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Category: Insurance Company Delays

  • Car Insurance Exclusions: The Battle Between Intent and Fine Print

    Car insurance policies can be riddled with complex terms and conditions, often leading to misunderstandings between policyholders and insurers. The case of Mandi and Abigail Ardda v. Danielle T. Peters, et al. brings this issue to the forefront, highlighting the challenges of navigating insurance exclusions and the importance of clear communication.

    The Accident and the Insurance Claim:

    Abigail Ardda was involved in a car accident while driving a car she co-owned with her husband, Mandi. They filed a claim with their insurer, GoAuto Insurance Company, but were shocked to discover Abigail was listed as an excluded driver, despite their belief that she was covered.

    The Dispute:

    The Arddas claimed they had explicitly instructed the GoAuto agent to include Abigail on the policy and had even paid an additional premium for her coverage. They argued that the exclusion was a result of a mistake by the GoAuto employee and sought to have the policy reformed to reflect their original intent.

    The Court’s Decision:

    The trial court initially ruled in favor of GoAuto, stating that the exclusion was clear and unambiguous. However, the Court of Appeal reversed this decision, stating that there were genuine issues of material fact regarding whether a mutual error had occurred. The case was remanded for further proceedings to determine the true intent of the parties.

    Key Takeaways:

    This case underscores the following important points:

    • Read your policy carefully: It’s crucial to review your insurance policy thoroughly and understand its terms, including any exclusions. Don’t hesitate to ask your agent for clarification if anything is unclear.
    • Document your interactions with your insurer: Keep records of all conversations, emails, and other communications with your insurance agent or company. This can be valuable evidence if a dispute arises later.
    • Don’t rely solely on verbal agreements: While verbal assurances from your agent are important, make sure they are reflected in your written policy. If there’s a discrepancy, address it immediately.
    • Seek legal help if necessary: If you believe your insurer has made an error or is acting in bad faith, consult with an attorney who specializes in insurance law.

    The Ardda’s case serves as a reminder that insurance policies are contracts and should accurately reflect the agreement between the insured and the insurer. When misunderstandings arise, it’s important to seek resolution and, if necessary, legal recourse to protect your rights. Remember, the fine print matters, but so does your intent.

    Written by Berniard Law Firm

    Additional Berniard Law Firm Blog Articles on Car Insurance Contracts: What happens if you are involved in a car accident where your damages exceed the auto insurance policy limits of the person responsible? and Understanding Insurance Exclusions: A Case of Property Damage Coverage for Borrowed Cars

  • Subrogation Rights Upheld: Insurer’s Claim Prevails Despite Settlement

    In the realm of insurance claims and legal disputes, the concept of subrogation often plays a crucial role. Subrogation allows an insurer, after paying a claim to its insured, to step into the insured’s shoes and seek reimbursement from the party responsible for the loss. But what happens when the insured settles their claim directly with the at-fault party? Does the insurer lose its right to subrogation? A recent Louisiana Court of Appeals case, Louisiana Farm Bureau Casualty Insurance Company v. David Scott Burkett, et al., sheds light on this issue.

    The Accident and the Claim:

    The case stemmed from a car accident where Katherine Burkett, insured by Shelter Mutual Insurance Company, collided with Jessica Hall, insured by Louisiana Farm Bureau Casualty Insurance Company. Farm Bureau paid Hall $5,000 for medical expenses under her policy and became subrogated to her claim for that amount.

    The Settlement and the Lawsuit:

    Hall later sued the Burketts and Shelter for her injuries. However, before Farm Bureau could intervene, Hall settled her claim with Shelter for $53,500. Farm Bureau, unaware of the settlement, filed a separate lawsuit against the Burketts and Shelter to recover the $5,000 it had paid to Hall.

    The Trial Court’s Decision:

    The trial court granted summary judgment in favor of the defendants, stating that Hall’s settlement released them from any further liability, including Farm Bureau’s subrogation claim.

