Articles Posted in Insurance Dispute

headlights_roads_night_highways-1024x683Insurance claims can be complex, even for the courts. Lawsuits involving multiple plaintiffs and defendants are just as complicated. Claims, cross-claims, and counterclaims can arise from a single accident. Questions can arise during litigation, such as; can you appeal a partial summary judgment in Louisiana? A recent motorcycle accident in Arnaudville, Louisiana, demonstrates how convoluted insurance claims can become, as shown in the court’s opinion below. 

 The Colomb Foundation, Inc. (“Colomb”) was a property owner with a building erected along Louisiana Highway 93. As Erik Moran (hereafter “Moran”) drove by Colomb’s property at night, a flood light came on that Moran mistook for the headlight of an oncoming car. Moran alleged he was blinded by the light, which caused him to wreck his motorcycle into a gate located on Colomb’s property. 

After the accident, Moran filed a lawsuit against Colomb and its alleged liability insurer, United Specialty Insurance Company (“USI”). Shortly after, USI contacted Colomb to explain that they would not cover Moran’s claims under their insurance because Colomb’s insurance policy had been canceled six months earlier. The cancellation occurred due to a failure to pay the insurance premium. Colomb challenged this cancellation by filing a cross-claim against USI. Then, to make matters even more complicated, Colomb filed third-party demands against four additional parties, including Standard Lines Brokerage, Inc. (“SLB”), which is the entity in charge of the collection and cancelation of insurance policies for USI. 

court_hammer_auction_law-1-1024x768Most consumers in the U.S. are aware of increasingly high medical costs. For most people, those high costs are not directly paid; instead, they appear on a bill along with what one’s insurance company will pay as part of an agreement with the medical provider. Many insured consumers will look for “in-plan” medical providers to ensure that most costs are covered. Those “in-plan” providers are part of a preferred provider organization (PPO), which is a subscription-based medical arrangement that allows a substantial discount on rates to be charged. 

PPOs are organized by separate companies that generate revenue by charging an access fee. This type of PPO arrangement sets the backdrop for Best Comp, a recent case by the Louisiana Court of Appeals where plaintiffs sought class certification and defendants, the PPO, challenged it. The central evidence that plaintiffs presented for class certification was a data disc containing a Microsoft Excel spreadsheet showing the recommended discounts for each provider.  

The plaintiffs were Opelousas-based healthcare entities representing healthcare providers who treated employees under the Louisiana Workers’ Compensation Act. The providers subscribed to PPO agreements with defendant Bestcomp, Inc., and alleged that Bestcomp discounted their billing without the notice required by statute La.R.S. 40:2203.1

tax_forms_income_business-1024x683If you’re in a car wreck, you expect, or hope, to be covered for UM Bodily injury (UMBI) up to certain policy limits. However, when signing up for insurance, you must carefully review the coverages. The law in Louisiana has strict requirements when it comes to selecting or rejecting Uninsured motorist coverage. If you aren’t careful, you may unknowingly reject or limit the coverage you thought you had. New Orleans citizen Zachary Addison learned this lesson the hard way after being involved in a car incident in 2013. 

After his car accident, Mr. Addison filed a lawsuit against the other party involved and his insurance company LM General Insurance. Mr. Addison sued his insurance company to ensure they would provide adequate coverage for his injuries. In a motion for summary judgment, LM General Insurance argued to the trial court that Addison was not covered for uninsured/underinsured motorist coverage and bodily injury coverage and that he only selected UMBI coverage for his economic damages. LM General filed the motion based on the fact that Mr. Addison electronically selected economic-only UMBI coverage. 

When obtaining insurance, Addison received a quote via telephone and was given the option to send documents by mail, fax, or electronically. He chose to submit the documents electronically; the electronic documents had selections of coverage pre-made based on the quote he received. The pre-selected information could not be changed. Mr. Addison electronically signed the documents. 

chalmette1972stbernardhwy-1024x664Car accidents are common and complicated. Wrecks can involve company cars, ride shares, and large commercial vehicles, all with different types of insurance. Impacts can occur while driving on a work errand. All these different types of accidents invoke numerous insurance questions. Questions such as; If you are out driving on a work errand, will your business’s uninsured motorist insurance provide coverage? The Louisiana Court of Appeals grappled with these issues in a recent appeal. 

