Articles Posted in Insurance Dispute

padlock_grating_insurance_security-1024x768Protection from on-the-job injury is vital to any employee, especially those doing manual labor. But when so many types and subtypes of insurance coverage are involved in a single policy, how can you know when you’re covered? And what happens when you can’t tell if specific coverage applies to you? Can you still get protection and justice?

In August 2011, plaintiff William Weems was an employee of Cane River Construction LLC (Cane River). While on the job, Weems was driving a car owned by Cane River when another vehicle struck him from behind, and he suffered severe injuries. Defendant Houston Speciality was the automobile insurer for Cane River, and following the accident, Weems and his family sought uninsured/underinsured motorist (UM) coverage from Houston Speciality for his injuries. Houston Speciality denied that its policy extended UM coverage to Cane River and instead filed a third-party complaint against its insurance agent employed by Moreman Moore

Moreman Moore’s agent Mr. Dickerson was responsible for completing Houston Specialty’s insurance file. Mr. Dickerson is the agent with whom Cane River’s owner, Mr. Moran, secured the insurance agreement. The Louisiana Commissioner of Insurance requires insurance companies to employ UM waiver forms in their policies and allow their clients to accept or reject UM coverage. Dickerson delivered this waiver to Mr. Moran, and Mr. Moran denied UM coverage via the release. Therefore, Cane River’s insurance policy with Houston Speciality on the accident date thus did not include any UM coverage.

coins_currency_investment_insurance_0-1024x683One’s life is forever altered after an incapacitating injury. While the situation comes with enough issues, problems are enhanced when medical providers merge and change the disability benefits you have relied upon for a year. Unfortunately, this is precisely what happened to Michael Swinea after Humana Inc. bought Kanawha Insurance Company. 

Swinea required a total knee replacement after he was injured in March 2012. After this surgery, Swinea attempted to return to work. After working for about six months, Swinea’s physician instructed him to stop working again. Starting in April 2012, Swinea was given $2,700 per month in disability benefits through Kanawha. In November 2013, however, Humana bought Kanawha, and Swinea’s payments ceased. Humana informed Swinea that he would no longer be covered in a letter mailed to his home address.

After receiving the letter, Swinea contacted the appeals body specified in the letter. The Humana appeals body instructed Swinea to send any pertinent documents that he would like to be considered during the review. After complying, Swinea received a letter from a Humana Grievance and Appeals Specialist notifying him that his request for disability benefits was denied. 

car_old_car_car-1024x683Driving while on the job can be a common occurrence for many employees. Sometimes you may even use your personal vehicle on a workplace errand. If so, beware; Accidents happen, and your employer’s insurance may not cover you. 

Kim Simon was struck by an uninsured motorist when driving her personal vehicle while doing her job. Simon’s vehicle was damaged, but her employer’s insurance would not pay to fix the damages. So Simon sued her employer’s insurance to get coverage for her personal vehicle. 

Her company’s insurance provider argued that Simon’s personal vehicle was not covered under the policy because it was not a “covered auto” defined by the policy. Simon argued that because the auto policy did not list any “covered autos.” Further, she felt Louisiana revised statute 22:1295(1)(e) required the insurance policy to cover her unlisted car. 

housing_real_estate_estate-1024x681Generally, when you ask an insurance agent for a specific policy, you expect them to honor your request. But what happens when your insurance agent doesn’t procure the coverage you requested for? The following case is an example of a property owner who believed he maintained insurance when he did not. 

