Articles Posted in Insurance Dispute

black-calculator-near-ballpoint-pen-on-white-printed-paper-53621-1024x603Every adult in America has dealt with insurance in some manner, whether it be life, car, house, rental, or health. Therefore, it is important to understand that the insurance policy you agree to constitutes the law between the you and the insurance company; it governs the whole relationship. As a result of the policy between the insured and insurer being drafted by the insurer, the insurer has the right to limit provisions, and impose restrictions or conditions, so long as these do not conflict with legal statutory provisions or public policy. Thus, strict compliance with the insurance policy terms and conditions is required for a change of beneficiary. Standard Ins. Co. v. Spottsville, 204 So.3d 253, 258 (La. Ct. App. 2016).

In this case, Tanya Offord (“Tanya”) had changed her primary beneficiary from her previous husband to her mother, Alfreda Smith. However, in February 2009, Tanya married Thurman Offord, Sr. Following her marriage to Mr. Offord, Tanya submitted a change of beneficiary to Allstate. She listed Mr. Offord and her three children as the primary beneficiaries, and she listed her mother as the sole contingent beneficiary. She also listed both Mr. Offord and Ms. Smith as the adult custodians for her children, so that they may receive and control any monies owed to any children who are minors at the time of her death.

Allstate responded to Tanya’s beneficiary change request, acknowledging receipt of Tanya’s beneficiary change request. They then informed her that they could not process the request because, per her policy, only one custodian could be named per child. They included a new beneficiary change request form for Tanya to complete and return. Tanya failed to resubmit the change of beneficiary request form and subsequently died without submitting the form.

blue-and-silver-stetoscope-40568-1024x683Health insurance is extremely important and often a vital key to keeping both financial and physical health.  When insurance payments collide with lawsuit payouts, things can become confusing. There are certain parts of Louisiana law that serve to protect  those that have been injured in such instances. The Second Circuit Court of Appeal considered such a protection in 2017.

In 2014, Dustin Patterson was injured in a car accident.  He settled his claims against the other driver as well as the owner of the driver’s vehicle and the driver’s insurance company.  Mr. Patterson’s insurance company, American National Property and Casualty Insurance (“ANPAC”), remained in the lawsuit and went to trial in Caddo Parish.   At trial, Mr. Patterson was only permitted to present, as evidence of his medical expenses, the discounted amount paid by his health insurance. This was factored into his total recovery of $23,632.63.  Believing himself entitled to a higher amount, Mr. Patterson appealed.

The issue for the Second Circuit was whether the plaintiff’s recovery could be reduced due to “write-offs” by his insurance company.  Through negotiations with the health insurance company, the cost of Mr. Patterson’s healthcare was reduced by the providers. The difference between the original amount of his care and the negotiated amount was “written off”.  Mr. Patterson argued he should be awarded the “written off” amount since he had paid health insurance premiums. The Second Circuit considered this argument under the collateral source rule. This is a principle of Louisiana law that prevents a plaintiff from being denied any portion of their monetary awards in a lawsuit just because they received money from an independent source.  Bozeman v. State, 879 So. 2d 692 (La. 2004).  One reason for the implementation of this rule is to prevent a defendant from benefiting from the plaintiff’s decision to obtain insurance.  This is balanced, though, with the desire to prevent a plaintiff from receiving an undeserved “windfall” of excess payments.  

party-glass-architecture-windows-34092-1024x683Obtaining insurance coverage to protect a new company purchase can be crucial to preventing financial loss. But does a company have policy coverage on a new purchase when the insurance company provides only a certificate of insurance? A case in the First Circuit Court of Appeal for Louisiana recently addressed the issue. 

J&M Piling Driving (“J&M”) requested a quote for insurance from Chabert Insurance Agency (“Chabert”), in August of 2010. J&M was looking to insure the company’s new vessel, called the Lil Cherie. The Lil Cherie sank one month later, and J&M discovered that Chabert was not willing to provide coverage for the accident despite issuing two certificates of insurance. 

J&M then filed a lawsuit against Chabert. In the lawsuit, J&M alleged that Chabert informed J&M that the vessel was covered by insurance and therefore J&M was under the impression that Lil Cherie was fully insured. J&M sought damages for the value of Lil Cherie, personal items on Lil Cherie, salvaging the sunken vessel, and loss of income. 

photo-of-person-holding-pen-1028726-1024x683Why do we buy insurance? Most people expect that when they buy insurance, they will receive financial reimbursement for losses caused by accidents or many of life’s unexpected circumstances. It can certainly be a surprise when they expect insurance and then the insurance company refuses to provide it. What are their options when this happens? Filing a lawsuit is one, but won’t always guarantee a day in court, as a 2017 case from the Court of Appeal for the Third Circuit illustrates.

Advanced Radiographics Inc., (“ARI”) is a company that stores health records for medical providers in Louisiana. Its corporate office and one of its warehouses are located in Duson, Louisiana, but the company also has eight other locations. For insurance, ARI purchased general liability coverage which covered all ten of ARI’s locations, and property insurance which only covered ARI’s corporate office. Colony Insurance Company (“Colony”) provided the property insurance which was purchased through insurance broker Kellie Stein (“Stein”) of Brown and Brown of Baton Rouge, LLC (“Brown”).

