Articles Posted in Insurance Dispute

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The term “venue” refers to the particular court where a plaintiff should file his suit. In the case of car accidents and other tort actions, the Louisiana Code of Civil Procedure gives the plaintiff a choice of venue. The plaintiff can file the suit in the parish where the accident occurred or, alternatively, in the parish where the defendant driver resides. When a liability insurer is involved as a defendant, the suit can also be filed in the parish where the insurance company is registered. The case of Lopez v. Richard illustrates how the misapplication of the venue rules can have serious, undesirable consequences for a plaintiff.

On March 31, 2006, Gil Lopez was rear-ended by another driver in Lafayette Parish. The driver was Josette Richard, a resident of Lafayette Parish who was insured by Allstate. On the last day of the one-year prescriptive period (April 2, 2007), Lopez filed suit in Iberia Parish, which is the parish where he and his wife live. Richard and Allstate filed an exception for improper venue, and the parties agreed to transfer the case to Lafayette Parish in August of 2007. Once the case was transferred, Richard and Allstate filed an exception of prescription, arguing that Lopez’s action was not properly filed before the expiration of the prescription period. The Third Circuit agreed, stating that “it is well settled that the transfer of an action to a correct venue, after prescription has run, does not resurrect the plaintiff’s lawsuit.” In an attempt to preserve his cause of action, Lopez offered the novel argument that venue in his home parish was proper under the state’s “joint obligor” statute. That is, Lopez argued that because he was a beneficiary under Richard’s Allstate policy, he was also an “insured” under the terms of the policy which provided Allstate’s connection to Iberia Parish and permitted suit there. The court deemed this theory a misapplication of the law which was intended for suits involving Uninsured Motorist coverage, but not a direct policy such as the one Allstate had issued to Richard. Instead, Lopez is merely a “claimant” who will “be paid by Allstate on behalf of their insured, Richard, if Richard is found liable” for the accident. Thus, because Lopez filed his suit in the wrong parish and did not transfer it to a proper parish before the running of the prescription period, his case was dismissed.

The lesson from the Lopez case is that proper venue should be identified as early as possible to ensure that the prescriptive period does not expire before the suit can be filed in the correct court. Misfiling a suit does not toll the running of the period. Had Lopez not waited until the very last minute to file his original suit, he may have been able to transfer to the correct venue and avoid losing his case on a mere (but critically important) technicality.

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A person’s worst fear when undergoing an invasive surgery, is for something to go wrong. For one patient, this fear came true when his doctor operated on the wrong knee. This severe error was not disputed by the Doctor, who admitted he erroneously operated on the plaintiff’s right knee when he intended to treat the plaintiff patient’s left knee with arthoscopic surgery. What was at issue in this recent Louisiana Second Circuit Court of Appeals decision, is whether or not the injured plaintiff was awarded an appropriate amount in damages. Numerous factors are weighed when determining damages. However, in Louisiana, as well as numerous other states, there is a cap on how much a person may recover in a medical malpractice suit. Patients who have been injured face a litany of complicated issues and standards that are difficult to understand, thus, obtaining legal representation as soon as possible is highly recommended in order to protect legal rights throughout the process.

In a recent Louisiana Second Circuit Court of Appeals decision, the court explored the amount of damages a patient was initially awarded for damages they sustained from an erroneously performed surgical procedure. The plaintiff patient complained on appeal that the trial court abused its discretion in awarding inadequate damages for past lost wages, past medical expenses, as well as pain and suffering. Additionally, the victim contended that the trial court erred in failing to award future lost wages and future medical expenses for the patient plaintiff and loss of consortium for his wife. The appellate court affirmed the trial courts damages award for numerous reasons, many based on statutory limits that are in place restricting the amount a patient may obtain. Yet, the decision is in large part held by the jury. The jury has the duty to hear the evidence and determine a price that may “make the plaintiff whole again.” In this case, the jury decided that the patient plaintiff had $40,000 in pain and suffering and $10,000 in loss of income. It may seem a harsh factor in the legal process, that despite the severity of a patients injuries, the numerical value given such injuries is designed to “fix” such issues. The plaintiff in this case felt that the jury’s damages award did not adequately resolve any of the issues he was experiencing after having the botched surgical procedure. Since the accident, the victim of this botched surgery had been experiencing serious issues in almost every part of his life, including that the knee which was erroneously operated on was in constant pain, decreased his range of motion, his sense of instability caused him to limp, insomnia, impaired ability to work, back pain induced by the limp which resulted in a herniated disk, and loss of consortium with his wife. Thus, the problems went deeper then the categorical terms such as “pain and suffering and loss of income.” The court however, explains and supports their decision by exploring the governing statutes at issue.

