Justia Insurance Law Opinion Summaries

Articles Posted in Louisiana Supreme Court
by
This matter arose from alleged violations of the Health Care Consumer Billing and Disclosure Protection Act (“Balance Billing Act” or “Act”). The Louisiana Supreme Court granted certiorari review to resolve the question of whether a patient’s claims against a contracted healthcare provider for an alleged violation of La. R.S. 22:1874(A)(1) were delictual in nature. The consolidated lawsuits in this matter were filed by Matthew DePhillips and Earnest Williams, individually and on behalf of putative classes, against Hospital District No. 1 of Tangipahoa Parish d/b/a North Oaks Medical Center/North Oaks Health System (“North Oaks”). In February, 2011, Williams was injured in a motor vehicle accident. He sought emergency medical treatment from North Oaks. At the time of the accident, Williams was insured under an insurance policy administered by Louisiana Health Service & Indemnity Company d/b/a Blue Cross and Blue Shield of Louisiana (“BCBS”). North Oaks is a contracted healthcare provider with BCBS pursuant to a certain Member Provider Agreement (the “MPA”) between North Oaks and BCBS. After Williams’ treatment, North Oaks filed a claim with BCBS, and BCBS paid a discounted rate on the claims as provided by the MPA. Thereafter, North Oaks sought to collect from Williams by filing a medical lien against his liability insurance claim for the full and undiscounted charges. Williams alleged that North Oaks filed this lien despite being a contracted healthcare provider with BCBS and despite its legal and contractual requirements to accept the insurance as payment in full. The trial court denied the exceptions of no right of action for breach of contract and prescription, but granted the North Oaks’ exception of no cause of action for claims arising before the effective date of the Balance Billing Act. The court of appeal granted writs in part, finding DePhillips did not have a right of action to assert a claim for breach of the MPA, as he was neither a party nor a third-party beneficiary to that agreement. The appellate court denied North Oaks’ writ application insofar as it related to the trial court’s denial of its exception of prescription. After review, the Supreme Court determined plaintiff's claims were delictual in nature, subject a one-year prescriptive period. View "DePhillips v. Hospital Service Dist. No. 1 of Tangipahoa Parish d/b/a North Oaks Medical Center et al." on Justia Law

by
The Louisiana Supreme Court granted review in this case to determine whether the Louisiana Commissioner of Insurance was bound by an arbitration clause in an agreement between a health insurance cooperative and a third-party contractor. The Louisiana Health Cooperative, Inc. (“LAHC”), a health insurance cooperative created in 2011 pursuant to the Patient Protection and Affordable Care Act, entered an agreement with Milliman, Inc. for actuarial and other services. By July 2015, the LAHC was out of business and allegedly insolvent. The Insurance Commissioner sought a permanent order of rehabilitation relative to LAHC. The district court entered an order confirming the Commissioner as rehabilitator and vesting him with authority to enforce contract performance by any party who had contracted with the LAHC. The Commissioner then sued multiple defendants in district court, asserting claims against Milliman for professional negligence, breach of contract, and negligent misrepresentation. According to that suit, the acts or omissions of Milliman caused or contributed to the LAHC’s insolvency. Milliman responded by filing a declinatory exception of lack of subject matter jurisdiction, arguing the Commissioner must arbitrate his claims pursuant to an arbitration clause in the agreement between the LAHC and Milliman. The Supreme Court concluded, however, the Commissioner was not bound by the arbitration agreement and accordingly could not be compelled to arbitrate its claims against Millman. The Court reversed the appellate court's judgment holding to the contrary, and remanded the case for further proceedings. View "Donelon v. Shilling" on Justia Law