Unfortunately for ARI, in 2014, a car crashed into the Duson warehouse and caused a fire to break out. ARI filed an insurance claim to Colony, but Colony denied it. For refusing to file, ARI sued Colony, Stein, and Brown in the Fifteenth Judicial District Court for Lafayette Parish. Stein and Brown filed a peremptory exception of no cause of action and in 2016, the District Court granted the exception. ARI then appealed, claiming that the exception of no cause of action should not have been granted.

aged-alarm-clock-antique-background-552774-1024x762When a lawsuit is filed for an injury, most people assume that the claim will be sorted out in court in a timely manner.  Sometimes, however, a case can get significantly delayed by years, even before a trial has occurred. In these instances, it is also possible that the case becomes “abandoned” if neither side takes any action towards furthering the course of the lawsuit.  For one West Feliciana woman, the defense tried to do just that and claimed case abandonment.

In September 2005, Sheryl Cummings filed a lawsuit individually and on behalf of Shedrick Cummings, alleging that Shedrick became a quadriplegic after sustaining severe injuries from a football game at West Feliciana High School Stadium.  Cummings named the West Feliciana Parish School Board (WFPSB), West Baton Rouge Parish School Board (WBRPSB), and several insurance companies, including AIG Insurance (National Union), claiming that there was insurance accident policy coverage of $1,000,000. 

The district court judge dismissed claims against several insurance companies and severed the claim from WFPSB from the claims against National Union.  In July 2009, all of Cummings’ claims against WFPSB were dismissed. In January 2016, National Union filed a motion to dismiss Cummings’ claims, alleging abandonment because of no steps taken on the case in over three years.  The trial court granted the motion and dismissed the claims. Shedrick Cummings appealed the decision to the State of Louisiana First Circuit Court of Appeal.

black-calculator-near-ballpoint-pen-on-white-printed-paper-53621-1024x603Businesses face many liability risks or risks of being sued. These include injuries to their employees on the job. Workers’ compensation is designed to address such injuries. In Louisiana, businesses in specific industries may agree to pool together with one another in order to “self-insure” these claims.  This means that the businesses pay the claims from a specific fund rather than handle them through outside insurance companies. The concept of indemnity is important in these sorts of arrangements. Indemnity involves the paying back of money or the defense in court of one party by the other. Of course, money is not unlimited, and organizations providing may exclude certain coverage in particular situations. The business affected may not agree with this.  The Fourth Circuit Court of Appeal recently considered such a dispute.  

Two employees of The Columns Hotel in New Orleans got into a physical altercation while at work.  One of them was injured and sued the hotel and his coworker. As part of this same lawsuit, the Columns Hotel (“the hotel”) brought in the Louisiana Restaurant Association Self-Insurers Fund.  The hotel claimed that the indemnity agreement between the parties should have applied in this situation. The fund disagreed, filing for summary judgment to have the court dismiss the claim on the basis that the agreement was not insurance.  The trial court agreed and dismissed these particular claims. The hotel appealed.

The issue for the Fourth Circuit Court of Appeal ultimately dealt with how to interpret the indemnity agreement.  Although the hotel argued that insurance law should apply to this contract, Louisiana law specifically excludes self-insurance organizations from the Louisiana Insurance Code. La. R.S. 23:1195(A)(1).  Thus, the Fourth Circuit looked at the indemnity agreement between the hotel and the fund itself to determine how it should be applied.  Contracts in Louisiana must be interpreted only to determine what the parties intended the terms to mean. La C.C. art 2045 Here, the parties disagreed as to what situations would be excluded from coverage by the fund.  The exclusions the fund relied on were bodily injury, as well as assault and battery. The exception for bodily injury excluded from coverages situations where someone was injured by actions that should have been reasonably expected to cause such an injury.  The court applied this to the fight between the employees. Their actions during the altercation would have been reasonably expected to cause injury. Thus, the Fourth Circuit found that the bodily injury exclusion would have applied. Therefore, the fund had been entitled to summary judgment on that point.    The other exclusion was that of assault and battery. The exclusion includes reference to bodily injury caused by assault and battery. In Louisiana, battery is a “harmful or offensive contact” and assault is any action that would threaten such contact. Lawson v. Straus, 750 So. 2d 234 (La. Ct. App. 1999).  Under these definitions, the fight between the employees would be considered assault and battery.  Thus the agreement would not cover the se bodily injuries. Because these two exclusions applied to the situation, the Fourth Circuit found that summary judgment had been correctly granted.  

alcohol-architecture-bar-beer-260922-1024x576Almost all companies have insurance policies to protect them from liability that may arise during the course of business. In this case, the defendant, Reggie’s, had a commercial general liability (“CGL”) policy through Century Surety Company (“Century”). Generally, an insurance company may limit coverage, so long as the limits to not conflict with any laws or public policy, and when there is a limit, the insurance contract must be strictly construed against the insurer. La. C.C. art. 2056. This means that if there are any ambiguities in the exclusion or limitations, they are construed in favor of the insured. See Edward v. Daugherty, 833 So.2d 932, 940 (La. 2004). Here, the question that arose is whether the August 22 fight at Reggie’s bar was excluded under the policy provided by Century under the assault-and-battery endorsement exclusion.