Juries factual finding decisions are highly regarded, and under Louisiana law such decisions may not be set aside unless the appellate court finds that it is manifestly erroneous or clearly wrong. The appellate court will review the witnesses testimony at trial in order to determine whether or not their may have been an erroneous decision. Here, the plaintiff alleged he had to undergo four surgeries due to the Doctor operating on the wrong knee plus a discogram of his back. To support the additional damages that were a result of the erroneous surgical procedure performed by the defendant doctor, the plaintiff offered the testimony of a doctor who contended that the plaintiff would need two back and neck surgeries and would have pain in his right knee for the rest of his life. Further, the plaintiff would have to get a total knee replacement at some point in his life. In consequence to the erroneous surgery, the plaintiff was declared disabled by Social Security and began receiving Social Security Income payments. Additionally, the plaintiff was unable to perform the part time work he was previously able to and the couple eventually went bankrupt. Despite these very sad consequences, the court has to abide by the regulations and statutes that are in place and govern medical malpractice issues.

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As discussed previously on this blog, the primary duty of Louisiana’s Department of Transportation and Development (DOTD) is to maintain the public roadways in a condition that is reasonably safe and which does not present an unreasonable risk of harm to motorists who exercise ordinary care. As outlined in this recent post, a plaintiff must prove the following elements in order to hold the DOTD liable for damages arising from an accident on the roadway: (1) that the condition that caused the damage was in DOTD’s control; (2) that the condition amounted to a defect that presented an unreasonable risk of harm; and (3) that the DOTD was aware or should have been aware that the defect existed. In addressing the extent of the risk of harm, litigants often rely on the standards established by the American Association of State Highway and Transportation Officials (“AASHTO”) which, while not mandatory in Louisiana, offer a point of reference for whether DOTD’s design of a particular roadway presented an unreasonable risk. The AASHTO’s standards have evolved over time, however, and in many cases they have become stricter and more elaborate as vehicular traffic volume has increased. In light of this, the Louisiana Supreme Court has held that DOTD does not have duty to bring old highways up to modern standards unless a major reconstruction of the highway is undertaken. The question of what qualifies as a “major reconstruction” was at the center of the recent case in the First Circuit Court of Appeal, Davis v. Travelers Property Casualty Insurance Co.

On the evening of April 22, 2003 Nathaniel Davis, a flatbed truck driver for the Purpera Lumber Company, legally parked his truck in the northbound lane of La. Hwy. 308 so he could deliver a load of lumber to a residential construction site adjacent to the highway. Davis parked in the travel lane because there was no driveway at the site that would accommodate his truck and because the road, which was maintained by DOTD, had no shoulder. Davis was severely injured when his truck was rear-ended by an elderly driver who made no attempt to slow down before she collided with the truck. Davis filed suit naming DOTD as a defendant. His theory of recovery was based on the road’s lack of a shoulder, a deisgn which violated the then-current AASHTO standards requiring an eight-foot extension of the highway. Presumably, the shoulder would have offered a safer location for parking his truck. Ultimately, the First Circuit reviewed a verdict in the trial court in which the jury determined that the lack of a shoulder posed an unreasonably dangerous risk to Davis. However, the jury also found that DOTD did not know (and had no duty to have known) about this condition and thereofre had no duty to cure the defect by constructing a shoulder. Davis argued that a resurfacing project undertaken by the DOTD some years prior to the accident qualified as “major reconstruction” which put DOTD on notice of its duty to upgrade the roadway to include a shoulder. The First Circuit court disagreed, noting that “there is no evidence from which to conclude that the roadway underwent a major reconstruction at that location or even that the State had obtained additional rights of way [necessary for such significant work] in the area of the accident site.” Accordingly, the court affirmed the jury’s verdict in favor of DOTD.

This is another example in a long line of cases that demonstrates the challenge of winning a claim against DOTD under an ordinary negligence theory. The Louisiana legislature and courts have made clear that DOTD is not the “guarantor for the safety of all of the motoring public [n]or the insurer for all injuries or damages resulting from any risk posed by obstructions on or defects in the roadway.” As a result, an injured plaintiff must have a skilled attorney who understands the nature of DOTD’s responsibilities to those who use the highways.

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The doctrine of res ipsa loquitur can be employed by a plaintiff to establish the defendant’s breach of duty in the absence of direct evidence of the defendant’s negligent conduct. However, use of the doctrine “does not relieve the plaintiff of the ultimate burden of proving by a preponderance of the evidence all of the elements necessary for recovery.” To prevail in a negligence claim based on the “ruin, vice, or defect in things,” the plaintiff must show that the defendant knew or should have known of the defect and that the harm to the plaintiff could have been prevented by the defendant’s reasonable care. See Cangelosi v. Our Lady of the Lake Medical Center.

