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Category: Settlement

  • Work-Related Injury and Subsequent Leave: When is Compensation Due?

    Navigating the complexities of workers’ compensation claims can be challenging, especially when subsequent health issues and leaves of absence are involved. A recent case highlights the importance of understanding the nuances of Louisiana workers’ compensation law and the critical role of proving causation in obtaining benefits.

    Jerry Neal, Jr., a radiology technician, sustained a back injury while lifting a patient at St. Tammany Parish Hospital in 2014. He returned to work on modified duty and eventually full duty. However, he re-injured his back in a similar incident in 2015. Again, he was placed on modified duty but later took a leave of absence for an unrelated neck surgery. When his leave expired, he was terminated because he was not medically cleared to return due to his neck, not his back. Subsequently, he filed for workers’ compensation benefits, claiming he was unable to work due to his back injury.

    The court’s decision hinged on whether Mr. Neal’s inability to work was directly caused by his work-related back injury or his non-work-related neck surgery. The court also examined whether he was entitled to temporary total disability (TTD) or supplemental earning benefits (SEB).

    Key Takeaways from the Ruling:

    • Clear and Convincing Evidence for TTD: To receive TTD benefits, an employee must prove by clear and convincing evidence their inability to engage in any employment due to the work-related injury. Mr. Neal’s doctor testified that he could have performed the modified-duty work offered, thus undermining his TTD claim.
    • SEB Eligibility: SEB benefits are available when an employee cannot earn 90% or more of their pre-injury wage due to a work-related injury. The court emphasized that the employee must prove the work-related injury, not another cause, led to the wage loss. Mr. Neal’s voluntary leave for neck surgery was deemed the reason for his inability to work, not his back injury.
    • Doctor’s Testimony and Modified Duty: The court considered the doctor’s testimony that Mr. Neal could have performed modified duty and that his work restrictions were related to his duties as a radiology technician. This further supported the denial of benefits.

    This case underscores the critical importance of establishing a clear causal link between a work-related injury and any subsequent inability to work. If an employee’s absence from work is due to an unrelated medical issue, even if they have a pre-existing work-related injury, they may not be eligible for workers’ compensation benefits. It also highlights the importance of understanding the specific requirements for TTD and SEB benefits and providing sufficient evidence to meet the burden of proof.

    Additional Sources: JERRY HEAL SR. VERSUS ST. TAMMANY PARISH HOSPITAL

    Written by Berniard Law Firm

    Other Berniard Law Firm Articles on Workers Compensation Issues: 1010 Form Required For Company To Cover Medical Expenses in Workers Compensation and Worker Did Not Commit Fraud In Pre-Work Medical History Questionnaire

  • The Importance of Changing a Life Insurance Beneficiary After Divorce

    Divorce can be tumultuous, marked by significant stress and numerous life changes. Amidst the emotional and practical adjustments, it is crucial not to overlook a critical task: updating the beneficiary of your life insurance policy. In Claiborne Parish, a compelling case serves as a cautionary tale, underscoring the paramount importance of understanding and verifying your designated beneficiary on all insurance plans. The story unravels the unsettling reality that the proceeds from your life insurance policy may not end up in the hands of the intended recipient.

    In this case, Hillie Patrick Cox took out a whole-life insurance policy with Southern Farm Bureau, where he listed his mother, Ruby G. Cox, as a beneficiary. Later, he amended the beneficiary to list his wife, Connie Gonzales Cox. Seven years later, however, Hillie and Connie obtained a divorce judgment. Hillie then died approximately 14 years later without executing another change of beneficiary form.  

    Southern Farm Bureau subsequently filed a petition for concursus in the 2nd Judicial District Court for the Parish of Claiborne, claiming that a judgment of possession awarded Ruby usufruct over the entire estate and recognized Debra Cox Diffey, Hillie’s sister as the sole surviving heir. As a result of the judgment, Ruby, Debra, and Connie all presented claims for the insurance proceeds. 