    The Court of Appeals’ Reversal:

    The Court of Appeals reversed this decision. It emphasized that Farm Bureau had notified Shelter of its subrogation claim well before Hall’s settlement. This prior notice prevented the defendants from using the settlement as a shield against Farm Bureau’s claim. The court highlighted that a subrogated insurer has an independent right to pursue reimbursement from the at-fault party, even if the insured has settled their claim.

    Key Takeaways:

    • Timely Notice is Key: Insurers must promptly notify the at-fault party’s insurer of their subrogation interest. This notice protects the insurer’s right to reimbursement, even if the insured later settles their claim.
    • Subrogation is an Independent Right: Subrogation is not dependent on the insured’s actions. An insurer can pursue its subrogation claim even if the insured has settled their claim, as long as the at-fault party was previously notified of the subrogation interest.
    • Understanding Solidary Obligations: In Louisiana, when multiple parties are liable for the same debt, they are considered solidary obligors. This means the creditor (in this case, Farm Bureau) can seek full payment from any of the liable parties.

    The Louisiana Farm Bureau case serves as a crucial reminder for insurers to be proactive in protecting their subrogation rights. Timely notice to the at-fault party is essential to ensure that a subsequent settlement between the insured and the at-fault party does not extinguish the insurer’s right to reimbursement.

    Written by Berniard Law Firm

    Other Berniard Law Firm Blog Articles on Subrogation: Insurance Ruling Upholds Third-Party Fire Damage Claims and Read the Fine Print, Louisiana Court Finds Company Falls With Subrogation Waiver

  • Injured Worker Wins Right to Shoulder Surgery: Court Upholds Decision Against Employer and Insurer

    In a victory for injured workers in Louisiana, the Court of Appeal for the Fourth Circuit recently upheld a decision granting Lorae Burnett the right to shoulder surgery following a work-related motor vehicle accident. The case, Burnett v. Full Force Staffing, LLC, & LUBA Casualty Insurance Company, centered on interpreting the state’s Medical Treatment Guidelines and whether the recommended surgery was medically necessary and appropriate.

    Background of the Case:

    Mr. Burnett, an employee of Full Force Staffing, was injured in a motor vehicle accident while on the job. He sought workers’ compensation benefits for various injuries, including significant pain in his right shoulder. After receiving conservative treatment that failed to alleviate his pain, Mr. Burnett’s orthopedic shoulder specialist, Dr. Savoie, recommended surgery.

    Dispute Over Surgery:

    LUBA Casualty Insurance Company, the Full Force Staffing insurer, denied the surgery request. They claimed the surgery was not pre-authorized, and there was no prior indication that Dr. Savoie was Mr. Burnett’s chosen physician.

    Mr. Burnett challenged this denial, filing a Disputed Claim for Medical Treatment with the Office of Workers’ Compensation’s (OWC) Medical Director. After reviewing Mr. Burnett’s medical records, the Medical Director determined that the surgery was in accordance with the OWC Medical Treatment Guidelines and should be covered.

    The Appeal

    Full Force Staffing and LUBA appealed the Medical Director’s decision, arguing that the surgery was unnecessary and did not comply with the Medical Treatment Guidelines. They also asserted that Mr. Burnett had not undergone sufficient conservative therapy before opting for surgery.

    Court’s Decision:

    The Court of Appeal reviewed the case and found that Mr. Burnett’s medical records clearly showed that conservative treatment had failed to relieve his pain. The court also noted that the Medical Director had likely reviewed additional medical records not presented in court, further supporting the decision to approve the surgery.

    The court ultimately affirmed the OWC’s judgment, upholding Mr. Burnett’s right to receive the recommended shoulder surgery. It concluded that the appellants failed to provide clear and convincing evidence to overturn the Medical Director’s decision, especially since they did not present any countervailing medical evidence to dispute Dr. Savoie’s recommendation.

    Key Takeaways:

    This case is an essential reminder that injured workers in Louisiana have the right to receive medically necessary treatment, even if it requires surgery. The Medical Treatment Guidelines provide a framework for determining appropriate care, and the OWC Medical Director plays a critical role in resolving disputes.

