Justia Insurance Law Opinion Summaries

Plaintiffs, alleging to be putative class members of multiple class actions, have filed their own individual suits against the defendant, Louisiana Citizens Property Insurance Corporation (Citizens). Plaintiffs were residents of, and owned homes in, St. Bernard Parish at the time Hurricane Katrina. Their properties were insured under policies of all-risk or homeowners insurance by defendant. Plaintiffs originally filed suit against Citizens on December 3, 2009, seeking contractual and bad faith damages arising out of Citizens’ handling of their property damage claims related to Hurricane Katrina. Citizens excepted on grounds of prescription and lis pendens. At issue is whether the doctrine of lis pendens barred plaintiffs’ suits where the plaintiffs were not named parties in the first-filed class actions. The Supreme Court found the trial court erred in overruling the defendant’s exception of lis pendens. View "Aisola v. Louisiana Citizens Property Insurance Corp." on Justia Law

The question before the Supreme Court was whether La. R.S. 23:1203.1 applied to requests for medical treatment and/or disputes arising out of requests for medical treatment in cases in which the compensable accident or injury occurred prior to the effective date of the medical treatment schedule. The Office of Workers’ Compensation (OWC) ruled that the medical treatment schedule applied to all requests for medical treatment submitted after its effective date, regardless of the date of injury or accident. The court of appeal reversed, holding that La. R.S. 23:1203.1 was substantive in nature and could not be applied retroactively to rights acquired by a claimant whose work-related accident antedated the promulgation of the medical treatment schedule. The Supreme Court disagreed with the conclusion of the court of appeal and found that La. R.S. 23:1203.1 was a procedural statute and, thus, did not operate retroactively to divest a claimant of vested rights. As a result, the statute applied to all requests for medical treatment and/or all disputes emanating from requests for medical treatment after the effective date of the medical treatment schedule, regardless of the date of the work-related injury or accident. View "Church Mutual Insurance Co. v. Dardar" on Justia Law

The Supreme Court granted certiorari in this case to consider whether La. R.S. 23:1203.1 applied to a dispute arising out of a request for medical treatment where the request for treatment was submitted after the effective date of the statute and the medical treatment schedule, but the compensable accident and injury that necessitated the request occurred prior to that date. Both the Office of Workers’ Compensation (OWC) and the court of appeal ruled that La. R.S. 23:1203.1 applied to all requests for medical treatment submitted after the statute’s effective date, regardless of the date of accident and injury. Finding no reversible error, the Supreme Court affirmed. View "Cook v. Family Care Services, Inc." on Justia Law

The issue this case presented to the Supreme Court centered on whether the Patient’s Compensation Fund (PCF) could be bound by summary judgment rendered solely against a defendant physician in the underlying malpractice proceeding on the issue of causation. Plaintiffs, Majdi Khammash and his wife and children, filed suit against various defendants, including Dr. Gray Barrow. After approving plaintiff’s settlement with Dr. Barrow for the $100,000 Medical Malpractice Act (MMA) cap, the District Court granted partial summary judgment, finding plaintiff’s injuries were caused by the fault of Dr. Barrow. The case then proceeded to jury trial against the PCF for the remaining $400,000 MMA cap. The jury returned a verdict in the PCF’s favor, finding Dr. Barrow’s malpractice did not cause plaintiff damage. The Court of Appeal reversed, finding as a result of the partial summary judgment, the issue of causation was not properly before the jury, and remanded for a new trial on damages only. The Supreme Court granted certiorari to address the extent, if any, the PCF was bound by the partial summary judgment on causation. The Court found, in accordance with La. Rev. Stat. 40:1299.44(C)(5)(a) and its holding in "Graham v. Willis-Knighton Med. Ctr.," (699 So.2d 365), the partial summary judgment against Dr. Barrow on the issue of causation was not binding on the PCF in plaintiff’s claim for damages exceeding the $100,000 MMA cap. Furthermore, the Court found no manifest error in the jury’s factual findings on causation. The Court therefore reversed the judgment of the Court of Appeal and reinstated the District Court’s judgment in its entirety. View "Khammash v. Clark" on Justia Law

Plaintiff Ashley Hoffman was insured under an automobile insurance policy issued by defendant Travelers Indemnity Company of America. Following an automobile accident, plaintiff received medical treatment at Baton Rouge General Medical Center and sought reimbursement for the hospital bill under her Travelers' medical payments coverage. The Supreme Court granted certiorari to determine whether the Travelers’ policy, which provided for payment of medical expenses "incurred," allowed plaintiff to be reimbursed for the full, nondiscounted amount of the hospital bill when the charges were contractually reduced pursuant to the hospital’s agreement with plaintiff's health insurer, AETNA Insurance Company. The Court answered that question in the negative and reversed the rulings of the lower courts. View "Hoffman v. Travelers Indemnity Company of America" on Justia Law