Dr. Kenneth Allan, a Chalmette based veterinarian, is the sole member of Chalmette Pet Wellness Clinic and Hospital. Dr. Allan was transporting a dog to his clinic when he was rear-ended. Dr. Allan was driving a vehicle in his wife’s name and sustained injuries from the car accident. Dr. Allan sued his uninsured motorist insurance carrier, Bankers, which provided coverage for his work vehicle to recover compensation for his injuries. 

Bankers balked at paying his claim. Bankers and Dr. Allan asked the court to settle the coverage issue by filing summary judgment motions. They asked the court to determine if the Bankers policy provided uninsured/underinsured motorist insurance coverage for vehicles not owned by the pet clinic. The trial court ruled in favor of Dr. Allan, stating that Bankers should cover his claim. An appeal of the decision followed.

balconyKnowing what is in an insurance agreement can determine whether or not you are covered for different injuries. If a buyer signed a policy, did not ensure that certain aspects were covered, and then never bothered to check or revise the policy, this person will likely be held accountable for knowing precisely what is in that policy.

In April 2011, Ray Periso rented a house from Mr. Vu on Ashville Drive in Slidell, Louisiana. When he was on the balcony, its railing collapsed, causing Mr. Periso to fall fifteen feet and sustain injuries. Mr. Periso sued his landlord as part of a tort lawsuit in the Twenty-Second Judicial District Court for the Parish of St. Tammany, but Mr. Vu wanted his insurance company to pay for these damages. Unfortunately, his insurance plan did not cover personal liability; therefore, he filed a third-party demand against Southern Fidelity Insurance Company (SFIC) and his insurance agent, Mr. Frazier, alleging negligence in not covering personal liability. The District Court dismissed this third-party demand. A series of appeals by Mr. Vu in the Louisiana First Circuit Court of Appeal followed.

In Mr. Vu’s first appeal, the Court of Appeal affirmed dismissing SFIC because its insurance policy plainly did not provide for personal liability coverage. However, it left open the issue of Mr. Frazier’s negligence. Mr. Frazier then filed a peremptory exception, claiming that Mr. Vu’s negligence assertions were perempted or filed too late. The Court of Appeal agreed with Mr. Frazier and dismissed Mr. Vu’s claims.

crash_test_collision_60-1024x645One of the first things that occur after a car accident is the parties exchange insurance information. But, unfortunately, just because someone has an insurance card doesn’t always mean they are covered for the wreck they caused. A driver in Metairie learned that lesson the hard way, as shown by the case below.

In 2012 in the Parish of Jefferson, Miriam Blandino was driving her partner’s car with their children inside when she was rear-ended at a stop sign. She and her partner subsequently sued the driver (from now on “Ms. Doe”) and the driver’s insurance (from now on “USAgencies”) for damages. However, USAgencies was let out of the lawsuit because Ms. Doe never actually obtained insurance through them.

Earlier that year, in February, Ms. Doe had signed up for an automobile insurance plan covering her from February through August, but her initial payment was declined. USAgencies notified her of this failure to pay and allowed her to reinstate her policy: she would need to provide the proper amount and a fifteen-dollar fee within ten days of the notice. Unfortunately, USAgencies never received payment from Ms. Doe, and thus her policy never became effective, so she was never covered.

car accident lawyer louisianaUsually, in a dispute concerning a car accident, the issue surrounds fault or the extent of injuries. Occasionally though, the argument is whether a passenger in one of the vehicles was even a passenger. Evidence that one was a passenger and present during the accident would seem helpful but does not guarantee recovery, as one plaintiff learned after a 2011 car accident in Jefferson Parish.

In 2012, Cindy Perez filed a lawsuit in the Jefferson Parish Twenty-Fourth Judicial District Court against Mary B. Gaudin and LM General Insurance Company. Perez alleged that in 2011, she and her mother, Edis Molina were passengers in a car driven by Reinaldo Martinez-Perez. Perez claimed that she was sitting in the backseat when Gaudin rear-ended the car with her own vehicle, causing a propane tank to hit Perez’s arm. The case went to trial on July 20, 2016, with the sole issue being whether Perez was actually a passenger in the vehicle when the accident occurred.