    If your workers’ compensation claim for medical treatment is denied, you can challenge that decision. It is crucial to consult with an experienced workers’ compensation attorney who can guide you through the dispute resolution process and advocate for your right to receive the necessary medical care.

    Written by Berniard Law Firm

  • Louisiana Court Upholds Insurer’s Position in Uninsured Motorist Claim Dispute

    In a recent ruling, the Louisiana Court of Appeal, Third Circuit, affirmed a trial court’s decision denying Amanda Bertrand’s claim for penalties and attorney fees against her underinsured/uninsured motorist (UM) insurer, Progressive Security Insurance Company. The case stemmed from a dispute over the timeliness of Progressive’s payment following Ms. Bertrand’s demand for the limits of her UM coverage.

    Ms. Bertrand was injured in a car accident in 2012. The at-fault driver’s insurance company, Farm Bureau, tendered its policy limits of $15,000 in early 2013. Subsequently, Ms. Bertrand notified Progressive, her UM insurer, of the accident and demanded payment of her $15,000 UM policy limits.

    Progressive received Ms. Bertrand’s demand letter but requested an additional medical record from her treating physician. Upon receiving this record, Progressive promptly issued payment. However, due to a communication issue, Ms. Bertrand’s attorney indicated that the payment had not been received, leading Progressive to stop the initial payment and reissue it.

    Ms. Bertrand’s attorney then raised concerns about the language on the reissued check and accompanying release document, suggesting they constituted a conditional tender rather than the unconditional tender required by law. Progressive assured Ms. Bertrand’s counsel that the tender was unconditional.

    Ms. Bertrand eventually negotiated the check but later filed a lawsuit against Progressive, claiming they failed to issue an unconditional tender within the statutory timeframe and seeking penalties, attorney fees, and costs.

    The Court of Appeal focused on two key issues:

    1. Satisfactory Proof of Loss: The court determined that Progressive did not receive a satisfactory proof of loss until it received the additional medical record from Ms. Bertrand’s physician. This record was crucial in confirming the extent of Ms. Bertrand’s injuries and their relation to the accident.

    2. Unconditional Tender: The court concluded that Progressive’s subsequent communication clarifying the unconditional nature of the payment constituted an unconditional tender.

    Furthermore, the court addressed procedural objections raised by Ms. Bertrand regarding the evidence presented by Progressive. It determined that Progressive’s submissions complied with the relevant legal requirements.

    Based on its analysis, the Court of Appeal affirmed the trial court’s judgment, dismissing Ms. Bertrand’s claims against Progressive. It held that Ms. Bertrand failed to prove that Progressive’s actions were arbitrary, capricious, or without probable cause, which is necessary to recover penalties and attorney fees.

    This case highlights the importance of clear communication and complete documentation in insurance claims, particularly when dealing with UM coverage. It emphasizes the insurer’s right to request additional information to assess the claim’s validity and the insured’s obligation to provide a satisfactory proof of loss. Additionally, the ruling underscores the necessity of demonstrating an insurer’s bad faith to recover penalties and attorney fees.

    Additional Sources:AMANDA BERTRAND VERSUS PROGRESSIVE SECURITY INSURANCE COMPANY

    Written by Berniard Law Firm

    Other Berniard Law Firm Articles on Bad Faith Insurance Lawsuits: Court of Appeals Awards Bad Faith Damages Against Insurance Company Who Refused to Pay and Bad Faith Insurance Claim Dismissed Due To Waiting Too Long To File

  • Unexpected Acceleration or Failure to Yield? Louisiana Court Reverses Summary Judgment in Car Accident Case

    In personal injury law, car accidents at intersections are all too common. However, the case of Trapp v. Allstate Property and Casualty Insurance Company brings a unique twist: the claim of a sudden, unexpected vehicle malfunction. This Louisiana Court of Appeal decision underscores the importance of thoroughly investigating all aspects of an accident before assigning fault, especially when a vehicle defect may have contributed.

