Articles Posted in Insurance Dispute

69-Email-05-22-19-picture-1024x683Insurance policies are often complex and difficult to understand. However, especially when an insurance policy is at issue in a lawsuit, it is essential that you fully read and understand what the insurance policy covers in order to maximize your chance of recovery success, as well as understand the principles that courts use in interpreting policy provisions.

In September 2014, Peyton Wilt was tragically killed when he was riding in a gyrocopter, an experimental amateur-built aircraft, piloted by Darren Mahler. Lindsey King, the mother of Peyton, brought a claim individually and behalf of Wilt, against Mahler’s insurance company, Old Republic Insurance Company. King alleged that the Mahler’s pilot insurance policy covered the bodily injury and property damage resulting from the crash.

Old Republic filed a motion for summary judgment, arguing that its policy did not cover the gyrocopter’s flight or crash, or Peyton’s death. Old Republic pointed to the declarations section of the insurance policy, which listed a 1973 Piper PA-28-140 fixed wing aircraft, not the gyrocopter involved in the crash. King countered that the policy covered “any aircraft” “used by the named insured” which was not described in Item 5 of the Declarations. In response, Old Republic argued that King’s argument would lead to absurd results because it would provide coverage for any aircraft that Mahler used, without consideration of its ownership airworthiness, certification, weight, or seating capacity. The New Orleans Parish Civil District Court found in favor of Old Republic, dismissing all claims against Old Republic with prejudice (meaning the claims could not be filed again). King appealed this finding.

car-buying-car-dealership-car-key-97079-1024x683In today’s world, consumers are faced with increasingly complicated contracts and waiver forms for even the simplest transactions. These contracts not only have the potential to confuse consumers, but create an opportunity for corporate exploitation. The following case illustrates an example of the courts reaffirming protections for consumers over companies. 

Andrea Weddborn and Rene Martinez (“Plaintiffs”) had two car insurance policies that covered their 2007 Toyota Camry. They purchased these policies from Affirmative Insurance Company (“Affirmative”) and National Insurance Company (“National”) (collectively referred to as “Defendants”). In December 2012, Plaintiffs were involved in an automobile accident in Orleans Parish of Louisiana. The accident was caused by an unidentified driver of another vehicle who changed lanes, struck Plaintiffs’ vehicle, and then fled the scene. 

Both Affirmative and National refused to compensate Plaintiffs for the damages suffered in the accident, arguing that Plaintiffs’ insurance policies did not include Uninsured Motorist (“UM”) coverage. Plaintiffs subsequently filed suit against the insurance companies.

art-close-up-costume-1144283-1024x683A Mardi Gras Ball can be an exciting and fun event; however, when someone is injured, the mood turns from festive to fearful. If you were the one injured, from whom do you recover your damages? Can you even recover? If you are the organization, are you insured? Who will bear the cost associated with the injury? For an organization, having a strong insurance contract from the beginning can work to alleviate these concerns and many others.  

 Ms. Clesi had attended a Mardi Gras Ball at the Pontchartrain Center when she sustained injuries resulting from a fall. She then filed suit against The City of Kenner (“the City”) and Certain Underwriters at Lloyd’s of London (“Lloyd’s”). The underlying case is pending. The City proceeded to file for damages against The Krewe of Argus (“Argus”). The City alleged that there was a Use License Agreement between it and Argus, which required Argus to obtain an insurance policy from Lloyd’s for the use of the Pontchartrain Center for its Mardi Gras Ball. The City claimed that it was entitled to protection under the insurance policy in the same way Argus was. If the City’s claim was correct, Lloyd’s would be forced to defend the City against Ms. Clesi’s damages claims. Further, the City seeks reimbursement from the attorney fees and other costs associated with defending Ms. Clesi’s suit.

The trial court found in favor of the City. An appeal followed. Defendant appellants argued that the court must further interpret the indemnification provision of the Use License Agreement so that there could be a determination of the scope of Lloyd’s duty to defend the City.   

ship-cranes-1238624-1024x683Insurance policy language is carefully crafted to limit the areas of coverage. A Ponchatoula area boating business tried and failed to extend their insurance policy coverage for accidents on the water to a land-based crane accident. So what happens when you try to cover a land based accident with maritime insurance? 

Larry Naquin was operating a land-based crane for Elevating Boats (EBI) when the pedestal of the crane snapped, and the crane toppled over. Mr. Naquin jumped from the crane and broke both of his feet and a suffered a lower abdominal hernia. The crane landed on another EBI employee and that employee was killed. As a result of his injuries, Mr. Naquin had several surgeries and attended physical therapy but was never able to return to physical work.