    To support their claims, Ruby and Debra presented allegations asserting that Hillie and Connie’s relations following their divorce were openly hostile, that Hillie thought Connie was not the beneficiary, and the proceeds should go to Hillie’s estate. Conversely, Connie filed a motion of summary judgment and asserted that she was the beneficiary, entitled to the insurance proceeds and that life insurance proceeds were considered non-probate and not part of the decedent’s estate. See American Health & Life Ins. Co. v. Binford. 

    After hearing the evidence, the District Court found the 14-year gap between Hillie and Connie’s divorce and the insured’s death concerning and that awarding the proceeds to Connie could lead to an absurd result. As such, the District Court denied Connie’s motion for summary judgment. Connie then filed an appeal to the Louisiana Second Circuit Court of Appeal. 

    The Court of Appeal found that, under law, the lawful beneficiary of a life insurance policy shall be entitled to the proceeds, and when the insured names a beneficiary, the proceeds of the policy do not become any part of the insured’s estate at his death. See Fowler v. Fowler. Additionally, when the policy unambiguously names a beneficiary, the court cannot inquire whether the insured wishes to change the beneficiary. 

    The Court of Appeal found the insured, Hillie, named his wife, at the time of the execution of the policy, Connie, as the beneficiary of an insurance policy. Although the couple divorced, Hillie did not act to change Connie as the beneficiary. The Court of Appeal also found the policy, application, and change of beneficiary form to be free of ambiguity. Additionally, the extrinsic evidence brought by Ruby and Debra was irrelevant to how the law perceives such situations. Thus, there was no genuine issue of material fact, and Connie was entitled to the insurance policy’s proceeds as a matter of law. 

    This case highlights the potential consequences of neglecting to update the beneficiary designation on your life insurance policy following a divorce. Failing to make this crucial revision can lead to complex legal battles and unintended outcomes. It is a stark reminder of the importance of staying proactive and diligent in managing your insurance plans, ensuring that your wishes are accurately reflected, and your loved ones are protected. By seeking the guidance of a knowledgeable attorney and promptly addressing beneficiary updates, you can help secure the financial well-being of those who matter most to you, even in the face of life’s challenging transitions.

    Additional Sources: SOUTHERN FARM BUREAU LIFE INSURANCE COMPANY versus RUBY S. COX, ET AL.

    Written by Berniard Law Firm Blog Writer: Samantha Calhoun

    Additional Berniard Law Firm Articles on Conflicts involving Life Insurance Beneficiaries: The Life Insurance Beneficiary: Allstate Fails to Accept Change in Beneficiary Form, Creating Conflict — Louisiana Personal Injury Lawyer Blog

  • No Pay, No Play, No Problem? Uninsured Motorist Injured in Car Accident Obtains Jury Award

    Car accidents are traumatic experiences that occur every day across Louisiana. An accident can cause initial damage upon impact, but many accident victims also spend months and sometimes years coping with accident-related injuries.

     On June 27, 2014, Jasmine Raymond, a twenty-four-year-old driver who did not have auto insurance as required by Louisiana law, was heading eastbound on Interstate 10. Her car was rear-ended by Lance Cook, a truck driver for Rubber & Specialties, Inc. when he took his eyes off the road to check the GPS on his phone. Over the next two years following the accident, Raymond required numerous surgeries and procedures to address injuries she sustained in the crash.

     Raymond filed a lawsuit against Cook and his employer, seeking damages for injuries arising from the accident. Before trial, Cook, his employer, and his insurance company filed an affirmative defense to Raymond’s claims under the “no pay, no play statute.” This law states that the victim of a car accident without proper insurance may not recover the first $15,000 of bodily injury damages and the first $25,000 of property damages in any claim related to the accident. La. R.S. 32:866. The rule does not apply when the accident is caused by a drunk driver, a driver who flees the scene, or a driver who otherwise intentionally causes the accident. According to a 2012 report by the Insurance Research Council, the no pay, no play rule intends to provide relief for at-fault drivers who nevertheless complied with state insurance requirements. Raymond filed a motion to dismiss the defendant’s affirmative defense. However, the trial court deferred the issue and proceeded to trial.

