Articles Posted in Insurance Dispute

Being 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.

The 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. 

Insurance 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.

Sometimes, 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. 

In 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.