wreck_shattered_broken_accident-768x1024Injury and negligence alone cannot support a personal injury claim. There must be causation or a link connecting a negligent act and the related injury to succeed at trial. A consistent medical history and a plaintiff’s credibility can enormously impact whether a jury decides that a negligent act caused an alleged injury. This principle was affirmed by the Calcasieu District Court when plaintiff Treima Williams was unsuccessful in her claim for damages arising from a road traffic accident. The case below shows how contradictory medical history can affect the outcome of your injury lawsuit.

A truck driven by Marvin Gainous rear-ended Williams’ vehicle. Gainous had been stopped behind Williams. However, his truck moved forward and struck her vehicle when his foot slipped off the break. Williams claimed that her head, neck, and left shoulder started hurting immediately after the incident. Following the accident, she called an ambulance, which arrived shortly afterward. Williams complained of pain in her left shoulder and back at the hospital, and she was prescribed pain medication. X-rays of her back were interpreted as normal. 

Williams had prior back injuries from a motor vehicle incident in 2006, another motor vehicle injury in 2011, and an injury she sustained at work in 2011. Williams had also complained of back pain during her pregnancy in 2012. Williams received treatment for neck and back strain from 2013 to 2015. In 2016, an independent medical exam was conducted by an orthopedic surgeon who testified that while he believed Williams suffered neck and back strain based on a subjective assessment, there was no objective evidence. He deduced that the MRI could be that of a completely asymptomatic patient. 

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What do the movie, “Charlie and the Chocolate Factory,” and final judgments have in common?  Both require a “golden ticket” to succeed in the next phase.  In Charlie and the Chocolate Factory, each contestant must have a golden ticket to gain access to Willy Wonka’s Chocolate Factory.  In trial-level court cases, judgments must include clear, specific language that makes them valid and disputable.  Although the chances of Charlie discovering one of the five golden tickets were rare, the chances of an appeal being heard are less likely without a valid, disputable judgment.  

What language is required to make a judgment valid and disputable?  How does a court correct a judgment that does not include clear and specific language?  A recent case out of Lafayette addressed these questions and offered preventative measures to avoid future occurrences of the same dilemma.   

Curley Mouton lost his life in an automobile accident on April 24, 2014, after a tire on a tractor-trailer failed and burst, causing debris to fly into the roadway.  Mouton’s surviving spouse and oldest son filed lawsuits against the truck driver, Arthur Huguley, Huguley’s employer, AAA Cooper Transportation, Inc. (ACT), and the insurance company, Ace American Insurance Company (ACE).  After a jury trial, a decision favoring Mouton’s spouse and son was made.  The jury found Huguley and ACT responsible for the accident, with 10% of the responsibility allocated to Huguley and the remaining 90% allocated to ACT.  The jury awarded the Mouton family damages for the survival action and wrongful death damages.  

skeleton_bone_medical_doctor-1024x768Injuries sustained on the job present challenges for the employee and employer, especially when multiple sites of injury are involved. In addition, injuries all over the body can require different medical treatments for each affected area. Specialized treatments such as a spinal cord stimulator can be recommended to alleviate pain to an injured worker. However, a workers compensation insurance company may not be amenable to pay for such treatment. The following case addresses the question, can a workers compensation claimant receive spinal cord stimulator treatment in Louisiana?

Byron Gulley sustained injuries to his head, shoulder, wrist, back, knee, hip, foot and ankle as a result of a golf cart accident while working for the Hope Youth Ranch in June 2009. The claimant was seeing a pain management specialist, Dr. Chad Domangue, who recommended a spinal cord stimulator trial because other medications and treatments failed to address Gulley’s significant low back adequately, left hip, and leg pain. As such, Dr. Domangue filed the proper form requesting this treatment pursuant to the Medical Treatment Guidelines. This request was ultimately denied by the employer’s insurance carrier. Gulley brought the denial to the Medical Director of the Office of Workers’ Compensation, which also rejected the request and the Workers’ Compensation District two affirmed the denial. 

Thereafter, Dr. Domangue continued to see and treat Gulley. Even though the spinal cord stimulator could not address all areas of Gulley’s pain, he believed it was the best option to treat his most significant pain areas. As such, he filed a second request, which was also denied by the employer’s insurance carrier. Gulley then sought approval for the procedure from the Medical Director, who again denied approval because the topography of the claimant’s pain was not amenable to stimulation coverage. 

slip_heads_up_warning-1024x728Slip and fall claims are among the most common types of personal injury lawsuits. But how do you ensure that your claim makes it through the legal process? A dismissed case against a Metairie restaurant can show you what mistakes to avoid in setting up your slip-and-fall claim for success. 