    The case arose from an accident at an intersection in Louisiana. Mr. Trapp was entering the highway from a gas station parking lot when his truck collided with Mr. Martin’s truck. While Mr. Trapp was cited for failure to yield, Mr. Martin claimed his truck suddenly accelerated out of control, preventing him from avoiding the collision.

    The trial court initially granted summary judgment, finding Mr. Martin 100% at fault. However, the Court of Appeal reversed this decision, stating that genuine issues of material fact existed regarding comparative fault and the potential for a third party (the vehicle manufacturer) to be at fault.

    The Court of Appeal emphasized that summary judgment is only appropriate when there’s no genuine dispute about any material facts. In this case, Mr. Martin’s consistent testimony about his truck’s sudden acceleration raised questions about whether the accident was solely his fault. The court noted that while an expert couldn’t reproduce the malfunction, this didn’t negate Mr. Martin’s claim.

    Additionally, the court considered Mr. Trapp’s statement to the investigating officer that he believed Mr. Martin had time to slow down. This suggested Mr. Trapp might have incorrectly assumed Mr. Martin would yield, even though the law required him to yield when entering the highway.

    The court concluded that these disputed facts warranted a trial to determine each driver’s degree of fault and whether any third party, such as the vehicle manufacturer, might also be liable.

    Things to Consider: 

    • Sudden Acceleration Claims: While rare, claims of sudden unintended acceleration can complicate car accident cases. It’s essential to thoroughly investigate such claims and consider all potential contributing factors.
    • Comparative Fault: Louisiana follows a comparative fault system, meaning fault can be apportioned between multiple parties, including drivers and potentially even vehicle manufacturers.
    • Summary Judgment Requires No Disputed Facts: Summary judgment is only appropriate when there’s no genuine dispute about critical facts. These issues must be resolved at trial if there are conflicting accounts or evidence.

    The Trapp decision reminds us that assigning fault in car accidents isn’t always straightforward. Factors like potential vehicle malfunctions and the actions of both drivers must be carefully considered.

    If you’ve been involved in a car accident, seeking legal advice from an experienced personal injury attorney is crucial. They can help you investigate the accident, identify all potentially liable parties, and fight for the compensation you deserve.

    Additional Sources: JEFFREY TRAPP, ET AL. VERSUS ALLSTATE PROPERTY AND CASUALTY INSURANCE COMPANY AND JOHN R. MARTIN

    Written by Berniard Law Firm

    Other Berniard Law Firm Articles on Car Accidents: Can a Prior Insurance Lawsuit Affect Your Personal Injury Claim?  and Louisiana Court Upholds Modest Damages in Minor Car Accident Case: Highlighting the Importance of Proving Causation and the Impact of Pre-Existing Conditions

  • When Does an Insurance Contract End? Louisiana Court Reverses Summary Judgment in Dispute Over Coverage Extension

    In the complex world of insurance coverage disputes, a recent Louisiana Court of Appeal decision underscores the importance of thoroughly examining factual issues before granting summary judgment. The case involved a personal injury lawsuit and a subsequent dispute over insurance coverage. The appellate court’s ruling is a stark reminder that seemingly straightforward cases can hinge on nuanced contractual interpretations and disputed facts.

    The case originated from a 1998 accident where Bobbie Sanders, an employee of Mark A. Robicheaux, Inc., was injured while working on a vessel constructed by Swiftships, Inc. Sanders sued Swiftships, which, in turn, filed a third-party demand against its insurer, United Fire & Casualty Company, claiming coverage under a policy issued to Robicheaux.

    The crux of the dispute was whether Swiftships qualified as an additional insured under Robicheaux’s policy, even though the initial contract between the two companies had expired. Swiftships argued that the business relationship continued under the original contract’s terms, while United Fire contended there was no agreement to extend the contract.

