Articles Posted in Insurance Dispute

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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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Car accidents occur every day, and the first question that is usually asked is who was at fault for the accident. This determination is not easy, however, a Louisiana second circuit court of appeal’s case explored fault in order to allocate liability to the parties respectively. In Gentry v. State Farm, the Court held that both parties were at fault, the defendants were found to be 75% at fault, while the plaintiff, Gentry, was 25% at fault. The court came to this conclusion after looking at both drivers duties while driving, analyzing whether the drivers breached their duties, looking into the rules of the road, determining whether the duties of the road were breached, and looking at the duties that were found to be breached by each driver in order to find the ultimate percentages of fault in order to allocate damages. Thus, it is not always an either/or situation (one party may not be wholly responsible for the car accident) but, rather, partially responsible, so the analysis takes on a more in depth review of the circumstances that existed at the time of the accident.

An appellate court must give great deference to the allocation of fault determined by the trier of fact. Consequently, the allocation of fault may be determined within an acceptable range and any allocation by the fact finder, or trial court within that range, cannot be clearly wrong. The only way an appellate court may disturb the trial court’s fault determination is if the apportionment of fault is clearly wrong, allowing the appellate court, only then, to disturb the trial court’s award. Here, both parties were seeking a finding of 100% fault for the opposing party, asking the appellate court to reverse the apportionment determination found by the trial court in order to dismiss the percentages of fault that were initially determined. If the trial court’s determination of fault is found to be clearly wrong, the appellate court is then permitted to adjust the award, but only to the extent of lowering or raising it to the highest or lowest point respectively which is reasonably within the trial court’s discretion.

After reviewing both party’s evidence put forward at the trial court level, the appellate court determined that manifest error existed in the record, and allowed for a reframing of liability findings, but only to the minimum extent to achieve reasonableness. So, it is not unheard of for appellate courts to find error of fault determinations held at the trial level, if the trier of fact proves to be clearly wrong, the appellate court may proceed to adjust accordingly.

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In civil litigation, the defendant is responsible for the damage caused to the plaintiff(s) when found responsible for causing harm. This damage may be either physical or property damage. If a defendant is found to be at fault, the next question is usually to what extent the defendant is liable for any resulting injuries. In normal circumstances, experts provide testimony concerning physical and property damage, and any intangible damages such as lost wages, mental distress, etc. In some circumstances, the plaintiff may have a preexisting condition. This preexisting condition may make the damages the plaintiff suffers more likely. Further, the injury or accident may exacerbate the preexisting condition. There is a civil law maxim that “the defendant takes the plaintiff as he is at the time of the accident.” This is commonly referred to as the eggshell rule. In a recent case, Miriam Dyess vs. State Farm Insurance Co. ET AL., the Court describes how the eggshell rule relates to an award for damages.

In this case, Dyess was driving in Alexandria, Louisiana, when another car pulled in front of the plaintiff’s car. The result was that Dyess ran into the back of the other vehicle. The driver of the other vehicle was insured by State Farm Insurance. Plaintiff was insured by Farmer’s Insurances (Farmers). As a result of the injury, Dyess suffered injuries to the neck, shoulder, hand, back, right leg, and has headaches, foot pain, and numbness. The plaintiff was also awarded $103,000 in damages. Farmers appeals the decision stating (1) there was only $1,500 worth of damages, (2) plaintiff denied any injuries at the scene of the accident, and (3) plaintiff’s injuries were as a result of a pre-exisiting carpal tunnel syndrome and fibromyalgia. Farmers appealed to set aside or reduce the $103,000 award as manifestly erroneous, and that the court erred in awarding damages and medical expenses for injuries other than those to plaintiff’s neck.

The basis of the award that the trial court gave plaintiff was the eggshell rule. The trial court stated that plaintiff was an eggshell victim who already had some medical problems. But, as such, you must take the victim as you find them. The Appellate Court’s applicable standard of review is that it cannot set aside findings of fact unless it is manifestly erroneous or unless it is clearly wrong. Where the jury’s findings are reasonable, in light of the record viewed in its entirety, the court of appeal may not reverse. Although, there was some inconsistent evidence, plaintiff provided uncontroverted evidence that her preexisiting condition was exacerbated due to the accident. Defendant’s liability is not mitigated by the fact that plaintiff’s preexisting physical infirmity was responsible in part for the consequences of plaintiff’s injury by the defendant. It is clear that the defendant takes his victim as he finds him and is responsible for all natural and probable consequences of his tortous conduct. However, plaintiff fails to carry the requisite burden of proving causation if the pre-accident and post-accident conditions are identical in all meaningful respects. Thus, because the plaintiff provided uncontroverted evidence that the injuries exacerbated any pre-existing condition, she has met her burden.

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A gangway is a pathway that connects the ship to the dock at which it has stopped. It is the means by which the crew and cargo of a ship are moved onto and off of the ship. Usually ships have detachable gangways that the ship crew put on the side of the ship when the ship is docked. Other times, docks have policies that require the ships to use gangways that are provided by the dock owner. As in any other legal field, the use of gangways are subject to rules of negligence and duties of care. The question in a recent case, Landers v. Bollinger Amelia Repair, was whether a dock owner was liable for a gangway provided to a ship under the stated policy of the dock owner that all ships must use gangways provided by the dock.

On June 12, 2006, the M/V Roseanna docked on the Bollinger Amelia Repair (BAR) dock. The reason for docking there was that the Roseanna’s hull had been breached, and it needed repair. The Roseanna had a gangway on its ship, but it was full of cargo and could not be used to access the dock. In any case, BAR had a policy of requiring all docked ships to use a BAR provided gangway. Thus, Landers, an employee of the Roseanna, and another Roseanna employee got a gangway from BAR and installed it.

The gangway was inspected by a Roseanna employee and was found to be in good condition. The gangway was used many times that day. The crew of the Roseanna discovered that the hull of the ship could be fixed without the aid of BAR and proceeded to do so. At the end of its use, the gangway was removed by Landers and another member of the Roseanna crew. Upon removal, the gangway sprung up hitting Landers in the back and causing injury. Subsequently, Landers brought suit against BAR arguing that due to BAR’s stated policy of requiring the use of BAR gangways, BAR was liable for the injury caused to him under general Maritime negligence law.

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