Articles Posted in General Insurance Dispute Information

coins_currency_investment_insurance_0-scaledIf you are involved in an automobile accident, it can be difficult to navigate insurance claims and coverage. The situation becomes even more complicated when there are multiple insurance policies involved. How is coverage allocated between multiple relevant insurance policies?

Sonya Theriot was unfortunately in an automobile accident in Lafayette, Louisiana. The other driver involved in the accident, Todd Sparks, was working for Thermal Technologies at the time of the accident. He was driving a rental car Thermal Technologies had paid for when he rear-ended Theriot while she was making a right-hand turn. 

Thermal Technologies had a business automobile insurance policy with State Farm, a commercial general liability policy, and an umbrella insurance policy with Owners Insurance. Sparks had a personal automobile insurance policy with Travels Home Insurance Company. Theriot filed a lawsuit against State Farm, Sparks, and Thermal Technologies. She later added Travelers and Owners to the lawsuit. 

dsc05934_0-scaledDealing with the aftermath of a flood is never fun. This is especially true when the flood damages one of your vehicles. This is the situation Michael Jacobs found himself in after one of his cars was damaged in a flood. After a long fight with his insurance company, he eventually prevailed and was awarded damages. 

Jacobs owned multiple vehicles that GEICO insured. His parish in North Louisiana was affected by heavy flooding. When the flooding started, Jacobs and his brother tried to move the vehicles from his house to higher ground but were unable to remove them before the floodwaters rose, so they could not drive up to the house. Jacobs waded through the floodwater to retrieve one of the vehicles, a 2001 Honda Accord. In the days following the flood, the Honda kept overheating. Jacobs claimed this had only occurred after the flood. 

Jacobs submitted a claim to GEICO for the damage to the vehicle. The insurance inspector did not identify any flood-related problems and determined the upper radiator hose had blown out. Another mechanic gave Jacobs an opinion and concluded there were issues with his spark plugs. GEICO ultimately denied Jacobs’ claim because it had suffered a mechanical failure that was not flood-related. Jacobs filed a lawsuit against GEICO, alleging his Honda had been damaged from the flooding. At trial, the court ruled the Honda had suffered water damage and awarded vehicle property damages and attorney fees. GEICO filed an appeal.

ladder_art_red_garden-scaledIt can be challenging to interpret insurance policies, especially when they involve complex provisions such as coverage for an additional insured. Before signing an insurance policy, it is imperative to understand its language and what it does and does not cover. Here, the plain language of the insurance policy proved instrumental in the appellate court’s ruling.

Pamela Sloane was injured while working for Integrity Cleaning Services (“Integrity”) at Forestwood Apartments. She was cleaning a ceiling fan while standing on a ladder. She inadvertently touched an exposed wire, which electrocuted her, and she fell from the ladder. Sloane filed a lawsuit against CLK Multifamily Management (“CLK”) and others. Sloane claimed CLK had not adequately maintained the premises or warned of the dangerous condition of the exposed wire. CLK filed its answer to the lawsuit, denying the allegations, and added Travelers Indemnity (“Travelers”) to the lawsuit.  CLK claimed Integrity was contractually required to have a general liability insurance policy that covered CLK as additional insureds. 

Travelers filed a summary judgment motion, claiming CLK was not an additional insured under the policy. Travelers attached a copy of the relevant insurance policy to its summary judgment motion. CLK disagreed and claimed it was indeed an additional insured.  The trial court concluded CLK was not qualified as an additional insured and granted Travelers’ summary judgment motion. 

car_burglary_thief_burglar-scaledIn the legal system, dissenting opinions, i.e., opinions delivered by one or more judges who disagree with the decision, play a crucial role in shaping the interpretation and application of the law. They provide valuable insights into alternative viewpoints, often sparking discussion and debate and ultimately leading to the evolution of jurisprudence. One such notable dissenting opinion can be found in the case of Christopher Blanchard v. Demetrius J. Hicks et al., authored by Justice Cooks. In this blog post, we look at the case, the arguments made in the dissent, and the importance of dissent in the legal landscape.