    The trial court initially granted summary judgment in favor of Swiftships, but this was later overturned on appeal due to procedural errors. On remand, the trial court again ruled for Swiftships, ordering United Fire to pay defense costs. Both parties appealed this decision.

    The Court of Appeal reversed the trial court’s summary judgment and vacated the subsequent judgment, awarding defense costs to Swiftships. It emphasized that summary judgment is only appropriate when there are no genuine issues of material fact. In this case, there was an apparent dispute about whether the original contract between Swiftships and Robicheaux had been extended and, if so, whether its terms, including the insurance coverage provisions, still applied.

    The court stressed that the trial court’s role in a summary judgment motion is not to weigh evidence or make credibility determinations but to identify whether any genuine factual disputes exist that require a trial. By granting summary judgment, the trial court had effectively decided these disputed facts, which was an error.

    The Sanders case highlights several critical points:

    • Contractual Interpretation Matters: The outcome of insurance coverage disputes often hinges on the interpretation of contracts and agreements. It’s vital to carefully review all relevant documents and consider potential ambiguities.
    • Summary Judgment is Not Always Appropriate: Even when a case seems straightforward, underlying factual disputes can preclude summary judgment. Courts must be cautious not to usurp the jury’s role in resolving such conflicts.
    • The Importance of Appealing Procedural Errors: The initial summary judgment in favor of Swiftships was overturned on appeal due to procedural errors. This underscores the importance of following proper legal procedures and the potential consequences of failing to do so.

    The Sanders case serves as a reminder of the complexities involved in insurance coverage disputes and the critical role of the courts in ensuring a fair resolution. If you’re involved in a dispute with your insurance company or agent, seeking legal advice is crucial. An experienced attorney can help you navigate the legal landscape, protect your rights, and fight for the coverage you deserve.

    Additional Resources: BOBBIE J. SANDERS, JR. VERSUS SWIFTSHIPS, INC.

    Written by Berniard Law Firm

    Other Berniard Law Firm Blog Articles on Insurance Disputes: Injured Pedestrian in Ouachita Parish Unable to Recover from Multiple Insurance Policies and How Is Coverage Divided When Multiple Insurance Policies Are Involved?

  • Driver Not Liable for Passenger’s Injury in Accident Beyond His Control

    Sometimes, being a passenger in a car can be a frustrating and disturbing experience. This is especially true when actions beyond the passenger’s control, such as being involved in a collision, put his or her life in danger. When such a situation arises, the injured passenger will, understandably, seek compensation from the responsible party. However, if the person who caused the accident leaves the scene and is never apprehended by law enforcement, an injured person may turn their attention elsewhere for financial compensation. Such a situation arose following a car accident on a stretch of highway between Jennings and Lafayette, Louisiana. 

    Kyle Jordan was driving a rental car with Riley Moulton as a passenger. The vehicle was sideswiped, causing Jordan’s car to flip over and injure Moulton. The hit-and-run driver was never identified, so Mouton sued both Jordan and the rental car company, EAN Holdings, for damages. The defendants moved for summary judgment, arguing that since Mouton admitted in his deposition that Jordan was driving safely at the time of the accident and did nothing to cause it, Moulton offered no evidence to support a theory of recovery against Jordan or EAN Holdings. The trial court granted the defendant’s motions for summary judgment. Mouton appealed to Louisiana’s Third Circuit Court of Appeal.

    The Appellate Court reviewed the facts of the case as laid out by Mouton himself in his deposition testimony. Mouton stated that Jordan had set the cruise control in the car to 70 MPH, consistent with the speed limit, and was “driving correct.” He further testified that the accident occurred when Jordan made a proper change into the left lane to pass a large truck.

    A driver in a Kia came up from behind and, in a dangerous and illegal move known as “shooting the gauntlet,” attempted to pass Jordan’s vehicle on the right-hand side between it and the truck Jordan was trying to pass. The Kia sideswipedan’s vehicle, sending it out of control. Jordan attempted to regain control but overcorrected and flipped the car. Mouton’s testimony made it evident that Jordan could not have done anything to avoid the accident.