     The jury returned a verdict in favor of Raymond, awarding her over 1.5 million dollars in damages for her injuries. The defendants filed a motion for a new trial, arguing that the court failed to consider its affirmative defense. The trial court denied the motion, so the defendants appealed to Louisiana’s Court of Appeal for the Fifth Circuit. Unfortunately for readers of this blog, the parties eventually settled, resulting in a dismissal of the appeal. This meant that the Fifth Circuit Court of Appeal would not have the opportunity to determine the proper application of the no pay, no play statute in this case.

    Presumably, the trial court intended to defer deciding if and how the no pay, no play statute should apply in the case until the verdict was reached. If the jury favored the defendants, the issue would not be revisited. If instead, the jury found in favor of Raymond, as it did, the trial court presumably could have reduced the jury’s damages award based on the no pay, no play law. Understandably, Raymond and the defendants alike would have preferred to have the question settled by the trial court before the trial began. And because of the ultimate resolution of this case, no appellate court can review the trial court’s handling of the matter in a way that might be instructive to future auto accident litigants.

    Louisiana’s no pay, no play statute adds a potential complication for parties in a lawsuit resulting from a car accident. For this reason, among many others, anyone involved in a car crash should ensure they are represented by a qualified attorney experienced in personal injury and accident litigation.

     Additional Sources: RAYMOND v. DEPOSITORS INS. CO.

    Written by Berniard Law Firm Blog Writer: Gina McKlveen

    Additional Berniard Law Firm Articles on Car Accidents: Claim Against State Farm Denied After New Orleans Car Accident; Parties Take Issue with Compensation Awarded to Victim of DeSoto Parish Car Accident; Jury Award of Limited Damages to “Serial Plaintiff” in Personal Injury Case Upheld by the Fifth Circuit Court of Appeals

  • Careful Review of Home Insurance Policy Crucial

     

    It is extremely important to review your home insurance policy to determine what types of damages the policy will actually cover, especially in areas prone to suffer from hurricane damages. Under Louisiana law, the insured individual is required to first prove that the insurance policy covers the cause of the claim. For example, if the policy only covers certain types of causes of damage, such as wind and hail, then the insured must prove that the damage was in fact caused by either wind or hail. Once the insured has done this, then the insurance company can argue that the incident is not covered by the policy. Therefore, it is extremely important that the insured take the time to determine the cause of the damage in order to prove that the policy covers their claim.

     

    A case arising from Lake Charles, Louisiana illustrates this point. In this case, a homeowner suffered roof damage that they believed was caused by Hurricane Ike around September 13, 2008. Four shingles were missing and the insured claimed that this resulted in leakage in several rooms of the home. However, State Farm, the homeowner’s insurance company, determined that the leakage was not caused by Hurricane Ike and reclassified the claim as a “non-hurricane” claim.

     

    State Farm, using several experts, determined that the leakage resulted from normal wear and tear on the roof, and therefore the homeowner’s insurance policy did not cover the leakage damage. Instead, State Farm concluded that only the four missing shingles were the result of wind and that they were the only damages that State Farm should reimburse to the insured; State Farm did not reimburse the insured for the damages caused by the leakage, but just the replacement value of the four damaged or missing shingles. The total damages that State Farm paid were under $500.00.

     

    The insured had damages that were estimated at $9,385.00 by one expert and $204,717.78 by another expert. However, while these experts estimated what the cost of the leakage damage and repairing the roof would be, neither expert determined the actual cause of the damages. One of the insured’s experts thought that the wind had lifted the house’s flat roofing, which allowed water to enter the home. However, the expert could not explain why the nails on the flat roofing were still in place if the wind had lifted it. The State Farm expert, on the other hand, determined that the wind damage only included those four damaged or missing shingles and the leakage was actually caused by normal wear and tear. The State Farm expert concluded that there was “no evidence of roof damage that would be caused by severe weather . . . . The roofs, both asbestos shingle and built up roofs and all associated flashings are past their life cycle and are in need of replacement.”