As the plaintiff in Shuff v. Brookshire Grocery Co. learned, the doctrine cannot be invoked to circumvent this fundamental burden.

On October 15, 2006, Ashley Shuff entered the Super One Foods grocery store in Bastrop with her two children. Upon arrival, Shuff placed her 20-month-old daughter, Cloe, into the child seat that was built into one of the store’s shopping carts and fastened the seat belt. Shuff admitted that the belt mechanism appeared to be working properly when she buckled Cloe in. A short while later, Cloe fell from the seat to the store’s concrete floor and broke her arm. A store patron who observed the incident later inspected the seat and discovered that a prong on the belt’s snap was broken. Shuff sued the grocery store on behalf of her daughter on a negligence theory for damages caused by “ruin, vice, or defect in things.” In the trial court, the parties filed cross-motions for summary judgment. Shuff argued that the store’s liability for the incident was governed by the doctrine of res ipsa loquitur becuase it had responsibilty to maintain the seat and its safety belt. The court denied Shuff’s motion and dismissed her claims.

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According to Louisiana law, a landowner “owes a duty to a plaintiff to discover any unreasonably dangerous condition, and either to correct the condition or warn of its existence.” However, the courts have consistently held that landowners generally have no duty to protect against “open and obvious” hazards. If the facts show that the condition that caused a plaintiff’s injury should be “obvious to all,” the condition is less likely to be considered unreasonably dangerous; in such a situation, the landowner may owe no duty at all to the injured plaintiff. The determination of whether a crack in a Shreveport sidewalk was unreasonably dangerous was at the center of the recent case of Williams v. Rubens Residential Properties, LLC.

On the morning of May 4, 2006, Marion Williams was walking with her friend on Line Avenue in the Cedar Grove neighborhood. Williams tripped on a buckle in the concrete sidewalk, fall forward, and shattered her right wrist. After seeking immediate medical attention, Williams returned to the scene and took several photographs of the buckle. Over the next several months, she required several significant surgeries which left her with pins in her wrist and lingering pain which is expected to get worse over time.

Williams sued the City of Shreveport, which filed a motion for summary judgment in which it argued that it was obligated to provide a sidewalk in reasonably safe, but not perfect, condition and that it was not liable for the “open and obvious hazard which should have been observed by anyone in the exercise of reasonable care.” The City relied on the deposition testimony of its Superintendent of Streets and Drainage, Ernie Negrete, who explained that the City does not perform routine inspections of all its sidewalks because doing so would be too costly. Instead, the City takes corrective action based on the roughly 6,000 calls it receives from citizens each year to report problems. The City had no record of any calls about the particular location where Williams fell. Williams’s cross-motion urged that the sidewalk posed an “unreasonable risk of harm” of which the City did have notice, given that the buckle apparently had existed for over 15 years. The trial court denied the City’s motion and the matter went to a bench trial in February, 2010. The trial judge found Williams’s testimony and the testimony of her friend and husband “extremely credible” and accepted her assertion that she simply could not see the buckle in the sidewalk. The court awarded Williams almost $340,000 in damages including lost wages and medical expenses. In its appeal, the City argued that the trial court committed manifest error in failing to find that the defect in the sidewalk was open and obvious. The Second Circuit noted that the trial court’s decision was based on the testimony of three witnesses who claimed that from the pedestrian’s vantage point, the buckle was not apparent. Also, the City did not put on any evidence as to the height of the buckle or whether it was obvious to a pedestrian. Thus, the court concluded that the trial judge “was entitled to find that the condition was not open and obvious to a person walking straight down the sidewalk in the exercise of reasonable care.” Finding no manifest error, the court affirmed the trialc court’s judgment for Williams.

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Under the Louisiana Workers Compensation Act, an employer takes a worker as he finds him or her. A worker who is more susceptible to injury is entitled to no less protection than a healthy one.

The Louisiana Appellate Court held that employees, who are injured during the performance of their job duties, are to be provided appropriate compensation and medical care. A recent 2nd Circuit Court of Appeals Decision explored workers compensation in Louisiana, and the elements necessary to obtain compensation, despite underlying health risks that may have helped create the injury in question. In Lloyd v. Shady Lake Nursing Home, the nursing home sought for the court to apply the Louisiana Worker’s Compensation Act, in order to avoid having to pay higher damages to the surviving spouse and family under a negligence or tort based remedy.