    Summary judgment should be granted if “the adverse party fails to produce factual support sufficient to establish that he will be able to satisfy his evidentiary burden of proof at trial.” Hardy v. Bowie, 744 So.2d 606 (La. 1999). In this instance, the Court noted, Mouton was unable to point to any evidence suggesting Jordan’s liability for the injuries he suffered in the crash.

    Mouton freely admitted in his deposition that Jordan was “driving as he was supposed to” by following the speed limit and remaining in his lane. Mouton also revealed that Jordan could not have taken any actions to avoid the accident. It was beyond his control, and the Kia driver was solely responsible for side-swiping Jordan. 

    Jordan also was not at fault for any action he may have taken after being sideswiped by the Kia under the sudden emergency doctrine. The doctrine provides that “one who finds himself in imminent danger, without sufficient time to weigh and consider all of the circumstances or means of avoiding danger, is not guilty of negligence if he fails to choose what subsequently appears to be the better method.” Bryn Lynn Corp. v. Valliere, 434 So.2d 600 (La. Ct. App. 1983).

    The Court determined that there was nothing Jordan could have done to avoid the accident, which occurred suddenly and unexpectedly; under the sudden emergency doctrine, he cannot be considered negligent for failing to regain control of the car. Instead, the driver of the Kia was solely at fault for the injuries Mouton suffered. Therefore, the Court affirmed the trial court’s grant of summary judgment in Jordan’s favor.

    Similarly, the Court held that Moulton offered no theory of recovery against EAN Holdings, which simply rented a car to Jordan. When a car renter is in “exclusive physical control of the lease object,” negligence “cannot be imputed to the lessor.” Dixie Drive It Yourself Sys. v. American Beverage Co., 137 So.2d 298 (La. 1962).  The Court noted that even if Jordan had been at fault for Mouton’s injuries, EAN Holdings would not have been liable under this “well settled” rule. Thus, the Court also affirmed the trial court’s grant of summary judgment in favor of EAN Holdings.

    This case demonstrates two important principles. First, it shows how courts attempt to resolve disputes quickly and efficiently through summary judgment when a plaintiff fails to provide factual support for his theory of recovery. Second, it demonstrates the operation of the sudden emergency doctrine that limits a person’s liability when unexpectedly thrust into a dangerous situation caused by another party’s negligent or reckless actions. In what should be a comfort to motorists across Louisiana, the doctrine affords them some leniency for not acting perfectly reasonably when they are put in a situation for which they are not trained and have little or no experience. In this case, Jordan was not a stunt driver or car racer; the Court determined he could not be expected to know how to react perfectly when his car was sideswiped at highway speeds.

    Additional Source:  RILEY MOUTON VERSUS EAN HOLDINGS, LLC, ET AL.

    Written by Berniard Law Firm

  • Prior Mistake Does Not Waive Insurer’s Defense In Subsequent Claim

    If you are in a car accident and your insurance pays your claim, you likely expect the same thing will happen if you are subsequently in a similar accident. What happens if your insurer paid your prior claim, but tries to deny a subsequent claim? 

    Brandon Forvendel was injured in a car accident. When the accident occurred, he was driving a car he owned and was insured by State Farm. Forvendel had uninsured motorist coverage. After the accident, Forvendel recovered under his uninsured motorist policy. 

    When the accident occurred, he was living with his mother, who also had insurance through State Farm. Forvendel also tried to recover under his mother’s uninsured motorist policy, which had higher policy limits. State Farm denied his attempt to recover under both his and his mother’s policies under the anti-stacking provisions in La. R.S. 22:1295(1)(c). Forvendel then filed a lawsuit against State Farm. 

    He claimed this situation was similar to what occurred when he was involved in another accident years earlier and State Farm had allowed him to recover under both his and his mother’s uninsured motorist policies. State Farm representatives testified they had not considered the anti-stacking statute at the time of the prior accident. 