by
In 2014, plaintiff George Blair filed a petition for damages in which he alleged that a 2011 Ford Escape driven by Lori Brewer struck his 2008 Honda Civic in 2013. According to Plaintiff, at the time of the collision he was at a complete stop at a traffic signal when his vehicle was suddenly struck from the rear by Brewer’s vehicle, propelling him into the intersection. At the time of the accident, Ms. Brewer was in the course and scope of her work and was driving a company vehicle owned by AmerisourceBergen Drug Corporation (“Amerisource”), which, according to the Petition, had a policy of motor vehicle liability insurance with ACE American Insurance Company Inc. (“ACE”) insuring against the negligent acts of Ms. Brewer (together with Amerisource and ACE, “Defendants”). Plaintiff alleged that the collision caused injuries to his neck and back for which he sought damages from Defendants related to, inter alia, his physical pain and suffering, mental pain, anguish, and distress, medical expenses, and loss of enjoyment of life. In an apparent effort to disprove a causal connection between Plaintiff’s injuries and the collision, Defendants sought to introduce at trial the expert opinion of Dr. Charles E. “Ted” Bain. Dr. Bain west forth his calculation of a low impact collision and the likely preexisting nature of Plaintiff's injuries, thus concluding that plaintiff was not subject to forces and acceleration that would have caused serious or long-lasting injuries. Plaintiff moved to exclude the expert's report, and the trial court granted the motion. The court of appeal would reverse that order, and the issue this case presented for the Louisiana Supreme Court's review was whether the appellate court was correct in summarily reversing the trial court's exclusion. Finding no abuse of discretion in the trial court's determination that Dr. Bain's testimony was not based on sufficient facts or data, the Supreme Court reversed the appellate court and reinstated the trial court's judgment. View "Blair v. Coney" on Justia Law

by
This litigation arose from a suit filed by plaintiff Beverly Smith against Darlene Shelmire and her insurer, GoAuto Insurance Company (“GoAuto”), as a result of an automobile accident in 2010. In 2015, following a trial on the merits, the district court entered judgment in favor of plaintiff against Shelmire and GoAuto in an amount in excess of the insurance policy limits. GoAuto appealed that judgment, but Shelmire did not. The court of appeal ultimately affirmed the district court’s judgment in March 2016. Thereafter, Shelmire assigned her rights to pursue a bad faith action against GoAuto to Smith. Through that assignment of rights, Smith filed the underlying suit against GoAuto on March 10, 2017, and amended her petition on September 27, 2017, asserting a bad faith claim based on GoAuto’s violation of its duties under La. R.S. 22:1973(A) as well as the recognized duty of good faith pre-existing the statute. GoAuto answered the petitions, asserting the prescriptive period for a bad faith claim against an insurer was a delictual action, and subject to a one-year prescriptive period. Plaintiff opposed the exception arguing a bad faith claim against an insurer was a contractual action and subject to a ten-year prescriptive period. The Louisiana Supreme Court granted this writ application to determine whether a first-party bad faith claim against an insurer was indeed a delictual action subject to a one-year prescriptive period, or whether it was a contractual claim subject to a ten-year prescriptive period. Finding the bad faith claim arose as a result of the insured’s contractual relationship with the insurer, the Court held it was subject to a 10-year prescriptive period. View "Smith vs. Citadel Insurance Company" on Justia Law

by
In this workers’ compensation case, the issue presented for the Louisiana Supreme Court’s review centered on whether the employer’s appeal, taken with devolutive appeal delays but outside of the suspensive appeal delays, was timely under the special provisions of La. R.S. 23:1310.5(C). While the Court acknowledged La. R.S. 23:1310.5 “is not a model of legislative clarity,” the Court broadly interpreted the statute to find nothing specified the time period in which this appeal have to be filed. The Court found the appeal should have been maintained as timely, but because the appeal was devolutive in nature, the judgment awarding benefits was subject to immediate execution. View "Jackson v. Family Dollar Stores of Louisiana, Inc." on Justia Law

by
Plaintiff Brandon Forvendel was injured in a multi-vehicle accident in 2013. At the time of the accident, plaintiff was driving a Chevrolet Equinox owned by him and insured under a policy issued by State Farm Mutual Automobile Insurance Company (“State Farm”), which included uninsured motorist (“UM”) coverage. Plaintiff recovered the limits of his UM coverage under his State Farm policy. At the time of the 2013 accident, plaintiff lived in the household of his mother, Deborah Forvendel, who was also insured by State Farm. Plaintiff also sought to recover under his mother’s State Farm UM policy, which carried significantly higher policy limits. State Farm refused to allow him to recover under his mother's policy, citing the anti-stacking provisions of La. R.S. 22:1295(1)(c). In this case, the issue presented for the Louisiana Supreme Court’s review centered on whether the insurer waived its defenses to plaintiff’s current claim by paying on an earlier claim to him in error. The Court found the insurer did not waive its rights. Accordingly, the Court reversed the judgments of the courts below. View "Forvendel v. State Farm Mutual Automobile Insurance Co." on Justia Law

