Articles Posted in Insurance Dispute

Every adult in America has dealt with insurance in some manner, whether it be life, car, house, rental, or health. Therefore, it is important to understand that the insurance policy you agree to constitutes the law between the you and the insurance company; it governs the whole relationship. As a result of the policy between the insured and insurer being drafted by the insurer, the insurer has the right to limit provisions, and impose restrictions or conditions, so long as these do not conflict with legal statutory provisions or public policy. Thus, strict compliance with the insurance policy terms and conditions is required for a change of beneficiary. Standard Ins. Co. v. Spottsville, 204 So.3d 253, 258 (La. Ct. App. 2016).

In this case, Tanya Offord (“Tanya”) had changed her primary beneficiary from her previous husband to her mother, Alfreda Smith. However, in February 2009, Tanya married Thurman Offord, Sr. Following her marriage to Mr. Offord, Tanya submitted a change of beneficiary to Allstate. She listed Mr. Offord and her three children as the primary beneficiaries, and she listed her mother as the sole contingent beneficiary. She also listed both Mr. Offord and Ms. Smith as the adult custodians for her children, so that they may receive and control any monies owed to any children who are minors at the time of her death.

Allstate responded to Tanya’s beneficiary change request, acknowledging receipt of Tanya’s beneficiary change request. They then informed her that they could not process the request because, per her policy, only one custodian could be named per child. They included a new beneficiary change request form for Tanya to complete and return. Tanya failed to resubmit the change of beneficiary request form and subsequently died without submitting the form.

Obtaining insurance coverage to protect a new company purchase can be crucial to preventing financial loss. But does a company have policy coverage on a new purchase when the insurance company provides only a certificate of insurance? A case in the First Circuit Court of Appeal for Louisiana recently addressed the issue. 

J&M Piling Driving (“J&M”) requested a quote for insurance from Chabert Insurance Agency (“Chabert”), in August of 2010. J&M was looking to insure the company’s new vessel, called the Lil Cherie. The Lil Cherie sank one month later, and J&M discovered that Chabert was not willing to provide coverage for the accident despite issuing two certificates of insurance. 

J&M then filed a lawsuit against Chabert. In the lawsuit, J&M alleged that Chabert informed J&M that the vessel was covered by insurance and therefore J&M was under the impression that Lil Cherie was fully insured. J&M sought damages for the value of Lil Cherie, personal items on Lil Cherie, salvaging the sunken vessel, and loss of income. 

Why do we buy insurance? Most people expect that when they buy insurance, they will receive financial reimbursement for losses caused by accidents or many of life’s unexpected circumstances. It can certainly be a surprise when they expect insurance and then the insurance company refuses to provide it. What are their options when this happens? Filing a lawsuit is one, but won’t always guarantee a day in court, as a 2017 case from the Court of Appeal for the Third Circuit illustrates.

Advanced Radiographics Inc., (“ARI”) is a company that stores health records for medical providers in Louisiana. Its corporate office and one of its warehouses are located in Duson, Louisiana, but the company also has eight other locations. For insurance, ARI purchased general liability coverage which covered all ten of ARI’s locations, and property insurance which only covered ARI’s corporate office. Colony Insurance Company (“Colony”) provided the property insurance which was purchased through insurance broker Kellie Stein (“Stein”) of Brown and Brown of Baton Rouge, LLC (“Brown”).

Unfortunately for ARI, in 2014, a car crashed into the Duson warehouse and caused a fire to break out. ARI filed an insurance claim to Colony, but Colony denied it. For refusing to file, ARI sued Colony, Stein, and Brown in the Fifteenth Judicial District Court for Lafayette Parish. Stein and Brown filed a peremptory exception of no cause of action and in 2016, the District Court granted the exception. ARI then appealed, claiming that the exception of no cause of action should not have been granted.

Almost all companies have insurance policies to protect them from liability that may arise during the course of business. In this case, the defendant, Reggie’s, had a commercial general liability (“CGL”) policy through Century Surety Company (“Century”). Generally, an insurance company may limit coverage, so long as the limits to not conflict with any laws or public policy, and when there is a limit, the insurance contract must be strictly construed against the insurer. La. C.C. art. 2056. This means that if there are any ambiguities in the exclusion or limitations, they are construed in favor of the insured. See Edward v. Daugherty, 833 So.2d 932, 940 (La. 2004). Here, the question that arose is whether the August 22 fight at Reggie’s bar was excluded under the policy provided by Century under the assault-and-battery endorsement exclusion.

On August 22, 2010, Juan Mendez (“Mendez”) was at Reggie’s bar when he allegedly threw a drink in another patron’s face. Mendez was then escorted out of the building by Evan Vincent (“Vincent”) a bouncer at Reggie’s, and a defendant in the case. After Mendez was removed from the building, he was injured when Vincent picked him up and forced him to the ground. The police and EMS were called, but Vincent was not charged.

Mendez subsequently filed a civil suit for damages against Vincent, Reggie’s, and Century. Following a hearing, the trial court granted summary judgment in favor, finding that the August 22, incident was not covered by Century. The plaintiff appealed, arguing that the incident was not precluded from coverage because the bodily injuries were intended and resulted from the use of reasonable force to protect persons or property.