In the Margaret Caldwell case the Court focused on her injury suffered and subsequent death for their analysis. Mrs. Caldwell was a fifty-four year old woman. She was known to be suffering from morbid obesity and she worked as a Certified Nursing Assistant at the Shady Oaks Nursing Home for over twenty years. One day, as she was cleaning her station and mopping the floors, she spotted a patient out of his room. She asked him to return to his room and at this point he attacked her, striking her in the face. Immediately following the attack, Mrs. Caldwell experienced elevated blood pressure levels and was taken to East Carroll Parish Hospital. Only a few hours later she was pronounced dead. The autopsy found the immediate cause of death to be hypertensive heart disease and coronary artery disease, with the underlying cause of death being a physical blow to the face. This last portion became the ultimate point of controversy between Mrs. Caldwell’s family and Shady Oaks, as her employer attempted to rely on a specific Louisiana Revised Statute that negates workers compensation benefits for heart related illnesses or death that arises during the scope one’s employment. The court explored the meaning behind each element of workers compensation and definitional terms in order to formulate their decision.

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The Louisiana Supreme Court recently provided guidance on the jurisdictional limit for proper filings in Louisiana civil courts. At issue in the case of Thompson v. State Farm was the jurisdictional limit required for proper filing in city court. While filing may seem to the unknowing person on the street like a minor issue, a failure to file a case in the correct district can have dire consequences for the case of a well-intending plaintiff.

In Thompson, the plaintiff sought damages from injuries she sustained in a rear-end chain reaction collision allegedly caused by a driver insured by State Farm. In her filing, she named the driver at fault and State Farm as defendants. Thompson’s husband joined the suit and sought damages for loss of consortium, medical expenses, and loss of his wife’s income due to the injuries she suffered. In their petitions, which were filed in Alexandria City Court, the plaintiffs explicitly demanded an amount “less than the jurisdictional maximum of [the] court.” The Alexandria City Court entered judgment for the plaintiff, awarding her $50,000 in general damages and her husband $20,000 for loss of consortium and $30,000 for past and future medical expenses on behalf of the community. Subsequently, State Farm filed an exception for lack of subject matter jurisdiction, arguing that it was improper for the city court to have heard the case since the amount of damages awarded exceeded the court’s jurisdictional limit of $50,000. The appellate court agreed, vacating the judgment and remanding the case to the lower court in order to transfer the action to a court of competent jurisdiction.

The Louisiana Supreme Court reversed the ruling, finding that the test for subject matter jurisdiction of a city court is the amount in dispute, or the amount demanded by the plaintiff. According to the Louisiana Code of Civil Procedure, the Alexandria City Court has concurrent jurisdiction with the district court in civil cases where the amount in dispute does not exceed $50,000, exclusive of interest and costs. Since both plaintiffs unequivocally limited the amount demanded to “an amount less than the jurisdictional maximum of… yet within the jurisdictional limits of [the Alexandria city] court,” the Supreme Court concluded that the city court had proper subject matter jurisdiction over the case. Accordingly, the Supreme Court reinstated the trial court’s judgment but remanded the case on another issue.

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Unfortunate instances can occur when a wild animal is involved. The First Circuit Court of Appeal for the State of Louisiana ruled that defendants Mr. and Mrs. Rivett, who were sued in addition to their insurer, are not liable for the injuries sustained by the plaintiff when he was riding their horse. The plaintiff sued under an ordinary negligence claim under Article 2321 of the Civil Code of Louisiana (amended in 1996), which renders the owner of an animal liable for damage caused by the animal. For the owners of all animals except dogs, an ordinary negligence standard applies. For dogs, a strict liability standard was retained.

In order to recover under Article 2321, the plaintiff must prove by a preponderance of the evidence that (1) the defendant was required to adhere to a specific standard of care (the duty factor); (2) the defendant did not adhere to the appropriate standard (the breach of duty factor); (3) the defendant’s failure to adhere to the standard in fact caused the plaintiff to be injured (the cause-in-fact factor); (4) the injuries of the plaintiff were legally caused by  defendant’s failure to adhere to the standard (the degree of liability or sphere of protection factor); and (5) the plaintiff’s actual damages (the damages factor). If the plaintiff fails to show any of these elements, there is no liability. The First Circuit referred to this analysis as the duty/risk analysis.

On appeal, the plaintiff asserted that the trial court committed five legal errors. The First Circuit found that the trial court did err by not instructing the jury with the correct standard with which to evaluate the defendants’ conduct and therefore set aside the jury verdict finding for the defendants. The court reviewed the case de novo, without giving any weight to the factual findings of the incorrectly instructed jury as it usually would, and still found that the plaintiff had not been able to establish that the defendants were negligent for the injuries caused by the startled horse.