Mr. Naquin brought a lawsuit under the Jones Act. The Jones Act is a federal law that gives employees that work at sea the ability to sue their employers. At trial, the court held that Mr. Naquin was properly viewed as a Jones Act seaman and that EBI was negligent. Mr. Naquin was awarded $1,000,000 for past and future physical pain and suffering, $1,000,000 for past and future mental pain and suffering, and $400,000 for future lost wages. EBI appealed and challenged the grant of Jones Act seaman status as well as the negligence ruling. EBI lost the appeal and a portion of the verdict was vacated and sent back to the Trial Court.

car-breakdown-1444955-1024x683Comedian Chris Rock once famously opined that insurance should be renamed, “In-case-of.” You pay for insurance every month “in case of” some unfortunate circumstance occurring. Well, you better have access to an excellent attorney “in case of’ the other driver not having the insurance, or even the car, in his name. This is what happened to Wanda Kahl. When the insurance company disputed its obligation to pay for her injuries, Ms. Kahl was subject to a protracted legal battle in court.

Ms. Kahl was driving down Jane Ave in New Iberia one summer day in 2012 when she was rear-ended by a hit-and-run driver. She filed a lawsuit against the vehicle’s owner and his insurer. The registered owner, Tricky Chevalier, later testified in a deposition that the vehicle in question was ostensibly a “straw purchase.” That is to say, Chevalier had purchased, registered, and insured the vehicle in his name but all for the benefit of his cousin, one Joseph Pete. Mr. Pete operated the vehicle, and also paid the insurance premiums, while Chevalier remained owner in name only. After this deposition, Safeway Insurance moved for summary judgment. A summary judgment motion requests that the court rule for the movant without a trial because the evidence presented thus far shows “no genuine dispute of material fact.” La. C.C.P. art. 966. Safeway claimed Chevalier’s admission constituted a material misrepresentation of fact, without which he would not have received coverage. Since the coverage was procured by misrepresentation, Safeway argued that the contract for coverage was not valid, so they were not responsible for payment.

Ms. Kahl appealed Safeway’s summary judgment motion and countered with a summary judgment motion of her own, asserting that the law clearly states the accident must be covered. She relied on La. R.S.32:900(F)(1) to show that Safeway is obliged to pay. Safeway argued that the statute does not apply to the policy in question since this policy is an “automobile policy,” and not a “motor vehicle policy.” Safeway contended that to be a “motor vehicle policy,” the policy must be certified in accordance with La. R.S.32:898, and there no proof of this. Therefore, the policy in question is an automobile policy and not a motor vehicle policy. The trial court agreed, granting Safeway’s motion and denying Ms. Kahl’s.

Constr-hats-768x1024Dot your i’s and cross your t’s. We’ve heard it since kindergarten. Yet, sometimes it is easy to forget the basics when a case seems to be open-and-shut.

In 2003, Mr. JL, an East Baton Rouge employee of Landis Construction Company (“Landis”), was injured on the job. Landis’ insurance carrier, (“Gray”), paid workers’ compensation and medical benefits to the employee. Landis and Gray asked the Office of Workers’ Compensation Administration (“Board”) to reimburse the payments made to Mr. JL but the Board denied the request. Six years later, Landis and Gray entered a Consent Judgment with the Board. Later, in 2013, Landis and Gray filed a Petition to Enforce Consent Judgment to enforce the 2009 Consent Judgment. One year later, in 2014, Landis and Gray filed a Motion to Enforce Consent Judgment.

The trial court held for Landis and Gray, awarding $28,095.60 in April of 2017. The Board appealed.

revolt-368925-unsplash-1024x683Imagine you are driving home from work and you collide with another vehicle. Would your employer be liable for the damages? For most commuters, the employer is not accountable for any accidents that occur on the way to or from the place of work and the employee’s residence. But in certain cases, such as where an employee is traveling with a specific business purpose under the direction of the employer, the employer may be on the hook under a theory known as vicarious liability. Effectively, vicarious liability holds an employer liable for an employee’s negligence when the employee is acting within the scope of the employer’s business. La. C.C. art. 2320.

On December 20, 2009, James Richards was traveling from Texas to his home in Florida along Interstate 10. In Bienville Parish, Louisiana, Richards collided with a van, causing the death of the driver and severe, paralyzing injuries to the passenger, Ricky Winzer. In 2010, Winzer filed a lawsuit against Richards and Richards’s employer, Certified Constructors’ Service, Inc. (“CCSI”). Winzer alleged that Richards was acting in the course and scope of his employment at the time of the accident, making CCSI liable through the doctrine of vicarious liability. CCSI filed a motion for summary judgment, arguing that Richards was not employed at the time of the accident and therefore CCSI could not be liable for his negligence. The trial court, after an evidentiary hearing in which depositions, interrogatories, and payroll documents were submitted, granted CCSI’s motion. Winzer appealed to Louisiana’s Second Circuit Court of Appeal.