     

    The insured’s policy did not cover “poor workmanship; wear, tear, deterioration, or latent defect; settling, cracking, or expansion of walls, roofs, or ceilings; or leakage of water from air conditioning systems, household appliances, or plumbing.” Since the State Farm expert determined that the cause of the damage was from normal wear and tear, there was no way that the insured could satisfy the requirement to prove that the policy covered his claim. As such, the court granted State Farm summary judgment.

     

    The court will grant summary judgment where one party cannot meet their required burden as a matter of law at trial. Summary judgment allows the court to avoid costly trials where there is one clear winner before the trial even begins. In this case, where the insured had no evidence that all of the damage he was claiming was caused by an occurrence included in the insurance policy, the court determined that summary judgment was appropriate. If the insured had employed experts that specifically testified as to the cause of the leakage damage, then the court may have allowed the case to proceed to trial. Further, the insured could have made a more diligent effort to report leakage as it occurred, which would help prevent the damage from spreading in the long run.

     

    This case illustrates several very important points for the average homeowner. First, you should carefully read your policy so that you know what type of damage is covered. Second, if necessary, you may need to acquire experts that can explain what caused the damage to your home. Lastly, report damages immediately so that you can avoid costly repairs later on.  (more…)

  • Understanding the Direct Action Statute and Insurance Disputes

    Louisiana has a Direct Action Statute that allows injured third parties to sue an insurance company directly when the insurance company’s insured causes an injury. For example, if you are involved an automobile accident where you are not at fault, you can sue the at-fault driver’s insurance company directly instead of suing the at-fault driver themselves. The Direct Action Statute is beneficial because it gives injured third parties access to the entity that will actually pay compensation for the injuries. It can be especially helpful where the insured fails to file a claim with their insurance company themselves. However, the injured third-party’s ability to sue the insurance company directly is limited by the insurance contract between the insurance company and the insured.

    Despite the fact that the insurance contract is between the insurance company and the insured, an injured third party must still comply with most of the terms of the contract. This overarching rule applies specifically to whether the policy covers the insured and whether the policy covers a particular event. The insurance company will ask: Did this person have coverage when this accident happened? and Does this policy cover this type of event? For example, in insurance contracts limited to specific times, the insurance company will not cover a claim that occurred outside the time frame of the contract, regardless of who brings the claim. In a related example, automobile coverage that is limited to only certain vehicles will cover only those vehicles, regardless of who brings the claim. That is, the injured third party can have no greater rights than the insured would have had if he or she brought the complain themselves.

    In a United States Fifth Circuit Court of Appeals case, the court determined that specific requirements of the contract also extend to injured third parties. That case involved a “claims-made-and-reported” policy. That type of policy not only requires that a claim arise within the policy period, but also that the insured (or another party under the Direct Action Statute) had to have reported the claim within the policy period. This type of notice requirement helps insurance companies avoid claims that are reported years after they happen; instead, this policy requires notice within a certain amount of time.

    The case in the Fifth Circuit involved a Lawyers Professional Liability Policy that covered Titan, L.L.C. (“Titan”) for a period of one year. The policy stated that it would cover damages and expenses resulting from “a claim that is both first made against [Titan] and reported in writing to [CNA] during the policy period.” The policy requires that Titan must “immediately give written notice to [CNA] during the policy period . . . of any claim made against [Titan].”

    A lawsuit was filed against Titan while Titan was issuing title insurance policies on behalf of First American. The claim was filed within the policy period, but it was not reported within the policy period. Since Titan was acting on behalf of First American, First American was also injured by Titan’s actions. In order to avoid some liability, First American notified the insurance company (CNA) of the suit, but it was about six months after Titan’s policy had expired.