Deputy Zlatko Brujic of the Jefferson Parish Sheriff’s Office was the officer who investigated the 2011 accident. Though he could not testify at trial in person, he gave a deposition that was admitted as evidence. In his testimony, Deputy Brujic stated that according to the accident report, Reinaldo Martinez-Perez’s car only had one passenger: Edis Molina. He noted that another woman was at the scene after he arrived, but this woman’s description did not match that of Perez’s.

reserved_sign_wedding_decorations-1024x683Car accidents can be a problematic scenario for the parties involved emotionally and financially. This situation can become even more complicated when the insurance company provides coverage to both parties involved in the accident, and the injured party files a lawsuit against the insurance company, arguing that the injured party is a first-party claimant. The Fourth Circuit Court of Appeals for Louisiana recently addressed the issue. 

In August 2009, Mr. Sapp drove a vehicle down Prytania Street in New Orleans, Louisiana. Unfortunately, Mr. Sapp collided with the car driven by Mr. Lee. After the accident, Mr. Lee filed a lawsuit in the Orleans Parish of Louisiana against Mr. Sapp and State Farm Insurance Company. In the case, Mr. Lee alleged that the accident resulted in personal injuries. All the parties reached a settlement agreement seven years after the accident occurred.

The settlement agreement covered all claims from the accident in 2009, except for the exception of “Reserved Claims.” The agreement between the parties provided that “Reserved Claims” meant all claims of bad faith by Mr. Lee against State Farm Mutual Automobile Insurance Company. One month after the settlement agreement was entered, State Farm filed an exception. In this exception, State Farm sought to dismiss all reserved claims except one. This one was for Mr. Lee’s misrepresentation claim, pursuant to La. R.S. 22:1973(B)(1). The Trial Court ruled in favor of State Farm, sustaining the exception and dismissing all of Mr. Lee’s bad faith claims except for misrepresentation. Mr. Lee then appealed the decision of the Trial Court. 

Car Accident uninsured motorist coverage louisianaWhat happens when a motorist is injured in an automobile accident while operating a vehicle owned by an employer? While Louisiana law often permits named insured employees to receive reciprocal coverage under an employer’s insurer, insurance law is a complex and, at times, unclear field, especially in relation to uninsured/underinsured motorist coverage. In the case of Chris Loudermilk of New Roads, Louisiana, the Louisiana First Circuit Court of Appeal felt that Loudermilk was not permitted to recover under the language of his employer’s insurance policy.

Loudermilk was injured in an automobile accident while operating a vehicle owned by his employer, Environmental Safety and Health Consulting Services Inc. (ES&H). Loudermilk filed suit against the drivers at fault and their insurers, as well as XL Specialty Insurance Company, ES&H’s insurer.

In acquiring insurance for ES&H, the company’s CFO executed a valid Uninsured Motorist Bodily Injury Coverage Form to reject uninsured motorist coverage completely on June 23, 2010. The policy was renewed in June 2011 through June 2012, and it was in effect at the time of Loudermilk’s accident. At the time of the renewal, ES&H added two entities to the “named insured” section of the policy.

Uninsured Motor Coverage Post
Car accidents are scary. Whether any parties are injured or not, dealing with the insurance company for vehicle damage or personal injury is not an enjoyable activity for the general public. The situation is even less enjoyable when the person dealing with the insurance company is not the policyholder.

 In March 2007, Brian Duplichan’s daughter and the mother of his daughter were passengers in a car driven by Beverly Hooper. Although his daughter, Kadie, survived the accident, her mother, Sarah, did not. Both Sarah and Kadie lived with Sarah’s mother, Mary Elizabeth Reeves. Duplichan brought a lawsuit against State Farm Mutual Automobile Insurance for recovery of damages.

 Kadie and her mother were riding with Beverly Hooper when Hooper swerved off the road into a culvert. These facts are not disputed—it’s the aftermath of the accident that put Spears’ mother—Mary Reeves—and Duplichan through the wringer. 

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