Plaintiff Richard J. Boutall lost his footing and fell to the floor while exiting Minerva Cafe in 2013. As a result of his fall, Boutall broke his femur, was hospitalized for three weeks, and incurred over $30,000 in medical bills. In addition, during this three-week stay, Boutall endured multiple surgeries, including a hip replacement and an insertion of a surgical rod in his leg.

In a lawsuit against the cafe owner, he alleged that a small concrete ramp caused his fall at the door’s threshold. To support his claim, the plaintiff presented the expert report of a professional engineer who studied photographs of the cafe’s entryway. However, the trial court dismissed this case on summary judgment, meaning that it found that the claim did not state facts that would entitle the plaintiff to relief if they were proven true. Mr. Boutall appealed the dismissal. 

maritime_history_metal_historical-1024x680Medical conditions can be a sensitive topic for both employers and employees. While employers are extremely cautious in not asking discriminatory questions, the employees may still be reluctant and afraid to lay all cards on the table. Understandably, workers who suffer from pre-existing medical conditions feel that they don’t need to inform their employers as long as the illnesses are not getting in the way of work. But should they? A recent case from Lousiana Fourth Circuit illuminates the legal consequences where the employee lied on the medical forms and later requested worker’s compensation.

Seaman Rousse injured his back while performing his duties as a deckhand on a United Tugs vessel in 2014. His injuries caused him to have two lumbar spine surgeries. United Tugs paid his maintenance and cure, covering his medical expenses. However, three years later, in 2017, United was alerted that Rousse had significant back injuries before he started working on the vessel. He failed to disclose his prior medical treatments during the hiring process. As a result, United sought restitution of the paid compensation. The district court ruled in favor of United, holding that Rousse had forfeited his entitlement to receive maintenance and cure because he concealed that he had suffered back injuries before employment. Rousse appealed.

A duty for maintenance and cure means that the vessel owner must “provide food, lodging, and medical services to a seaman injured while serving the ship.” Lewis & Clark Marine Inc., 531 U.S. 438, 441 (2001). However, this duty is not absolute. When a seaman intentionally conceals or fails to disclose past illness when required by an employer, the employer’s obligation to pay maintenance and cure is eliminated. McCorpen v. Cent. Gulf S.S. Corp., 396 F.2d (5th Cir. 1968). This exception rule is called the McCorpen defense. The U.S. Supreme Court has neither adopted nor rejected the McCorpen defense, resulting in a split among the federal circuit regarding what non-disclosures could bar the employee from receiving benefits. The Louisiana Fourth Circuit found McCorpen persuasive and decided to follow McCorpen in this maritime lawsuit.

source_grass_lawn_water-1024x683The Collateral Source Rule in Louisiana law prevents a tortfeasor (a person who harmed another) from benefiting from the victim’s receipt of funds from an independent source.  So what does that mean?

Let’s say you were injured in a car wreck. As a result of your injuries, you have back surgery before the lawsuit settles. If you have health insurance, that surgery may be paid for by your health insurer. However, your health insurance company pays only part of the bill; they pay some agreed-upon amount with the medical provider. The collateral source rule allows the injured person to argue for the amount paid for the surgery plus 40% of the difference of the billed amount. An example is shown below:

  1. Joe is injured in a car wreck, has health insurance, and undergoes a $100,000 back surgery by ABC Back Drs.

courthouse_court_law_justice-1024x683Lawsuits and appeals can bring up complicated legal issues such as jurisdiction. Jurisdiction is a legal principle that determines the extent and authority of a court to hear and decide cases. There are two primary types of jurisdiction: personal jurisdiction and subject matter jurisdiction.

The first type, personal jurisdiction, is a court’s power to have jurisdiction over the person or parties in the lawsuit. For example, a court in Ohio would most likely have jurisdiction over a resident of Ohio because that person lives and resides there. However, a Florida court would be less likely to have personal jurisdiction over that same Ohio resident unless some exceptions or circumstances occurred.

The other type of jurisdiction is called subject matter jurisdiction, which is a court’s power to have jurisdiction over the subject matter of a lawsuit. The Louisiana Fourth Circuit in Joseph stated that regardless of whether the parties address or challenge subject matter jurisdiction, courts have a duty to determine whether this type of jurisdiction exists before hearing a case. To do this, appellate courts, therefore, must first determine whether the ruling from the trial court that the appellant, the person appealing the decision of the lower court to the higher court, is an appealable judgment.

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. 

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