    The court determined that since neither Titan nor First American gave “written notice . . . within the policy period” as the policy required, then First American did not have a claim, regardless of the Direct Action Statute in Louisiana. Essentially, the court determined that the reporting requirement that Titan was subjected to also applied to First American, who was not a party to the insurance contract. Although First American may have been unaware of the terms of the contract, the court determined that to rule otherwise would give First American broader powers against the insurance company than Titan would have had.

    As someone that might be injured by an insured, it is important to make yourself aware of potential pitfalls like these in the insurance policy. Reporting claims right away can help avoid this type of situation. Navigating insurance contracts and insurance claims can be tricky. Contact The Berniard Law Firm at 1-855-550-5000, and we would be happy to help you with your legal questions and concerns.

  • Uninsured Motorist Coverage: What Are Your Rights?

    When you signed up for automobile insurance, you might have noticed that many states now require automobile insurance agencies to include some sort of uninsured motorist (“UM”) clause in your insurance agreement. Oftentimes, the only way to get out of including this in your coverage, and therefore having to pay a higher premium, is by explicitly rejecting this additional coverage. How exactly do you reject this additional coverage, though? While this might seem like an easy question, most states, including the state of Louisiana, require very specific requirements to be met in order for rejection of UM coverage to be proper.

    In the State of Louisiana, that is exactly the case: In order to get out of paying a higher premium for this uninsured motorist coverage, the insured has to explicitly reject that coverage. And the state of Louisiana has many rules with regard to how to properly complete this task.

    In order for an uninsured motorist rejection to be considered proper, Louisiana courts have found six tasks that must be completed by the insured. In Duncan v. U.S.A.A Ins. Co., 06-0363 (La. 11/29/06), 950 So. 2d 544, the court outlines these six tasks as follows:

    1) initialing the selection or rejection of coverage chosen;
    2) if limits lower than the policy limits are chosen (available in options 2 and 4), then filling in the amount of coverage selected for each person and each accident;
    3) printing the name of the named insured or legal representative;
    4) signing the name of the named insured or legal representative;
    5) filling in the policy number; and
    6) filling in the date.

    While the Court in Duncan did not explicitly deal with the timing of these tasks, a couple years later, the Court in Gray v. American National Propery & Cas. Co., 07-1670 (La. 2/26/08), 977 So. 2d 839, discussed the requisite timing in which the above tasks need to be completed. According to the Court in Gray, all six of these tasks have to be completed before the UM selection form is signed by the insured. The Court also went on to say that the completion of these tasks has to be done in a manner showing that the insured’s signature signifies that he or she agrees with all of the information that is contained in the insurance form. While the Court said that the tasks have to be completed before the UM selection form is signed by the insured, that was not the most important part of the Court’s findings. Rather, the most important part of the Court’s holding was that the insured’s signature needs to signify agreement with all that is contained in the form.

    In the recent case decided by the Louisiana Supreme Court, Edward Morrison v. U.S.A.A Casualty Ins. Co., No. 2012-CC-2334, the Court really focused on the fact that the most important part of the timing of the UM selection form is that the insured’s signature is affirming agreement to all the clauses contained therein. This case primarily deals with task #1 listed above which requires that an individual properly initial the selection or rejection of coverage chosen in order for UM rejection to be considered proper.

    In this case, the insured’s representative clearly meant to reject UM coverage but accidentally did not initial the line that stated such in the agreement form. When the insurer received the form, he or she noticed that the form was incomplete and sent it back to the insured’s representative. At that time, the representative initialed the proper line rejecting UM coverage and returned the form to the insurer. This clearly showed that the insured agreed with all of the clauses and various information contained in the form. Furthermore, all of this was completed before the relevant accident, so the court held the UM rejection valid.

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  • Accident Reviews Nature of Employer-Employee Relationship

    If you have ever been injured on the job or if you have ever known an employee who broke the law while on the job, you might know something about an employee-employer relationship and the legal obligations that come with such a relationship. Typically, if you are working for an employer and one of the two above-mentioned scenarios happens (in addition to several other possible scenarios), the employer can be held vicariously liable for the actions of the employee. Furthermore, the employer’s insurer might also be held liable if the accident or unlawful behavior happened while on the job.