by
Plaintiff Kerry Maggio was injured in an automobile accident when his vehicle was struck by a vehicle operated by James Parker, an employee of The Sandwich Kings, LLC d/b/a Jimmy Johns (“Sandwich Kings”). The vehicle operated by Parker was owned by Brenda Parker and insured by Louisiana Farm Bureau (“Farm Bureau”). Plaintiff filed a petition for damages naming as defendants: Parker; Sandwich Kings (contending that Parker was in the course and scope of his employment at the time of the accident); Republic Vanguard (Sandwich King’s automobile insurer); and Metropolitan Property Casualty Insurance Company (plaintiff’s uninsured motorist insurer). Notably, plaintiff did not name Brenda Parker or Farm Bureau as defendants. Less than one month later, plaintiff entered into a “Final Release and Settlement of Claim” (“Release”) with Brenda Parker and Farm Bureau. In exchange for Farm Bureau’s $25,000 policy limits, plaintiff executed a release agreement. In this matter, which was at the summary judgment phase, the Louisiana Supreme Court was called upon to decide whether the settlement which purported to release “all other persons, firms, or corporations who are or might be liable” applied to defendants who were not direct parties to the settlement. The Court found that the defendants were not entitled to summary judgment, reversed the opinion of the court of appeal, and remanded for further proceedings. View "Maggio v. Parker" on Justia Law

by
Ron Warren, individually and on behalf of the Estate of Derek Hebert, filed a petition for damages seeking to recover for the wrongful death of his son in a recreational boating accident under general maritime law and products liability. A jury found the defendant, Teleflex, Inc. liable under the plaintiff’s failure to warn theory of the case and awarded compensatory damages of $125,000 and punitive damages of $23,000,000. The court of appeal affirmed. The Louisiana Supreme Court granted certiorari mainly to review whether the trial court properly granted the plaintiff a new trial and whether the award of punitive damages was excessive and resulted in a violation of the defendant’s right to constitutional due process. After reviewing the record and the applicable law in this case, the Supreme Court found no reversible error in the trial court’s rulings; however, the Court did find the award of punitive damages was excessive and resulted in a violation of the defendant’s right to constitutional due process. View "Warren v. Shelter Mutual Ins. Co." on Justia Law

by
The Louisiana Supreme Court granted review to determine the applicability of La. R.S. 9:2795.3, the Equine Immunity Statute. The trial court granted a motion for summary judgment filed by Equest Farm, LLC, finding that the immunity statute applied because plaintiff Danielle Larson was a participant engaged in equine activity at the time an Equest Farm pony bit her. The court of appeal reversed, holding that Larson was not a “participant” under the immunity statute, and that summary judgment was inappropriate because there were genuine issues of material fact as to whether another provision in the immunity statute might apply. The Supreme Court held that there were indeed genuine issues of material fact on the issue of whether the immunity statute applied. Accordingly, the Court affirmed the court of appeal and remanded to the trial court. View "Larson v. XYZ Ins. Co." on Justia Law

by
The issue this case presented for the Louisiana Supreme Court's review was whether the duty to defend in long latency disease cases could be prorated between an insurer and its insured when occurrence-based policies provide coverage for only a portion of the time during which exposure occurred. In the underlying Arceneaux suit, plaintiffs alleged that they suffered hearing loss from exposure to unreasonably loud noise in the course of their work at American Sugar’s refinery in Arabi, Louisiana. Two sets of plaintiffs, the Barbe plaintiffs and the Waguespack plaintiffs, filed suit against American Sugar in 2006. These suits were consolidated with the Arceneaux action, which was filed in 1999 against American Sugar’s predecessor, Tate & Lyle North American Sugars, Inc. This opinion concerned only the Barbe and Waguespack plaintiffs, and not the Arceneaux plaintiffs whose claims had been litigated extensively in the trial court, the court of appeal, and the Louisiana Supreme Court. Continental Casualty Company argued that defense costs should have been prorated among insurers and the insured if there were periods of non-coverage. American Sugar Refining, Inc. claimed that the duty to defend as agreed upon in the policy provided for a complete defense so long as the duty to defend attached, even if some claims fell outside of coverage. The Supreme Court held that the duty to defend should have been prorated in this case based upon policy language. View "Arceneaux v Amstar Corp." on Justia Law