    The district court found in favor of Forvendel, noting State Farm had previously interpreted the policy to cover Forvendel under his mother’s policy, based on State Farm paying Forvendel when the prior accident occurred. State Farm appealed. The appellate court held the trial court did not err in holding State Farm had waived any defenses to the current claim by having paid Forvendel when the prior accident occurred. 

    The Louisiana Supreme Court noted Forvendel did not dispute that the anti-stacking provision applied here. However, he argued State Farm waived its right to this defense by paying out his prior claim. In Steptore v. Masco Constr. Co., the Louisiana Supreme Court held an insurer waives its right to coverage defenses if they assume and continue to defend the insured even when there are facts they had the right to deny coverage. 

    However, the court distinguished Steptore from the situation here. In Steptore, the waiver was based on the insurer’s actions with respect to a specific incident. In this case, Forvendel tried to rely on State Farm’s actions from a claim years earlier. Therefore, the Louisiana Supreme Court held the insurer had not waived its defenses to Forvendel’s current claim by paying out the claim associated with his accident years earlier and reversed the appellate court’s holding State Farm had waived its defenses by having paid the prior claim. Otherwise, the court noted State Farm would never be allowed to use the anti-stacking statue as a defense against subsequent claims.

    This case illustrates how just because your insurance policy paid out one claim, does not mean your insurer will have have to pay a subsequent similar claim. A good attorney can advise you on what your insurance policy does and does not qualify and what to do if your insurer denies your claim.

    Additional Sources: Brandon Forvendel v. State Farm Mutual Automobile Ins.

    Article Written By Berniard Law Firm

    Additional Berniard Law Firm Article on Insurance Coverage: Understanding Recovery in Excess of Insurance Coverage in Car Accident Cases in Louisiana

  • Insurance Coverage Turns On Distinction Between Flood Damage And Mechanical Issue

    Dealing with the aftermath of a flood is never fun. This is especially true when the flood damages one of your vehicles. This is the situation Michael Jacobs found himself in after one of his cars was damaged in a flood. After a long fight with his insurance company, he eventually prevailed and was awarded damages. 

    Jacobs owned multiple vehicles that GEICO insured. His parish in North Louisiana was affected by heavy flooding. When the flooding started, Jacobs and his brother tried to move the vehicles from his house to higher ground but were unable to remove them before the floodwaters rose, so they could not drive up to the house. Jacobs waded through the floodwater to retrieve one of the vehicles, a 2001 Honda Accord. In the days following the flood, the Honda kept overheating. Jacobs claimed this had only occurred after the flood. 

    Jacobs submitted a claim to GEICO for the damage to the vehicle. The insurance inspector did not identify any flood-related problems and determined the upper radiator hose had blown out. Another mechanic gave Jacobs an opinion and concluded there were issues with his spark plugs. GEICO ultimately denied Jacobs’ claim because it had suffered a mechanical failure that was not flood-related. Jacobs filed a lawsuit against GEICO, alleging his Honda had been damaged from the flooding. At trial, the court ruled the Honda had suffered water damage and awarded vehicle property damages and attorney fees. GEICO filed an appeal.

    On appeal, GEICO argued the trial court erred in finding it was liable because the relevant insurance policy had not been provided as evidence. The trial court record indicated GEICO had not raised issues related to insurance coverage at trial. GEICO had also not objected to letters it had sent to Jacobs recognizing “flood damage” insurance being entered as evidence. Therefore, the assumption at trial was Jacobs had flood damage coverage but not coverage for mechanical issues with the vehicle. An appellate court will generally not consider issues raised for the first time on appeal. See Costello v. Hardy. As a result, the appellate court held that the insurance policy was not introduced as evidence did not make the ruling wrong.

