as beneficiary. Mitch Ashmore, the insurance agent, filled out the application for the policy insuring William’s life and answered “No” to question 3(1) that asked if the applicant had been diagnosed, treated, tested positive for or been given medical advice for drug or alcohol use. In December 2012, the policy insuring William’s life became effective. On April 24, 2013, William died from a heart attack. Mr. Ashmore filed Mr. Burley’s claim for the policy proceeds. On October 14, 2013, New York Life sent a letter to Mr. Burley stating that the answer to question 3(1) should have been “Yes” because of William’s medical records and death certificate listed marijuana use. The letter also stated that New York Life’s normal procedure was to refund all premiums and void the policy. On January 30, 2014, New York Life sent Mr. Burley a check for the premiums.

Mr. Burley filed suit against New York Life seeking the $200,000 policy proceeds, as well as penalties and attorney fees. Mr. Burley filed a Motion for Default Judgment because of New York Life’s failure to Answer. The trial court awarded a default judgment to Mr. Burley for the $200,000 proceeds, $20,000 in penalties under La.R.S. 22:1973, as ewell as $100,000 in penalties under La.R.S. 23:1892. New York Life filed a Motion for a New Trial, which the trial court denied. New York Life appealed the default judgment and the denial of its Motion for New Trial to the Louisiana Third Circuit Court of Appeal.

car-crash-1316724-1-1024x768When insurance coverage doesn’t pay enough money to compensate a victim for injuries suffered in a car accident, underinsured motorist coverage exists to fill in the gaps. Louisiana law requires that insurance companies provide this coverage. La. R.S. 22:1295. Although this seems like a simple solution for undercovered individuals, many people are unaware that this type of insurance does not benefit every possible person who may be affected by a car accident; an insurance policy’s contract ultimately determines who and what the policy might cover. This common misperception was at issue in a case that arose in Caddo Parish.

In Texas in 2013, Helen Stopak was killed in an automobile accident while riding in a car owned by one of her daughters. The driver’s insurance company (Safeco) paid $30,000 in benefits to her daughters, one of whom was Lori Marshall. Soon afterward, Mrs. Marshall attempted to claim underinsured motorist benefits from her own husband’s insurance policy provided by the Louisiana Farm Bureau Casualty Insurance Company (the Farm Bureau). She believed she was entitled to damages under her underinsured motorist insurance policy for wrongful death and for her own mental distress since her mother had been in an underinsured car. The Farm Bureau refused to pay and she sued. The trial court ruled in favor of the Farm Bureau. Mrs. Marshall appealed.

At issue in the Court of Appeal was whether Mrs. Marshall’s mother was insured under the policy. If so, the Farm Bureau would be obligated to pay out its benefits. Even if not specifically mentioned in the policy, the law requiring underinsured motorist coverage acts as if it is part of the insurance contract. Some insurance policies simply include the wording of the statute in order to provide underinsured motorist coverage. A contract can, however, provide for exceptions to these payments, such as not extending it to people or cars not actually under the policy. Lafleur v. Fidelity & Casualty Co. of New York, 385 So.2d 1241 (La. Ct. App. 1980).

areopagus-1214742-1-1024x657Uninsured motorist (UM) liability coverage is additional coverage that can pay for injuries to individuals protected under your policy, including family members in other cars and passengers in your insured cars, resulting from a car accident caused by an uninsured driver. However, this additional coverage can be modified or inapplicable if the insured decides to reject coverage, select lower limits, or select economic-only coverage, which would only cover costs, not non-monetary damages, such as pain and suffering or quality of life damages. UM coverage is also part of most businesses insurance policies. All of these options allow for insurance policies to be flexible, and whatever a policy stipulates is what it will cover, but as a case that arose in the Parish of St. Landry shows, writing and reading an insurance policy isn’t always straight-forward.

In October of 2011, Crystal Bell was driving a company car, owned by Compass Behavioral Center for Crowley, when she was rear-ended by Merlyn Rodgers. Crystal Bell and the occupants of her vehicle filed a lawsuit against Merlyn Rodgers and her insurance company. After filing the lawsuit, the plaintiffs amended their complaint by naming Compass’ insurance company, Progressive Insurance Company, as a defendant in order to claim UM coverage.

