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Court Hears Appeal Regarding Alleged Insurance Company Delays

In a variety of states, including Louisiana, penalties are imposed on insurers who arbitrarily or capriciously fail to pay a claim. If an insurer behaves in a manner that could be construed as being in “bad faith,” they will face a host of possible penalties. Specifically, the insurer has duties to fulfill, such as paying the amount of any claim due any insured within thirty days respectively. However, determining whether or not the insurer is in bad faith is a two way street, the insured/claimant also has to satisfy certain burden(s) of proof. The court will take into consideration the totality of the circumstances, explore each parties behavior and provided proof, and will thus make their decision.

In a recent Louisiana appellate decision, the court denied finding an insurer in bad faith for denying the plaintiff additional damages. The damages sustained stemmed from an incident that occurred in Winn Parish, Louisiana. Specifically, a five year old boy was crossing Highway 167 to board a school bus when he was struck and injured by a vehicle driven by a minor. Apparently, the minor driving failed to heed the stop sign on the bus which was activated, nor slow down. The force of the impact caused the young boy to be thrown an estaimted distance of 65 feet. His injuries were quite serious, including a broken left femur, damage to the spleen, and severe lacerations to the face and neck. The injured boy had to remain in a full body cast for a number of weeks and incurred substantial bullying from classmates as a result of his visibly scarred facial appearance. The jury awarded damages to the plaintiff for the following: past special damages, future special damages, past general damages, future general damages, and loss of earning capacity.

The plaintiffs in this matter filed a motion for judgment notwithstanding the verdict (JNOV), and in the alternative, sought a new trial. After a hearing, the trial court granted the plaintiff’s JNOV and nullified the jury’s verdict. The court awarded $100,000 initially to the plaintiff; however, after the hearing, the damages were increased to a total of $600,000. This was a $500,000 increase in the amount of total damages to the plaintiff. However, the trial court, without explanation also ruled that the insurer was not in bad faith under Louisiana law in its handling of the plaintiff’s claim. Additionally, the judgment gave the insurer credit for all sums paid to date and further taxed all costs to the insurer. The defendant insurer appealed on the basis that the trial court erred in granting the plaintiff’s motion for JNOV, which increased the jury’s award by $500,000. On the other hand, the plaintiff asserted that the trial court correctly granted the motion for JNOV, but abused its discretion in awarding insufficient damages, specifically in the categories of general damages and loss of earning capacity.

The first issue the court explored was whether or not the JNOV ruling was correct. There is one main question that must be asked to determine whether granting the motion for JNOV was appropriate: do the facts and inferences point so strongly and overwhelmingly in favor of the moving party that reasonable men could not arrive at a contrary verdict? if the answer to that question in the affirmative, then the trial judge was correct in granting the motion. However, if a reasonable person in exercising impartial judgment might reach a different conclusion, then it was error to grant the motion and the jury should be reinstated. Here, the jury’s verdict awarded only special damages and no general damages. The court had to determine whether or not a jury could award one and not the other. The decision held that the jury’s verdict which failed to award general damages was “illogical and inconsistent, representing an abuse of discretion.” Addressing only the future medical expenses and ignoring the past special medical damages illustrated a large problem with the damages awarded the plaintiff. In fact, the court reasoned that the jury was confused in filling out the verdict form without consideration of the previously tendered insurance payments as instructed by the form. Thus, the trial court was correct in granting the JNOV and overruling the jury’s verdict.

Lastly, the plaintiff claimed that the insurer acted arbitrarily, capriciously, and without probable cause in failing to unconditionally tender more than $190,000 in payment of the damages. The plaintiffs alleged that they made numerous demands supported with medical proof, however, the insurer failed to comply. Under Louisiana law, La. R.S. 22:1892, an insurer owes a duty of good faith and fair dealing to its insured. As such, an insurer has an affirmative duty to adjust claims fairly and promptly to make reasonable efforts to settle claims with the insured. The statute provides that if an insurer is found to have acted in bad faith, several penalties are available to the claimant. First, the plaintiff must clearly show that the insurer was in fact arbitrary, capricious, and without probable cause in refusing to pay. Bad faith hinges on whether or not the insurer is aware of specific facts in making their decision not to satisfy a claimant’s damages. The basis of the plaintiff’s argument for additional damages from the insurer, was the fact that the little boy would suffer extensive mental difficulties in the future. The dilemma in such an argument, was the fact that the alleged future mental injury was Attention Deficit Disorder (ADD), which the defendant insurer argued was not a result of the injuries sustained when he was hit by the motor vehicle. The court reasoned that ADD could not be directly attributable to the incident in question and as a result, the insurer was not found to have acted arbitrarily, capriciously, or have acted without probable cause in denying such additional future damages.

Thus, insurers do have an affirmative statutory duty to act in good faith towards claimants. Insurers are prohibited from refusing to pay claims without a reasnable basis. The bad faith statute is designed to protect individuals who have been injured from having their claims declined without any reasonable basis.

Therefore, if you have been involved in an accident and are having difficulties communicating with the insurers involved, please call The Berniard Law Firm. We know what is at stake and how to protect your legal rights involved.