The case of Christopher Blanchard v. Demetrius J. Hicks et al. arose from an incident in which Officer Blanchard’s patrol car was struck by a stolen truck. The plaintiff, Officer Blanchard, alleged that the defendant, Demetrius J. Hicks, was negligent in leaving his vehicle unattended with the keys in the ignition and the engine running, thereby facilitating the theft that led to the accident.

The majority of the court relied on the precedent set by the Supreme Court’s decision in Racine, which held that leaving keys in a vehicle does not create liability for the motorist if a thief steals the car and causes injury to a third party. However, Judge Cooks dissented from the majority’s opinion, arguing that Racine does not dispose of the factual matter at hand.

war_worlds_movie_car-scaledImagine, for a moment, living a life of normalcy, the humdrum of day-to-day routines, a steady job, a peaceful existence. Suddenly, an unexpected accident shakes your world, thrusting you into the tumultuous tides of legal proceedings. This is the daunting reality Patricia and Calvin Henderson found themselves in, initiating a monumental case against Amy Lashouto and her insurer, State Farm Mutual Automobile Insurance Company (State Farm).

In a startling sequence of events, Patricia and Calvin Henderson found themselves in a legal confrontation against Lashouto. The case revolves around Patricia’s car accident, where a motor vehicle driven by Lashouto rear-ended her. Following the accident, the Hendersons filed a lawsuit against Lashouto, her insurer, and State Farm, contending that they were insured under a policy that could compensate them for their losses. State Farm, however, countered this claim, maintaining that the policy did not provide uninsured/underinsured motorist (UM) coverage for the accident.

After Lashouto and her insurer settled their case with the Hendersons, the couple found themselves embroiled in a legal dispute with State Farm. The latter moved for summary judgment, arguing that Calvin Henderson had validly rejected UM coverage on the policy. Despite the Hendersons’ absence from the hearing, the trial court sided with State Farm, dismissing the UM coverage claims.

supreme_court_building_washington_3_5-scaledLouisiana’s Workers’ Compensation fund exists to pay employees injured at work.  Payment can be used for medical care and lost wages.  When parties sign a settlement agreement on payment terms, an employee may assume payment is imminent.  In a recent case from Rapides Parish, an employee discovered some conditions in a settlement may delay payment.  

Mary Ortega sustained an injury while employed by Cantu Services.  Ortega filed a Disputed Claim for Compensation, and the parties entered a settlement agreement.  The parties settled for $120,000.  $56,049 of the total was allocated to a Medicare set-aside agreement (MSA) to cover future medical expenses related to the work injury. The MSA was filed with the Centers for Medicare and Medicaid Services (CMS) for approval.  The parties agreed that if CMS did not approve the full amount in the MSA, the employer would adjust the amount paid in monetary benefits, so Ortega would still receive $120,000.  Several months after signing the agreement, Ortega had not received any payments.   She filed a motion to enforce the settlement agreement plus a request for fees and penalties before the Office of Workers’ Compensation.   

The Workers’ Compensation Judge (WCJ) denied Ortega’s request because payment under the settlement agreement was conditioned on first getting approval from the MSA.   Pending approval suspended the statutory requirement of payment within thirty days.    Ortega appealed to the Louisiana Third Circuit Court of Appeal.     

paramedics_doll_hospital_medical_0-scaledA visit to the hospital is a stressful and anxious time for patients and family members. Most people, however, assume that their doctors are competent and will administer the proper standard of care. This was not the case for Richard Smallwood. 

Smallwood fell at his home and sustained bilateral patella tendon ruptures. He was admitted to the Ochsner-Baptist Hospital for surgery to repair the ruptures in his tendon. After a complicated postoperative course, Smallwood was discharged to another Oschner unit. After some time in the nursing unit, Smallwood died. The autopsy revealed that he had suffered a pulmonary embolism, a secondary result of his deep vein thrombosis (DVT). Since Smallwood had been in “generally good health” before the surgery, his sudden death was shocking. The petition for this case alleged that Smallwood was not given the appropriate prophylactic anti-coagulant medication in violation of the standard of care.