Prior to the accident, in 2007, a Compass representative, Mark Cullen, had signed a CSL automobile insurance policy with Progressive for $1 million in liability coverage. A CSL policy sets a predetermined limit for the combined total of the Bodily Injury Liability coverage and Property Damage Liability coverage per occurrence or accident. Under Louisiana law, UM coverage must be applied through an Uninsured/Underinsured Motorist Bodily Injury Coverage form, which is issued by the Commissioner of Insurance. La. R.S. 22:1295. This form, however, lacked a space for addressing CSL policies. So, Cullen initialed the box that stated he selected UM coverage but wrote in “$100,000” for coverage and marked out “each person” and wrote in “CSL.” Cullen did this even though the form indicated that it may not be altered or modified. Progressive filed a motion for summary judgment and asked that the district court rule that the policy in place at the time of the accident was only for $100,000. The plaintiffs’ filed a counter-motion for summary judgment. The plaintiffs argued that Compass’ UM form was invalid and therefore UM coverage provided for $1 million in coverage. Alternatively, plaintiffs argued that if the UM coverage form was valid, then it was for $100,000 per person as opposed to only $100,000 for each CSL accident.

energy-1495365-1024x768After making a successful workers’ compensation claim, an insurer may make a subrogation claim, which is the right of an insurer to recover the amount paid out in a claim from a third party that caused the claim to occur. However, failure to properly reserve this right can affect an insurer’s right to recovery and possibly bar recovery altogether. A recent lawsuit in the Orleans Parish highlighted this fact.

In the aftermath of Hurricane Gustav, numerous workers were needed in order to restore Louisiana’s power grid. Mr. Scarberry was a former electrical lineman for Oklahoma Gas and Electric company (OGE). OGE is part of the Southeastern electrical Exchange (SEE), which is a nonprofit trade association composed of numerous utility companies that provide electricity throughout the U.S. Members in the SEE enter into Mutual Assistance Agreements, which govern relationships between requesting members and responding members. In this case, Entergy Gulf States Louisiana L.L.C. and Entergy Services, Inc. (collectively referred to as Entergy) requested the assistance of OGE in restoring power throughout Louisiana. As a result of this request, Mr. Scarberry began working for Entergy in Jennings, Louisiana under an agreement.  

During his efforts, Mr. Scarberry was severely electrocuted and became permanently disabled as a result of the accident with no chance for gainful employment in the future. Mr. Scarberry filed a lawsuit in July 2009 against Entergy. During this period, Mr. Scarberry received workers compensation from OGE in the amount of $150,162.49. OGE received reimbursement for these payments from Entergy, which was acknowledged with a “receipt” executed on August 1, 2011, pursuant to their agreement.  OGE also reserved their right to subrogation with the receipt.  

misc-rig-oil-ship-yard-equipme-1468457-1024x768In the insurance industry, one of the most important issues to consider when determining whether a claim is covered under a policy is the wording of the contract. Whether it is home, auto, life, or, as in this case a marine insurance policy, the exact words of the contract will control whether or not a specific claim will be paid out. Equally important are the laws which will control how those words are interpreted. And in a recent case out of Louisiana, one insured was out of luck over the interpretation of one small word.  

In a recent Louisiana case, Union Oil Company of California, which owned an offshore drilling platform near the coast of Louisiana, contracted with Shaw Global Energy Services Inc. (“Shaw”) from Delcambre, Louisiana, to perform sandblasting and painting for the platform. In 2003, Michael Cash, an employee of Shaw, was injured by an employee of Max Welders, Inc. while being transferred by crane from a platform to a supply vessel. Mr. Cash filed a lawsuit against Max Welders, its primary insurance company, and its marine excess insurer, Liberty Insurance Underwriters, Inc. (“Liberty”).  During the course of the lawsuit, Liberty notified Max Welders that they were declining to cover the incident with Mr. Cash because the act of ferrying Mr. Cash to and from the platform fell under an exclusion in the excess insurance policy. The exclusion Liberty pointed to was a platform exclusion where they would not cover anything “arising out of the ownership, use or operation of . . . platforms.”  Max Welders, the primary insurer, and Mr. Cash settled for the policy limit of one million dollars. But because of the severity of Mr. Cash’s injuries, Max Welders agreed to pay an additional four hundred thousand dollars.