On August 22, 2010, Juan Mendez (“Mendez”) was at Reggie’s bar when he allegedly threw a drink in another patron’s face. Mendez was then escorted out of the building by Evan Vincent (“Vincent”) a bouncer at Reggie’s, and a defendant in the case. After Mendez was removed from the building, he was injured when Vincent picked him up and forced him to the ground. The police and EMS were called, but Vincent was not charged.

Mendez subsequently filed a civil suit for damages against Vincent, Reggie’s, and Century. Following a hearing, the trial court granted summary judgment in favor, finding that the August 22, incident was not covered by Century. The plaintiff appealed, arguing that the incident was not precluded from coverage because the bodily injuries were intended and resulted from the use of reasonable force to protect persons or property.

close-up-photo-of-man-wearing-black-suit-jacket-doing-thumbs-684385-1024x678Being allowed to use an employer owned vehicle is a nice benefit to have. When there is an accident there may be questions of who pays for the damage or injuries.  In this case, any accident and insurance policy questions were completely in favor of the insurance company and backed up by both state statutes and case law guidance. But, poor customer service by the insurance company turned a complete legal victory into costly litigation. 

Naddia Melder was employed by Grimes Industrial Supply. One of the benefits of her employment was the use of a pickup truck owned by Grimes. In March 2007, Mrs. Melder was involved in an accident with one other vehicle. It turned out that the other vehicle was underinsured and Mrs. Melder’s uninsured motorist insurance claim against her personal insurer was denied. Mrs. Melder brought a lawsuit against her personal insurance carrier, Louisiana Farm Bureau Casualty Insurance Company, in order to find a way for insurance to cover the accident.

Farm Bureau asked the Trial Court to grant summary judgment in favor of denying coverage for the accident and the Trial Court agreed. Mrs. Melder then appealed. Mrs. Medler’s appeal was based on her view that the Trial Court incorrectly determined that she was driving a vehicle that was owned or furnished by someone else and that her insurance policy did not extend to cover this vehicle. There was an exclusion in her policy which stated that coverage would not be extended to vehicles furnished to her, but she believed it should not apply because it conflicted with a Louisiana law. She also argued that the insurance payments she received were received late.

close-up-court-courthouse-534204-1024x569The jury trial is an infamously complicated process. From the trials of OJ Simpson to Paul Manafort, the jury’s role is to determine the truth behind the legal jargon, and to serve and protect justice. Juries rely on the information presented to them by experienced lawyers and judges to navigate the complexities of the courtroom. However, sometimes there are mistakes made. Despite some inaccurately presented technicalities, the Fifth Circuit Court has ruled to uphold the sanctity of the juror’s role as a fact-finder. 

On the afternoon of November 11, 2012, Mr. Vince, an operator at an aluminum plant in Gramercy, was travelling home on U.S. Highway 61 after his work shift. The road, known by locals as “Airline Highway,” stretched over a bridge which merged with an entrance ramp from a boat club in St. James Parish, Louisiana. Mr. Koontz, owner of a Denali and its attached yacht, stopped for several minutes at the ramp and decided to merge only when he felt that Mr. Vince’s car was at such a distance that it had not yet reached the bridge. He proceeded to merge onto the highway as Mr. Vince’s truck approached. As Mr. Vince drove onto the bridge, he looked down to check a fantasy football score on his phone. When he looked up, he was immediately confronted with the sight of a 27-foot yacht attached to a GMC Yukon XL Denali. The car collided with the boat, and Mr. Vince was knocked unconscious. 

Although the crash caused merely aesthetic damage to the car, Mr. Vince filed a lawsuit against State Farm Automobile Insurance Company (“State Farm”) claiming a loss of consortium. 

accounting-black-budget-53621-1024x603If you and the opposing party in your lawsuit reach a settlement agreement, it might seem like your legal battle is over. However, trouble can arise if the other party does not do what they promised to do. This is the situation Cheri Gardner found herself in following a car wreck and the resulting settlement with State Farm.  

In July 2009, Gardner was involved in a car wreck. Just under a year later, she filed a lawsuit against State Farm, Lisa Haefner, and AllState Insurance for her injuries. Gardner had to have spinal cord surgery and amassed medical bills exceeding $70,000. 

In May 2011, Gardner and State Farm underwent mediation and entered a “10-Day Option to Settle” contract that State Farm’s attorney drafted and provided to Gardner. The settlement stated that any liens for medical expenses that State Farm would agree to pay as part of the settlement had to be presented before July 13, 2013. After the parties signed the settlement agreement, Gardner’s attorney provided State Farm with a letter for a medical lien from BlueCross BlueShield of Louisiana from May 28, 2010 for a lien of $7,143.10. 

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