Since pulmonary embolisms are a common secondary result of DVT, Dorothy Pennington alleged a medical malpractice claim against the doctors and nurses in charge of Smallwood’s care. This included Dr. Todd, Dr. Hawawini, Dr. Jones, Dr. Ulfers, and the Ochsner Clinic Foundation. After moving for a directed verdict, the trial court found that all parties except Dr. Hawawini were liable for medical malpractice. Since Dr. Hawawini acted as the Hospital Director at the time of Smallwood’s death, it was challenging to show that Dr. Hawawini had breached a standard of care. This case centered around whether Pennington had properly established the standard of care and breach with respect to Dr. Hawawini. 

district_court_input_court-scaledWords matter, especially when it comes to trial court orders. Without the proper language, a judgment is not an appealable, valid final judgment, so an appellate court cannot consider the merits of an appeal. 

McKinley Taylor filed a lawsuit against Cajun Constructors, his former employer. He claimed Cajun Constructors owed him unpaid wages for his work as a carpenter. He claimed they had decided upon a daily per diem rate during his first week on the job. The trial court issued an untitled document, which appeared to be written reasons for a ruling, not a final judgment. The trial court found Taylor was not paid the agreed-upon per diem. The trial court also awarded Taylor penalty wages and attorneys fees under La. R.S. 23:632 because Cajun Constructors’ failure to pay him the per diem was not in good faith. Cajun Constructor appealed. 

Cajun Constructors was ordered to show why its appeal should not be dismissed because there was no valid final judgment. In its response, Cajun Constructor acknowledged the trial court’s ruling did not contain the required language “ordered, adjudged and decreed.” See GBB Props. Two, LLC v. Stirling Props. LLC. Additionally, there was not a separate document from the trial court other than the written reasons for its ruling, as contemplated under La. C.C.P. art. 1918. Therefore, Cajun Contractors agreed the trial court’s ruling did not appear to be a final appealable judgment. The trial court also had not yet determined the amount of attorney fees to award to Taylor. Despite agreeing the trial court’s document was not an appealable valid judgment, Cajun Constructors explained it had filed the appeal to preserve its right to appeal. Cajun Constructors then requested the appellate court dismiss the appeal without prejudice and send the case back to the trial court to enter a valid, appealable final judgment. 

prison_prison_window_window-1-scaledIf you receive notice of a court hearing, you must pay attention to it. The following case shows the potential adverse consequences if you ignore a court hearing notice. These can include a warrant being issued for your arrest or having your lawsuit dismissed. However, the case also unveils a glimmer of hope for those entangled in such legal dilemmas, offering a glimpse into the avenues available to those who believe justice has been denied.

Rita and Summer Brown were arrested for outstanding warrants from their failure to appear at a judgment debtor rule hearing. After their arrest, they filed lawsuits against the Terrebonne Parish Sheriff’s Office, Sheriff Jerry Larpenter, and an unnamed insurance company, seeking damages for false arrest. The claims against the Terrebonne Parish Sheriff’s Office were dismissed. The lawsuit against Larpenter went to trial. The court ruled in favor of Larpenter. The Browns then appealed. 

The Browns argued they had never been served the notice for the judgment debtor rule court hearing, so they were unaware they were required to appear in court. They also claimed they were unaware of the subsequent warrants for their arrest after they failed to appear at the hearing. 

detail_forum_romanum_rome-scaledMost of us get into contracts, not fully understanding all the ins and outs of what we are signing. Similarly, the multiple provisions that can slither their way into contracts can include things like forum selection clauses which can be easily overlooked. But when a lawsuit erupts, can you argue a provision isn’t applicable? The United States Court of Appeals for the Fifth Circuit addresses this question in the following case.

Al Copeland Investments, L.L.C. owned a food manufacturing facility in Louisiana. In October and December of 2015, there was some property damage to the facility, and they submitted a reimbursement claim under an insurance policy. Their insurance was held with First Specialty Insurance Corporation (“First Specialty”). They denied this claim, and AI Copeland sued in the Eastern District of Louisiana, believing they were entitled to recover from the costs and damages of the property. First Specialty asked the court to dismiss the case because the policies forum selection clause requires litigation in New York State court, not Louisiana. 

A forum selection clause is a section in a contract that states how all disputes must be litigated in a specific court in a jurisdiction that the parties agreed to. 

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