Max Welders brought a cross-claim against Liberty alleging the platform exclusion did not apply and that coverage should be extended to cover the four hundred thousand dollars in excess payment.  The United States District Court for the Western District of Louisiana agreed with Max Welders that the platform exclusion did not apply because the word “use” in the insurance policy was ambiguous.  The District Court reasoned that because the transferring of Mr. Cash to the vessel was not within the intended purpose of an oil rig platform (extracting energy) that the exclusion did not apply and the insurance company had to pay Max Welders for the four hundred thousand dollars.  Liberty appealed to the United States Fifth Circuit Court of Appeal.    

the-pig-1189462-1024x807When employees are fired they can often be entitled to benefits upon termination; including money payments to act as a substitute salary while the terminated employee searches for another job. While there is no federal requirement in the United States for an employer to offer severance pay, many do as it can be an attractive benefit to potential employees. Many employers choose to adopt a plan that falls under the Employee Retirement Income Security Act (“ERISA”).  Employers can get tripped up however when they fail to support a denial of severance pay by substantial evidence.   

In this case, Mr. Napoli was denied severance pay because the company he worked for claimed that he was terminated for violating company policies. Mr. Napoli was hired by Scios, Inc. in 2001 which was subsequently acquired in 2003 by Johnson and Johnson. He enrolled in the severance pay plan through Johnson and Johnson. After he was terminated, Mr. Napoli filed for severance pay and was initially told he was eligible. However, Johnson and Johnson later denied his claim asserting that Mr. Napoli committed a “Group 1 Violation” and that he made around $3,000 in wrongful charges to a corporate credit card. Mr. Napoli, in a wise move, hired an attorney who subsequently applied for severance pay again and requested additional information about why the claim was denied. Johnson and Johnson again denied the claim and included the provision of the severance agreement Mr.Napoli allegedly violated. Mr. Napoli appealed through the corporation’s internal procedures in 2012 and the claim was denied again.  

Mr. Napoli filed a lawsuit in state court alleging that the company denied him benefits without just cause and that such an act violated ERISA. Johnson and Johnson responded by removing the case to federal court and counterclaiming for $3,000 in unauthorized credit card charges. The United States District Court for the Middle District of Louisiana agreed with Johnson and Johnson that the denial was based on a reasonable interpretation of the severance pay plan. Mr. Napoli appealed that decision to the United States Court of Appeals for the Fifth Circuit.  

When a natural disaster strikes the issue of insurance comes to the forefront. What can a homeowner do when their home is damaged but the insurance company delays and fails to pay? That was the case when a Kenner, Louisiana, couple had their wood floors ruined by Hurricane Isaac. After taking the company to court, the family was finally able to recover claims for the damages as well as sanction the insurance company for the delay.

japanese-porch-tsumago-1228438-1024x768Russell and Tracy Varmall owned a home in Kenner, Louisiana. Their home sustained damages during Hurricane Isaac in 2012. The home was insured by Bankers Specialty Insurance Company (“Bankers”) for wind damage and New Hampshire Insurance Company for flood damage.

The Varmalls initially made claims to Bankers after the hurricane, which included damages to their roof and attic, water damage to their living room ceiling, damages to their fence, and a claim for spoiled food. These claims were adjusted in a timely fashion and were not an issue in the case.

mercedes-1450415-1024x683Louisiana has laws in place requiring drivers to carry car insurance. However, insurance policies are not uniform and some policies may contain ambiguities or be silent altogether on specific issues. The following case illustrates such a scenario.

Jeremy Elliot was a service technician working for a Mercedes-Benz dealership in Baton Rouge, LA and was involved in an accident while driving a customer’s car during a routine servicing. Elliot sued the other driver and the driver’s insurance company, State Farm; State Farm settled. Evidently, the other driver’s insurance policy was insufficient to cover the damages.   

Thus, Elliot sought reimbursement elsewhere and sued the insurance company that covered the car he had been driving, Encompass Indemnity Company (“Encompass”), as well as his employer’s insurance company, Travelers Indemnity Company (“Travelers”). Travelers filed a motion for partial summary judgment, asking the District Court to find that Encompass was liable for up to $500,000 in coverage for an underinsured motorist.