    GEICO also argued the trial court erred in finding the flood had damaged the Honda. The appellate court pointed to conflicting testimony at trial from different witnesses about the cause of the Honda’s damage.  An appellate court can only overturn a trial court’s factual finding if it is manifestly erroneous or clearly wrong. See Cole v. State, Dept. of Public Safety and Corr. The trial court appeared to have found the witness who testified the flooding had caused the Honda’s damage to be more credible. Because there was nothing clearly wrong or erroneous in the trial court’s finding, the appellate court did not disturb the trial court’s finding.

    As seen here, although GEICO initially denied Jacobs’ claim, Jacobs prevailed at trial. If you feel like your insurance company has improperly denied a claim, an experienced attorney can advise you on possible legal remedies. 

    Additional Sources: Michael J. Jacobs v. GEICO Indemnity Co.

    Article Written By Berniard Law Firm

    Additional Berniard Law Firm Article on Insurance Coverage for Flood Damage: Homeowners Recover Full Amount of Wood Floor Damages, and Home Insurance Company is Sanctioned for Delay

    Dealing with Flood Damaged Property? Be Prepared to Show Causation

  • Management Company Not Qualified As Additional Insured In Cleaning Company’s Insurance Policy

    It can be challenging to interpret insurance policies, especially when they involve complex provisions such as coverage for an additional insured. Before signing an insurance policy, it is imperative to understand its language and what it does and does not cover. Here, the plain language of the insurance policy proved instrumental in the appellate court’s ruling.

    Pamela Sloane was injured while working for Integrity Cleaning Services (“Integrity”) at Forestwood Apartments. She was cleaning a ceiling fan while standing on a ladder. She inadvertently touched an exposed wire, which electrocuted her, and she fell from the ladder. Sloane filed a lawsuit against CLK Multifamily Management (“CLK”) and others. Sloane claimed CLK had not adequately maintained the premises or warned of the dangerous condition of the exposed wire. CLK filed its answer to the lawsuit, denying the allegations, and added Travelers Indemnity (“Travelers”) to the lawsuit.  CLK claimed Integrity was contractually required to have a general liability insurance policy that covered CLK as additional insureds. 

    Travelers filed a summary judgment motion, claiming CLK was not an additional insured under the policy. Travelers attached a copy of the relevant insurance policy to its summary judgment motion. CLK disagreed and claimed it was indeed an additional insured.  The trial court concluded CLK was not qualified as an additional insured and granted Travelers’ summary judgment motion. 

    An insurance policy is a contract interpreted using general contractual interpretation rules.   Under La. C.C. art. 2045, the court’s role is to determine the parties’ common intent.  To do so, courts look first at the insurance policy’s language. See La. C.C. art. 2046. Here, CLK had the burden of proving the applicable insurance policy covered it because it was the party claiming to be covered by the insurance policy. 

    The court analyzed the additional insured provision of the insurance policy. While CLK and Travelers did not disagree that Integrity had agreed to have its insurance cover CLK as an additional insured, they disputed the scope of coverage and whether CLK qualified.  In interpreting the plain language of the insurance policy, the court concluded the policy only applied to CLK when Integrity would have been vicariously liable for something Integrity had done or had failed to do. 

    In this case, Sloane’s allegations would have involved something CLK had independently done or failed to do, not an act or omission of Integrity. Given the circumstances of Sloane’s injuries involving the exposed wire, Integrity could not be liable for her injuries, such as if Integrity had not properly trained Sloane how to clean a ceiling fan.  Therefore, the appellate court affirmed the trial court’s grant of Travelers’ summary judgment motion.

    As seen in this case, it was insufficient for CLK to confirm the insurance policy had an additional insured provision. Instead, CLK needed to read and understand the specific requirements for applying the provision. An experienced insurance claim attorney can help advise you on insurance policies so you know what the policy does and does not cover. 

    Additional Sources: Pamela Sloane v. Forestwoods Apartments/Baton Rouse, LTD., CLK Multifamily Management, LLC and Aspen American Ins. Co.

    Article Written By Berniard Law Firm

    Additional Berniard Law Firm Article on Insurance Coverage: Understanding Insurance Exclusions: A Case of Property Damage Coverage for Borrowed Cars