The sad fact is that everyday accidents happen on our nation’s roads. Especially tragic are ones where a family member is killed. Combined with the pain of losing a
loved one comes the burden of dealing with insurance policies, who is insured and who is uninsured at the time
of the accident and trying to get coverage. In prior posts. we have discussed how liability is hard to assign at times, especially when it takes a fact-finder to establish who is at fault. In this Louisiana court case, an insurance company refused to pay uninsured/underinsured motorist (UM) liability coverage to the daughter of the deceased driver of a vehicle which was struck by an oncoming motorist.
In March of 2006, Donald Anderson was killed in a car accident when his car was hit by an oncoming motorist, Gordon Pugh, Jr. During the time of his death, Donald Anderson was within the scope of his employment with Labor Finders. Labor Finders had a liability insurance policy issued by National Union which was in effect at the time of Anderson’s accident. After the accident, Anderson’s daughter filed a survival and wrongful death action naming Pugh and his insurer as the defendants. Several months later in December, Anderson amended her petition to include National Union as the defendant. Anderson claimed that since her father was insured under the liability policy issued by National Union to Labor Finders at the time of the accident, then he was entitled to the mandated uninsured/underinsured motorist (UM) insurance. National Union denied this fact while Anderson was able to settle the claims with Pugh’s insurer. National Union filed for summary judgment and the trial court stated that their policy was clear, unambiguous and that under the terms the policy provided, Donald Anderson was not an insured at the time of the accident to whom it could afford coverage. Therefore, the trial court granted summary judgment in favor of National Union leaving Anderson with nothing after her father’s death.
Summary judgments are reviewed based on material facts in order to avoid a full scale trial. The courts grant this motion when there is no issue as to material facts, and the moving party is entitled to judgment as matter of law. In this case, it was up to the Anderson to show that the insurance company was not entitled to judgment as a matter of law.
Insurance policies in the state of Louisiana function much like contracts, and are, therefore, interpreted as such. When the court interprets an insurance policy, it generally interprets the intent of the parties in forming the contract. In order to get to the common intent of the parties, the court looks primarily at the language of the insurance policy; Louisiana courts have struggled with this because at times, the technical meaning of the words is hard to differentiate from the generally prevailing meaning. If words in an insurance contract have a “technical meaning” then this meaning must be applied when the contract is interpreted. In addition to interpreting the meaning of words, each provision and section of this contract must be interpreted in light of the other provisions. Matters become more complex here because one provision cannot and should not be interpreted at the expense of another. Should the court find that words in an insurance contract are clear and explicit, it must strictly apply those words as written. Things become more difficult when ambiguities in the contract still remain even after the general rules of the contract have been applied; this may cause problems for both the policy holder and the insurance company.
All liability insurance policies issued in the state of Louisiana are required to issue UM coverage equal to the amounts in liability coverage when there is no express waiver of reduction of the UM coverage. This type of policy only requires that the person be injured by a UM. To simplify this complexity, there exists a test to determine whether a person qualifies for UM coverage under liability insurance. The test is to determine whether this person would be covered if they were liable for the accident.
In this case, National Union maintained that Donald Anderson was not an insured under the original terms of the National Union Policy. A section of the policy clearly stated that all Labor Finders’ employees (which Anderson was at the time of the accident) were insured as long as they were within the score of their employment at the time of the accident (Anderson met this criteria as well). A reader can see that the plain language of the contract points to the fact that Anderson was insured at the time of his accident, unless there was some exclusion.
The caveat here is that insurers have the right to limit coverage in any way they desire as long as these limitations are clearly set forth in the contract. It is at times like these that you need a professional in the field who will know how to maximize coverage. Coverage exclusions are construed strictly against the insurer. In the current case, the policy contained an Endorsement which stated that National Union shall not pay for any damage which arises out of aircraft, auto or watercraft injury owned or operated by the insured. Anderson fell into this exclusion because his injury and subsequent death arose out of the operation of his own vehicle. While Anderson fell into a clearly stated exception in the policy, many other endorsements are more ambiguous and require thorough interpretation and scrutiny.
If you think you deserve coverage or the appropriate amount has been denied to you, contact the Berniard Law Firm at 1-866-574-8005 to consult an attorney who can help understand the policies and whether an insurance company owes you coverage.