Ray Periso claimed he was an invitee to the property owned by Ban Vu when a balcony railing collapsed, causing Periso to fall fifteen feet. Periso also claimed that his subsequent injuries resulted from Vu’s negligence. Periso sued Vu, who then turned to his insurance company to provide coverage and representation for the claim. Vu was then told he didn’t have insurance coverage, which surprised him as he believed he told his insurance agent to “procure all necessary insurance on his properties for personal and property protection. “

To seek coverage, Vu filed a third-party demand against Frazier Insurance Agency, Inc. and Jamie Frazier (collectively referred to as “Frazier”), alleging negligence in not procuring a policy that provided personal liability coverage, as he requested. A hearing occurred in the 22nd Judicial District Court in and for the Parish of Tammany, Louisiana, wherein Frazier sought to exit the litigation by way of a peremption objection. The 22nd JDC ruled for Frazier, and an appeal to the Louisiana Court of Appeal First Circuit followed.  

texas_flag_texas_flag-1024x683Have you ever been involved in a car accident that potentially involved two states and wondered which state’s laws would govern your personal injury lawsuit? Say, you have an insurance policy issued in Texas, and you get into a car wreck in Louisiana. Which state’s laws will apply if you file a lawsuit related to the accident? The following case shows how Louisiana Courts use a choice of law analysis to determine what state laws should apply in these situations. 

Rafael Garces-Rodriguez and Julio Alonso (Rafels) were involved in a car accident when another motorist struck their car from behind. At the time of the accident, they were insured by Progressive County Mutual Insurance Company. Two years after the accident, Rafels filed a lawsuit against Progressive seeking compensation for their injuries and other damages sustained during the car accident. Progressive filed a motion with the court seeking dismissal of the case, asserting that Rafels rejected uninsured/underinsured motorist coverage (UM coverage). 

Progressive argued that Texas law should apply in the case because the policies were issued in Texas. Under Texas law, rejection for UM coverage is required to be in writing. However, there are no other special procedures or particular language that needs to be used for the writing. See: Ortiz v. State Farm Mut. Auto. Ins. Co., 955 S.W.2d 353 (Tex. App.-San Antonio 1997, pet. denied). A satisfactory rejection in Texas requires minimal effort by the insured. 

accident_auto_damage_vehicle_2-1024x768Automotive accidents can cause severe injuries to those involved. However, the testimony of accident reconstruction experts can help juries determine what happened and come to the correct conclusions about liability. The following lawsuit out of Baton Rouge shows how an accident reconstruction expert can help you win your automobile accident lawsuit.

In December 2012, Lisa Lirrochi was involved in a collision with a Peterbilt garbage truck driven by David Washington. At the time of the accident, Washington was in his capacity as an employee of Ace Waste Systems, Inc. Ms. Lirrochi was driving behind Washington’s truck around 4:30 A.M. when he moved the truck left into another lane in preparation to make a right-hand turn into a driveway. The two vehicles then collided. 

Lirrochi filed a lawsuit against Washington, Ace Waste, and the company’s insurer, alleging injuries and ongoing pain due to the accident. In return, Ace Waste filed a reconventional demand for the loss of its garbage truck. Lirrochi testified that she did not see Washington use his right turn signal and move into a clear open lane ahead. However, Washington testified that he did use his right-turn signal. 

oil_rig_technology_sea-768x1024Personal injury cases can be costly for all parties involved. Paying those costs can get confusing, especially when there is indemnification. Indemnification arises when a party is contractually obligated to foot the bill for attorney fees and defense costs. The question then arises, can you seek indemnification if fault was never established? This type of contractual clause and legal questions are the core issue in a recent appeal discussed below. 

In 2002, Murphy Exploration and Production Company contracted with McDermott, Inc. to design and construct an offshore oil rig facility fixed to the seafloor adjacent to the State of Louisiana. Part of that contract provided that Murphy agreed to indemnify McDermott against claims, losses, and expenses. 

James Hefren, a Murphy employee, filed a lawsuit against Murphy and McDermott, alleging an injury that occurred due to a defect on the facility. Eventually, McDermott filed a cross-claim against Murphy asserting that McDermott was entitled to indemnification, based on the 2002 contract between the two parties, for all costs related to its defense against Hefren’s lawsuit. The district court found that Hefren’s claims were barred and dismissed the claims with prejudice. Following that dismissal, McDermott sought indemnification for the expenses incurred in defending itself from Hefren’s suit. The district court entered a judgment for McDermott and awarded attorney costs. Murphy appealed the judgment.

coins_currency_investment_insurance_0-1024x683Auto insurance can be beneficial when you are in a car accident. However, it isn’t uncommon to have specific provisions in your insurance policy that can limit your coverage. A recent case out of Kenner, Louisiana, interpreted whether certain caveats in an insurance policy can limit a client’s uninsured motorist coverage (UM/UIM).