Dustin Watkins suffered an in utero stroke approximately two days before he was born (in 1990), allegedly arising out of the medical malpractice of the treating obstetrician, Dr. Richard Barry, which resulted in a brain injury. This medical malpractice action followed, and a November 2003 trial resulted in multiple damage awards. At issue in this case was the extent to which the Louisiana Patient's Compensation Fund (PCF) continued to be obligated to make advance payments for custodial/attendant care for a medical malpractice victim, after receiving information indicating that such care may no longer be needed, and whether the PCF had the right to unilaterally terminate such payments, without prior court approval, when a judgment was previously rendered ordering it to make said payments. Upon review, the Supreme Court held that when the PCF denies a claim for payment of a future medical or related expense and the district court thereafter exercises its continuing jurisdiction and issues a ruling as to that matter, the PCF is obligated to comply with the district court's ruling, order, or judgment unless it modified or set aside by the court. View "Watkins v. Lake Charles Memorial Hospital" on Justia Law

In 2005, Patrick Richard sustained a work-related injury at the State Department of Transportation and Development ("DOTD"). After Mr. Richard's injury, DOTD began paying him workers' compensation benefits. Mr. Richard took disability retirement in 2007. Upon retiring, Mr. Richard spoke with a DOTD employee about the effect his receipt of workers' compensation benefits would have on his disability retirement benefits. Thereafter, Mr. Richard began simultaneously receiving disability retirement benefits through the Louisiana State Employees Retirement System ("LASERs"), and workers' compensation benefits through DOTD. In August 2007, DOTD informed Mr. Richard it had been overpaying him for workers' compensation benefits. In early 2011, DOTD filed a disputed claim for compensation, seeking an offset. In response, Mr. Richard filed an exception of prescription, arguing DOTD's claim for reimbursement was subject to a three-year prescriptive period. The matter proceeded to a trial before the Office of Workers' Compensation ("OWC"). The OWC denied Mr. Richard's exception of prescription. The OWC further held DOTD is entitled to an offset of $224.05 per week as of April 21, 2007, until Mr. Richard converted to regular retirement benefits at age 60. Mr. Richard appealed. The court of appeal affirmed in part and reversed in part. The court of appeal affirmed the OWC's denial of Mr. Richard's exception of prescription. However, the court found the OWC erred in holding DOTD was entitled to an offset of workers' compensation benefits. Upon review, the Supreme Court concluded the court of appeal incorrectly applied the law. Accordingly, the Court reinstated the OWC's judgment granting the employer an offset. View "Louisiana v. Richard" on Justia Law

A pharmaceutical distributor/repackager sought review of an appellate court decision that reversed a decision of the Louisiana Office of Workers' Compensation Administration. The Office awarded certain unpaid invoices for physician-dispensed medications (subject to a statutory limit) in favor of the distributor/repackager. The appellate court reversed based on a finding that the distributor/repackager did not have a right of action. After considering the applicable law, the Supreme Court found the anti-assignment language of La. R.S. 23:1205(A) did not prohibit the assignment of a health care provider's claims to a third party, an express contractual novation was effective, and an agent could statutorily be considered a health care provider based on the definition contained in La. R.S. 23:1021(6). Accordingly, the Court reversed the court of appeal's decision and remanded the case back to that court for further proceedings. View "Rebel Distributors Corp., Inc. v. Luba Workers' Comp." on Justia Law

Plaintiff Mary Soileau was injured while working for the Town of Mamou when a front-end loader detached from a tractor and struck her in the leg. She named the tractor manufacturer, the Town, Smith's Hardware (where the Town rented the tractor for employees' use), the hardware store's owners and their insurance company. Trial began with only the owners and their insurer as the remaining defendants in the suit. On the third day, Plaintiff moved to dismiss the owners and their company in the presence of the jury, stating that she did not seek any damages personally against them. Hearing no objections, the trial court granted the request, but made no written (and therefore signed) judgment of dismissal. On day four, the insurer moved for a directed verdict, based on contract language that it was obligated to pay only if its insureds were legally obligated to pay. The insurer's motion was denied, and ultimately over $9 million in damages were awarded to Plaintiff. Concluding that the trial court erred in denying the insurer's motion, the appellate court reversed, dismissing the insurance company. The issue before the Supreme Court centered on the effect Plaintiff's in-court dismissal of the insured parties was during her personal injury action. Upon review, the Supreme Court concluded that the appellate court erred in its analysis, reversed and remanded the case for further proceedings. View "Solieau v. Smith True Value & Rental" on Justia Law

The issue before the Supreme Court in this case was one of first impression: whether the Louisiana Workers’ Compensation Law (specifically La. R.S. 23:1036) as the exclusive remedy for a volunteer firefighter in claims for personal injury against the "fire company," similarly applies to claims for personal injury against fellow volunteer members. After reviewing the record and the law, the Court found the defendant failed to establish that the Workers’ Compensation Law granted immunity to fellow volunteer members of a volunteer fire company from suits in tort. Accordingly, the Court affirmed the decisions of the lower courts in denying the defendants’ motion for summary judgment. View "Champagne v. American Alternative Ins. Corp." on Justia Law