Upon review, the Court reiterated the general rule under Louisiana jurisprudence that an employer is not liable for an employee’s negligence when they are driving to and from work unless the employer provides the transportation, pays expenses or wages for the time spent traveling, or has assigned the employee a specific  task to perform for the employer. See Woolard v. Atkinson, 988 So. 2d 836 (La. Ct. App. 2008). To determine if the employee’s actions fall within one of the above exceptions, courts must examine the following factors:  the employer’s power of control; the employee’s duty to perform the act in question; the time, place, and purpose of the act in relation to the employment; the relationship between the employee’s act and the employer’s business; the benefits received by the employer from the act; the employee’s motivation for performing the act; and the employer’s reasonable expectation that the employee would perform the act. See Orgeron v. McDonald, 639 So. 2d 224 (La. 1994).

the-last-drop-1306724-1024x768Louisiana, like most states, requires drivers to maintain liability insurance (or less commonly, a liability bond or certificate of self-insurance) to legally operate a motor vehicle. In 1992, an amendment to this law explicitly allowing insurance companies to offer “named driver” exclusions in their policies, which allowed an insured the option of paying a lower premium in exchange for insurance that provides no coverage while the specifically named driver operates a covered vehicle. The law was upheld by Louisiana courts, though it did create some disagreements in its interpretation, both among the appellate courts and between the Louisiana Supreme Court and the legislature. One of these disagreements concerned whether the owner of a vehicle could purchase liability insurance and then, through the named driver exclusion, exclude himself from coverage under the policy. Although the Louisiana Supreme Court determined that to allow such a maneuver would be violative of public policy, their interpretation was overruled by subsequent legislation explicitly allowing it.

In Bourg v. Southall, a motor vehicle accident occurred in Marrero, Louisiana where there was no question of fault: Plaintiffs were stopped at the intersection of LA-45 and Lapalco when they were hit from behind by an intoxicated driver. Although Plaintiffs were able to recover damages at trial, that ruling was overturned by the Louisiana Fifth Circuit Court of Appeal on the basis that the driver of the vehicle was listed in a named driver exclusion of the policy, despite the fact that he was both the owner of the vehicle and the named insured (he purchased the policy).

La. R.S. 32:900(L) clearly allows the owner of a vehicle to purchase liability insurance on a vehicle and to exclude himself from coverage under the policy. Sensebe v. Canal Indemnity Co., 58 So.3d 441, 451 (La. 2011). Furthermore, this provision does not set forth any specific requirements with respect to the form to exclude a named person from coverage; the only requirement is a written agreement. See Gilbert v. Reynoso, 917 So.2d 503, 505–06 (La. Ct. App. 2005).

torn-ligament-and-fractured-bone-bandages-1631721-1-1024x727
Whether we like it or not, bureaucracy pervades our lives. A failure to follow a single step of an administrative task can have far-reaching consequences. This is especially so when dealing with an insurance company. The case of Dr. James Moss is an example.

Dr. Moss, a Shreveport urologist, suffered from osteoarthritis. Because his condition prevented him from performing his work, he filed a claim with his insurance company, Unum. Unum denied Dr. Moss’s claim and told him that if he wished to appeal the denial, he had to file a written appeal within 180 days. Rather than filing a written appeal, Dr. Moss directly sued Unum, arguing that filing a written appeal would have been useless. The District Court was not convinced of Dr. Moss’s argument and dismissed his lawsuit. Dr. Moss then decided to file a written appeal with Unum. Unfortunately, by this point, more than 180 days had passed, and Unum refused to accept Dr. Moss’s appeal. Dr. Moss went back to court to sue Unum a second time. Again, the District Court rejected his claim because he had failed to file a written appeal with Unum. However, this time, the District Court told Dr. Moss he could not bring the same lawsuit against Unum ever again because he could no longer file a written appeal with Unum. Dr. Moss appealed the District Court’s decision.

The Fifth Circuit Court of Appeals first noted that Dr. Moss’s insurance policies were governed by the Employment Retirement Income Security Act of 1974 (“ERISA”). ERISA allows an individual to sue his or her insurance company. 29 U.S.C. § 1132(a)(1)(B). However, before being able to sue, the individual must “exhaust available administrative remedies.” Denton v. First Int’l Bank of Waco, 765 F.2d 1295, 1300 (5th Cir. 1985). This simply means that the individual must follow procedures for relief given to him or her by the relevant agency before seeking other options. Only after the individual has gone through these procedures and only after these procedures fail to provide relief can he or she sue the agency. In this case, Dr. Moss had to file a written appeal with Unum, and only after his written appeal was rejected could he sue Unum.

oil-platform-1336513-1024x683The term concurrent-cause is a legal doctrine that may be vital to your commercial property. If loss or damage occurs as a result of two or more causes, one event may be covered while the other is not. It would not matter if the events happened at the same time, or if one event occurred before the other. That is why [i]t is essential that the insured produce evidence which will afford a reasonable basis for estimating . . . the proportionate part of damage caused by a risk covered by the insurance policy.” Travelers Indem. Co. v. McKillip, 469 S.W.2d 160, 163 (Tex. 1971). 

The following case discusses the legal implications that a concurrent-clause can play in litigation in Louisiana.

Seahawk operated a drilling rig used in the Gulf of Mexico. In February 2010, the Rig became damaged, the legs were misaligned due to severe weather conditions.