Denise Breaux was driving on Interstate 10 behind a truck driven by Jonathan Blum. When a ladder fell off the back of Blum’s truck, Breaux tried to dodge the ladder that fell right into her path. Unfortunately, Breaux’s vehicle collided with Danny Castille’s tractor/trailer while attempting to avoid the ladder. Castille and his wife filed a lawsuit against Breaux, her insurer, and Blum, and then later added Lloyds at Lloyd’s, London (Lloyds) as a defendant. The Castilles were seeking UM/UIM coverage from Lloyds under a surplus lines insurance policy that was issued to Mr. Castille.  

Lloyds asserted that the Castilles were not entitled to UM/UIM coverage because they specifically issued an insurance policy that applied when the tractor did not have the trailer attached, known as Bobtail Liability insurance. Further, they argued that liability insurance was only available when the tractor was bobtailing; therefore, UM/UIM coverage only applied in the same scenario. Since, at the time of the accident, the Castilles’ tractor had a trailer attached and was not bobtailing, Lloyds sought summary judgment. 

law_justice_court_judge-1024x768Most lawsuits begin with a petition that lays out the facts and basis for a claim. These facts are pertinent to the survival of each claim and defense. Many pretrial hearings and motions are based on what is pleaded in the petition. The face of each pleading can determine the case’s outcome from the beginning. 

To attack the petition to have a lawsuit thrown out of court, attorneys will file motions alleging various exceptions. These exceptions can be based on different issues surrounding the case, such as a prescription or peremption exception. When arguing those exceptions, the attorney must be conscientious to “admit” all the evidence into the record that bolsters their position. The following lawsuit out of Ascension Parish, Louisiana, shows how important it is to properly admit evidence into the record when arguing in Court and what can happen when an attorney forgets to “offer and introduce” evidence filed with a motion.

William and Rosa Cambre owned a building they leased to Premier Performance Marine, L.L.C (Premier). Premier had the building insured by an Atain Specialty Insurance Company (Atain) policy. Therefore, when a storm severely damaged the building, Attain paid Premier under the insurance policy.

thirty_30_shield_mark-683x1024Once a case has been fully litigated, it has been established that the plaintiff cannot bring additional lawsuits against the same parties for the same cause of action. This principle, res judicata, promotes stability, efficiency, and fairness within our court systems. The following Ascension Parish case is decided based on this concept.   

Arthur Deal was involved in a motor vehicle accident with Billie Fortenberry on April 27, 2012. Following this accident, Deal filed a lawsuit against Mr. Fortenberry, Mr. Fortenberry’s insurer, Farm Bureau, and his uninsured/underinsured motorist insurer, State Farm Mutual Automobile Insurance Company. Deal then settled his claims with Farm Bureau and State Farm and agreed to dismiss the lawsuit on October 14, 2015. 

For the claim against Farm Bureau, Deal settled for the insured policy limit of $25,000, which Farm Bureau issued to Deal and his attorney in the form of a check on October 24, 2013. This amount, however, was not negotiated by Deal or his attorney. Following this, Deal retained new legal counsel. On September 23, 2015, almost two years after Farm Bureau issued the settlement check, Deal’s new attorney wrote the company a letter stating, in part, that the old check was not cashed and asked how long it would take Farm Bureau to issue a new one. Farm Bureau responded that, upon receipt of the old check, it would issue a new check to Deal and his attorney. Deal forwarded the old check to Farm Bureau on October 15, 2015. The company received it on October 16, 2015, and issued a new check on October 26, 2015. Deal and his attorney negotiated this check. 

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