    A recent case that took place in the Parish of Lafayette helps illustrate some of the issues of the employee-employer relationship and when exactly an employer might be held liable for the actions of someone else. In this Lafayette case, a lady had been riding on the back of a motorcycle when the driver of her motorcycle suddenly collided with another motorcycle. At the time of the accident, the driver was pulling into the parking lot of a truck stop. As a result of the collision, the female rider suffered severe brain injuries and was permanently disabled.

    In response to the serious injuries suffered by their daughter, the woman’s parents each sued several parties and insurers seeking recovery for the damages suffered by both their daughter and themselves individually. One of the parties was a business owner of the truck stop who the parents argued was the employer of one or both of the motorcycle operators involved in the collision. According to the parents’ lawsuits, under the employee-employer relationship, the truck stop owner was vicariously liable because the motorcycle operators were working for the owner of the truck stop at the time of the accident. Despite these allegations, the parents’ suits against the employer were dismissed when the employer filed a motion for summary judgment, which was granted.

    On appeal, the parents argued that the motion for summary judgment should not have been granted for several different reasons, one of them being that there was an issue of fact as to whether or not the two motorcycle operators were employees of the truck stop owner. In response to their appeal, the court shed light on some of the important considerations that must be made when analyzing an employee-employer relationship.

    First, the court looked to another Louisiana case, Savoie v. Fireman’s Fund Ins. Co., 347 So.2d 188 (La. 1977), in order to determine if an employee-employer relationship exists. In determining the existence of such a relationship, one of the main issues that has to be analyzed is whether or not the employer exercises sufficient right of control and supervision over the employee.

    Some of the factors that might result in a court determining that right of control does exist are selection and engagement of a a worker, whether or not the individual receives wages, the power of control the employer exercises over the worker, and whether or not the employer has the power to dismiss the individual.

    Ultimately, the court found that neither motorcycle operator was an employee of the truck stop owner and that the motion for summary judgment was proper. Neither driver received wages from the truck stop owner, and even if one of the motorcycle operators had been delivering a part to the owner, as was alleged, that alone was not enough to make him an employee, especially in light of the fact that the owner and the operator had been friends for years.

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  • Business Problems Arise Out Of Ambiguous Contract Terms

    One area where lawyers must continue to improve is drafting contracts. It is imperative that lawyers learn the intricacies of legal writing and the different meanings words have in the legal community and their ordinary meaning. If a word or phrase in a company’s contract is ambiguous, it is susceptible to multiple interpretations and might result in litigation at some point. A common example of litigation like this involves insurance policies. Therefore, it’s important to draft clear and concise contracts in order to save the time, money, and effort associated with litigation.

    Ambiguous contractual provisions are to be strictly construed against the insurer and in favor of coverage for the insured. Insurance coverage is meant to protect the insured, so the public policy reflects this favoring. However, this strict construction rule applies only if the ambiguous policy provision is susceptible to two or more reasonable interpretations. The key is that it must be reasonable, not just another interpretation. If the word or phrase is clear, then no further interpretation is necessary. The words and phrases used in insurance policies are to be construed using their plain, ordinary, and generally prevailing meaning unless the words have acquired a technical meaning.

    This seems to be a clear explanation of how contract terms are to be interpreted, but even so, many cases arise with an insured claiming that a certain phrase is ambiguous and they should not be denied relief under their policy. For example, Herbert Farms, who conducts a rice farming operation in St. Landry Parish, Louisiana, claimed the phrase “rice drying house” in their policy was ambiguous and other reasonable interpretations of the phrase was possible. Herbert Farms filed a claim for losses under its policy when its rice was damaged while in storage, seeking coverage under a section that listed “grain tanks” as covered property. However, there is a clear and unambiguous exclusionary clause that states that property covered in certain sections, including the section listing grain tanks, is not covered. The two pertinent pieces of property not covered in Herbert Farms’ policy were the contents of a rice warehouse and rice drying houses.

