Articles Posted in Insurance Dispute

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. 

car-buying-car-dealership-car-key-97079-1024x683Every adult has had to deal with some type of insurance in their life, whether it be home, auto, or life insurance. When it comes to car insurances, there are numerous different types of policies, and, in some situations, automobiles are covered by personal umbrella policies. Similar to any other contract, an insurance policy is a contract between the insurance company and the insured and must be interpreted using the general rules set forth in the Louisiana Civil Code. Reynolds v. Select Properties, Ltd., 634 So.2d 1180, 1183 (La. 1994). When the language of a policy is clear and unambiguous, the policy must be enforced as written, but the determination of whether a contract is unambiguous is a question of law. La. C.C. art. 2046.

In this case, Michael Rodriguez (“Rodriguez”) was driving a 2006 Toyota Tundra (“Tundra”) owned by Rodriguez Crop Consulting, LLC (“RCC”) and insured by Louisiana Farm Bureau Mutual Insurance Company (“Mutual Insurance”) when he struck Marcella Hurst (“Hurst”). Hurst was walking across a parking lot at L.A. Express when she was struck by Rodriguez’s vehicle. In February 2013, Hurst filed a lawsuit against Rodriguez, RCC, and the car insurers. Additionally, Rodriguez asserted that his claim for excess coverage under the umbrella policy was wrongfully denied, and that if the umbrella policy does not cover, then Blane Brignac (“Brignac”) and Kerney Trahan (“Trahan”), employees of Mutual Insurance, were liable because they held that the umbrella policy would provide full protection regardless of whether the vehicle was being used for personal or business reasons.

The Louisiana First Circuit Court of Appeal affirmed the trial court’s holding that the insurance companies were in the right when they denied Rodriguez’s claim for excess coverage under the umbrella policy. The Court of Appeal agreed the policy was not ambiguous and should be enforced as written. Under the policy, the Tundra falls squarely within the scope of a “regular use exclusion” included in the contract. Thus, the trial court correctly held that the car was not covered by the umbrella policy.

61-1024x683Insurance plans and policies are often riddled with complicated jargon and loopholes to protect insurance companies from financial loss. These confusing insurance provisions can lead an individual to think he/she is covered in case of an accident, but many times leaves individuals unprotected. In one recent Louisiana lawsuit, a consumer’s expectations of coverage are shattered by the complexity of insurance provisions.

 Cynthia Bennett was driving a vehicle that she borrowed from Service Chevrolet Cadillac (Service Chevrolet) in Lafayette, Louisiana when she was in a car accident with Samantha Brown. The vehicle Ms. Bennett was driving was a “covered auto” under a “garage policy” issued by Tower National Insurance Company (Tower) to Service Chevrolet. Samantha Brown had an auto liability policy issued under USAA and Cynthia Bennett had a personal automobile policy with Allstate that provided uninsured motorist (UM) coverage. Ms. Bennett was able to settle with USAA and Allstate but continued to pursue Tower National Insurance Company for the remainder of damages under her UM coverage provisions in Tower’s “garage policy.”

 Tower filed a motion for summary judgment. A motion for summary judgment should be granted when evidence shows that there is “no genuine issue as to material fact, and that the mover is entitled to judgment as a matter of law.” La. C.C.P. art. 966(B)(2). Tower argued that Ms. Bennett was not considered an “insured” under the liability portion of the policy because she had her own policy with Allstate, which showed that there was no genuine issue to material fact. Because Ms. Bennett had her own coverage under Allstate, she was not protected under Tower’s policy as an uninsured motorist. The trial court granted the motion for summary judgment and Ms. Bennett appealed that decision.

56Sometimes, a single witness can make the difference between winning and losing at trial. This is especially so when you are fighting for reasonable medical compensation. Since insurance companies generally try to give patients the least amount of money as possible, they look for all sorts of ways to do so. One way is to prevent a patient’s physician from testifying and giving an opinion of what he or she believes is causing the patient’s current pain. In the following case, the defendant attempted to do just this, but fortunately for the plaintiff, the Court of Appeal found error in the trial court’s decision to exclude the testimony of the plaintiff’s physician. 

Jasmine Jones and Keith Morgan were in opposite lanes of travel waiting for the traffic light to turn green. Morgan was driving a pickup truck while Jones was driving a compact car. When the light turned green, Jones headed straight, but Morgan made a turn and collided with Jones. Morgan struck Jones’s front tire, but Jones’s vehicle suffered only minor damage. However, Jones felt pain in her back and went to the Rapides Regional Hospital later that day. Dr. Gerald LaGlue, Jones’s initial physician, was unsuccessful in relieving Jones’s pain, and so he referred Jones to Dr. George Williams. Dr. Williams then referred Jones to Dr. Melanie Firmin who performed an epidural steroid spinal injection, which only increased Jones’s pain. 

After examining Jones further, Dr. Williams opined that the cause of her pain was radiculopathy, which likely originated from her car accident. However, Dr. Williams never actually performed a diagnostic test to determine if Jones’s pain was caused by radiculopathy. However, he was prevented from testifying about his opinion of Jones’s pain because the defendants succeeded in their Daubert motion, which essentially asks the court to exclude expert witness testimony because it is not reliable. As a result, Jones did not succeed in obtaining as much compensation as she desired because Dr. Williams was not able to testify. 

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.