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Previously on this blog, we examined the concept of a “substitute vehicle” for purposes of extending insurance coverage for an auto that is used only temporarily and in place of a policyholder’s usual car. In this situation, the insurer is required by state law to extend the same coverage to the substitute car as was in place for the regular vehicle. This requirement, however, does not necessarily apply to a vehicle that a driver simply borrows from another ownerin addition to the vehicle covered by his policy. A vehicle under this arrangement is known as a “non-owned” auto and, as the plaintiff in Burns v. Couvillionlearned, coverage is determined by the language of the owner’s policy.

On October 12, 2005, Linda Burns was driving on Highway 1 in Simmesport when she was rear-ended by a bean harvester farm vehicle operated by Burton Dupuis. At the time of the accident, Dupuis was engaged in work for his employer, Victor Lachney. The bean harvester was owned by Ted and Don Couvillion and had been loaned to Lachney for use by Dupuis that day. Burns filed a lawsuit for damages against the parties and also Progressive Insurance, alleging that Progressive had issued a policy to Lachney which applied to the bean harvester. Progressive admitted that it had issued a policy to Lachney that provided coverage on a different vehicle but denied that coverage extended to the bean harvester. The parties filed cross-motions for summary judgment and the trial court granted judgment in favor of Progressive.

On appeal, Burns argued that coverage should apply to the bean harvester because the Progressive policy included an “Employer’s Non-Ownership Liability Endorsement,” which stated that “[t]he definition of insured auto is modified to include a non-owned auto when you or any of your employees use the non-owned auto in your business.” Progressive countered that the policy had not been modified by the Endorsement because, although it was among the various endorsements and other forms that accompanied the policy, it was not listed on the policy’s Declarations Page which specifically identified the forms that modified the policy. In fact, the policy contained the following language:

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Under Louisiana law, an issuer of a property insurance policy is required to follow certain procedures when renewing the policy. Essentially, an insurance company must give a property owner 30 days’ notice of either 1) its decision not to renew a policy, or 2) the homeowner’s option to renew when it expires. La. R.S. 22:887(G). Case law adds the stipulation that, in most cases, an insurer’s failure to provide this notice will result in an automatic renewal of the policy. If there is a dispute, the insurer faces an initial burden to prove that it mailed the required notice, which creates a presumption the insured received the notice. The property owner may rebut this presumption by offering evidence that the notice was never delivered. The ultimate factual determination must be made by the trial court.

The Louisiana Supreme Court recently reaffirmed this approach in the case of Nolan v. Mabray. On June 18, 2005, Wilson Mabray and Marsh Nolan were shooting off fireworks at Mabray’s family farm in Union Parish. Wilson shot a bottle rocket which struck and severely injured Marsh. Wilson’s father (“Mabray”) maintained a farm-owner’s policy issued by Shelter Insurance Company. When March sued for his injuries, Shelter disputed that the policy was in effect at the time of the accident, arguing that the policy had lapsed: Shelter asserted that it mailed Mabray a renewal notice on April 28, 2005 which stated the premium was due on June 2, 2005. However, the company did not receive payment until nearly a month late, on June 29, 2005. At trial, a Shelter employee offered testimony about the company’s computer-generated renewal notices and automated mailing process. The employee produced records of the company’s April 28 letter and also a separate “lapse letter” mailed on June 20 that warned Mabray his policy had been cancelled. Mabray’s local agent, who was copied on the lapse letter, personally contacted Mabray on June 29 and collected payment the same day. On the issue of whether he ever received the renewal notice, Mabray testified by way of deposition that he did not remember receiving it, and that if he had, he would have paid the premium right away. However, Mabray testified it was possible he overlooked the notice as April through June were especially busy months on the farm during which he “might have stuff sit on [his] desk for a couple of weeks before it gets opened.” Mabray further stated that “[he] could certainly not swear that it did not come to [his] mailbox and actually get on [his] desk.” He also admitted that several other insurance policies with Shelter had lapsed in the past because he did not pay the premium on time. Based on this evidence, the trial court found that Shelter did mail the renewal notice to Mabray on April 28, 2005 and, therefore, the policy was not in effect at the time of the bottle rocket incident because it had lapsed.

The Second Circuit reversed, finding that there was insufficient evidence to support the trial court’s conclusion that the renewal notice had been mailed. This decision was based primarily on the fact that Shelter did not introduce evidence of any person’s actual knowledge that the notice was mailed. The Louisiana Supreme court disagreed. Applying the manifest error standard of review, the Court held that

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