    Herbert Farms argued that since the grain tanks were specifically listed in the coverage section, they policy should not be allowed to later exclude these tanks from coverage. They also argued that the storage bins were cylindrical in shape, and therefore do not comport with what a normal person would consider a “house.”

    Even though “rice drying house” is not specifically defined in the policy, it does not make that term ambiguous. The court looked at the ordinary, plain, and generally prevailing meaning of the phrase. The court held that “contents of a rice warehouse” normally includes the rice bins and any other rice storage devices. Furthermore, the grain tanks even meet the ordinary definition of house,” which means structure in the context of rice storage. So when grain tanks are used to store rice that is being dried, they are “rice drying houses” and the contents of the tanks is not covered. Therefore, the court denied Herbert Farms’ claim and affirmed the Western District of Louisiana’s ruling against Herbert Farms.

    Herbert Farms’ rice was ruined because three fans stopped operating. Unable to dry the rice until they were repaired, the rice was stained, making it far less valuable. As a result, Herbert Farms had to sell the rice at a lower price, costing them almost a quarter of a million dollars. Trying to recoup some of these losses, Herbert Farms was likely hoping for a settlement from the insurance company. Unfortunately, when a contract is drafted clearly and concisely, it is imperative for courts not to create ambiguity and stick to the black letter law.

  • Summary Judgment Risk When Failing to Follow Policy Language

    Regardless of your level of legal training, we’re all guilty of ignoring the fine print but insurance coverage is often determined by the placement of an unnoticed word or punctuation mark in the language of the policy. Under Louisiana law, the insured bears the burden of proving that an incident falls within the terms of the policy. In contrast, an insurer seeking to avoid coverage through a motion for summary judgment bears the burden of proving that a provision or exclusion precludes coverage. Courts treat insurance policies like other contracts and therefore strive to interpret each term according to its true meaning. As straightforward as it sounds, a contract’s true meaning is always disputed even if on its face the language appears clear. This requires courts to hear creative arguments on the meaning of particular terms buried in the policy.

    On June 8, 2010, in an unfortunate incident at the Library Lounge in Monroe, McKenzie A. Hudson (Mr. Hudson) was approached by an intoxicated patron and struck in the head. In December 2010, Mr. Hudson died from severe brain injuries allegedly suffered during the attack. Mr. Hudson’s mother filed a wrongful death/survival suit against several defendants including the entity that owned the bar as well as its principals. Several weeks later Ms. Hudson added First Financial Insurance Company (FFIC), insurer of the bar.

    Recognizing the language of the bar’s insurance policy, Ms. Hudson admitted that her son’s assailant did not intend or expect her son’s death but instead it resulted when he lost consciousness, fell to the pavement, and fractured his skull. The particular provision at issue in the policy read that it did not provide coverage for assault, battery, or other physical altercation. The policy defined assault in part as “a willful attempt or threat to inflict injury upon another” and battery as “wrongful physical contact with a person without his or her consent that entails some injury or offensive touching.”

    Ms. Hudson differentiated between the FFIC’s old policy language which was ambiguous as to “extraordinary” injuries and its current policy which included amendments intended to broaden and clarify exclusions. Ms. Hudson specifically pointed to the removal of an “or” between the assault and battery provisions which had the effect of causing the provisions to be read together. This eliminated coverage for all “intended” or “expected” injuries. Since her son was not intentionally killed or expected to die she argued coverage should be provided. In response, FFIC submitted numerous cases where similar assault and battery exclusions were upheld.

    Like the trial court, the court of appeals granted summary judgment in favor of FFIC for several reasons. First, the court reviewed the cases submitted by the FFIC and concluded that the “overwhelming” majority of insurers were dismissed from suits arising from injury or death after an assault or battery. Furthermore, the court pointed to a similar case where it was determined that the presence of an “and” or “or” did not necessarily indicate that the provisions should or should not be read together. The court concluded that the provisions were clear in their language and that there was no question Mr. Hudson was the victim of battery. Therefore, the policy excluded insurance coverage for his death.

    Although the courts demonstrate a reluctance to rule against the insurance companies in policy exclusion cases this does not mean a particular result is guaranteed. The terms of each insurance policy varies and requires careful review of its language before any legal action is taken.

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  • Louisiana’s Act 312 and its Impact on the Environment and Oil Exploration

    La. R.S. 30:29 (“Act 312”) was in enacted in 2006 and became effective in June of that year. Act 312 provides a procedure for the remediation of oil field sites as well as oil exploration and production sites. Generally, remediation is “the action of remedying something, in particular of reversing or stopping environmental change.” Before the Louisiana legislature enacted Act 312, most remediation requirements were through private party contracts; therefore, Act 312 did not change the normal trial procedures established by the Louisiana Code of Civil Procedure.

    The Louisiana Supreme Court recently discussed Act 312 at length, explaining what it did change, in a case involving the Vermilion Parish School Board. The Court explained that Act 312 was enacted because of serious concerns with the state of the land and ground water after an area was used for oil exploration and production. Parties would use the land and ground water under a mineral lease for several years, and leave the property in terrible shape by the time that they were done. Mineral leases allow the parties to contract for only the minerals or the potential oil that is located on that property. The party with the mineral lease, then, does not rent the entire property, but just the ability to find minerals or oil within or upon that property.

    Before Act 312, parties could still sue if one party left the land in terrible shape. Occasionally, however, it does not make sense economically to force a party to fix the land they damaged. Instead, the renting party would have to give the “landlord” the difference between the value of the land when they received it and the value of the land when it was returned after the lease, under a tort law theory. However, the person who owned the land, the “landlord,” was not required to use the funds to fix damage done to the land. As a result, property that had serious environmental problems often went without remediation because the landlord was not required to fix it. This creates health and safety concerns for the general public.

    When parties file under Act 312, a notice is sent to the Louisiana Department of Natural Resources, Commissioner of Conservation (“DNR”) and the attorney general. The court cannot issue a judgment unless this notice is filed. After the notice is filed, the DNR and the attorney general can intervene in the case if they so choose; they also retain the ability to bring an independent action through civil or administrative means. Then, the matter proceeds to trial as any normal case would.

    At the trial, the fact finder will determine if there actually is any environmental damage and whether the defendant or defendants were responsible for that damage. If the fact finder finds that there is environmental damage and the defendant is responsible, then the defendant is required to form a “remediation plan.” The remediation plan is submitted to the court for approval; the plaintiff is allowed to submit a suggested remediation plan to the court as well.

    Then, the DNR will hold a public hearing on the submitted remediation plans. The DNR will then determine the most feasible plan to accomplish the remediation of the environmental damage, keeping the health, safety, and welfare of the public at large in mind. After they approve the plan, the plan is sent to the court for further review. Within a certain time frame, parties can submit alternations, comments, or new plans to the court during this time as well. Unless the parties prove that another plan is more feasible, the court will allow the plan approved by the DNR to move forward. In addition, the court will determine how much of the damages amount will be required to be used exclusively for remediation. Then, the legally responsible parties will deposit funds into the court’s registry for remediation purposes.

    One of the many issues in the case involving the Vermilion Parish School Board was whether private parties could seek additional damages apart from the required remediation funds. The Court determined that Act 312 specifically provided that private parties would not be limited by the remediation plan. That is, if they wanted to seek damages beyond what would be required to correct the environmental damages, such as punitive damages (damages that are meant to punish the offending party), then Act 312 did not limit them from doing that.

    The Berniard Law Firm specializes in oil claims, including their effects on the environment. If you have questions about Act 312 or think your mineral lease has been violated, contact The Berniard Law Firm today.