Justia Louisiana Supreme Court Opinion SummariesArticles Posted in Insurance Law
LaFayette Bone & Joint Clinic v. Louisiana United Business SIF
Both of the injured employees in these cases, Charles Morris and Charles Poole, were treated at the Lafayette Bone & Joint Clinic (“LB&J”); Morris was treated by Dr. Louis Blanda and Poole by Dr. John Cobb. Louisiana United Business SIF (“LUBA”), sent letters to LB&J and its doctors stating that LUBA would no longer pay for prescription medications directly dispensed by LB&J and directing LB&J doctors to issue future prescriptions for the instant injured employees that could be filled at local retail pharmacies. Despite these notices and subsequent denials of requests for reimbursement of dispensed prescription medications, LB&J doctors continued to dispense prescription medications to these injured employee patients throughout 2008 and to submit requests for reimbursement to LUBA. LUBA declined payment for these requests, citing its prior notice. LB&J and the treating physicians thereafter filed disputed claim forms with the Office of Workers’ Compensation (OWC), seeking to recover the cost of the medications dispensed, along with penalties and attorney fees. Following a joint trial in these two cases, the OWC judge ruled that the plaintiff/health care providers’ recovery for medications dispensed after the 2008 notice were nonemergency treatment dispensed without consent of the payor. Further, the OWC judge found that no penalties or attorney fees were warranted because LUBA had clearly advised the plaintiff/health care providers that no further reimbursement would be made for prescription medications dispensed by LB&J doctors after the date of the notice. The plaintiff/health care providers appealed, seeking an increase in the amount awarded and an award of penalties and attorney fees. The Louisiana Supreme Court granted writs to review the appellate court decisions, which awarded unreimbursed prescription medication costs beyond the $750 limitation set forth in LSA-R.S. 23:1142(B) and awarded penalties and attorney fees. The Court reversed the appellate court's modification of the amount awarded by the OWC, and affirmed in part, the decision to award penalties and attorney fees. View "LaFayette Bone & Joint Clinic v. Louisiana United Business SIF" on Justia Law
Pierce Foundations, Inc. v. JaRoy Construction, Inc.
This matter stemmed from a public works project for the construction of a gymnasium in Terrytown. JaRoy Construction Inc. served as the general contractor, and pursuant to statute, furnished a surety bond to Jefferson Parish. Ohio Casualty Insurance Company was the surety. JaRoy entered into a written subcontract with Pierce Foundations, Inc. to provide and install pilings for the project. Once finished, Pierce alleged JaRoy failed to pay certain funds due under the subcontract. Pierce sued both JaRoy and Ohio Casualty Insurance, alleging they were jointly and severally liable to Pierce. JaRoy filed for bankruptcy, leaving only Ohio Casualty Insurance as party to the suit. When the project was substantially completed, the Jefferson Parish government filed a notice of acceptance of work with the Jefferson Parish mortgage records office. This occurred over a year after Pierce amended its lawsuit to add Ohio Casualty as a defendant. Pierce never filed a sworn statement of claim in the mortgage records. Ohio Casualty filed a motion for summary judgment, contending that Pierce was required to comply with statutory notice and recordation, and because it failed to do so within 45 days of Jefferson Parish’s acceptance of the project, Pierce could not recover from Ohio Casualty. Pierce argued that the statute did not affect its right to proceed in contract. After a bench trial, the trial court rendered judgment in favor of Pierce for sums owed under the contract plus judicial interest from the date of the original judgment. Ohio Casualty appealed, arguing that the trial court erred in not dismissing Pierce's claims. The court of appeal reversed and ruled in Ohio Casualty's favor. The Supreme Court, however, disagreed and affirmed the trial court judgment. View "Pierce Foundations, Inc. v. JaRoy Construction, Inc." on Justia Law
Aisola v. Louisiana Citizens Property Insurance Corp.
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
Hoffman v. 21st Century North America Insurance Co.
In October 2010, Eddie Hoffman was injured when his vehicle was rear-ended by a vehicle driven by Carolyn Elzy. Hoffman filed suit against Ms. Elzy and her insurer, 21st Century North America Insurance Company for damages allegedly resulting from the accident. This case presented with a question of first impression for the Louisiana Supreme Court's review as to whether a write-off from a medical provider, negotiated by plaintiff's attorney, could be considered a collateral source from which the tortfeasor receives no set-off. Applying Louisiana law and the principles set forth in our Civil Code, the Court found that such a write-off did not fall within the scope of the collateral source rule. View "Hoffman v. 21st Century North America Insurance Co." on Justia Law
Kelly v. State Farm Fire & Casualty Co.
The Fifth Circuit Court of Appeals certified a question of Louisiana law to the Louisiana Supreme Court. The questions stemmed from the claims handling by State Farm Fire & Casualty Company following an automobile accident. In 2005, Danny Kelly was injured when the insured, Henry Thomas, and he were traveling in opposite directions. Both Kelly and a witness told police that Thomas had failed to yield to oncoming traffic, but Thomas maintained he was not at fault. Kelly was taken to a hospital by ambulance and treated for a fractured femur. He remained hospitalized for approximately six days. The cost of his medical care totaled $26,803.17. Both questions related to claims that an insurer was liable for subjecting its insured to a court judgment in excess of insurance policy limits. The Louisiana Court responded to the questions: (1) A firm settlement offer was unnecessary for an insured to sustain a cause of action against an insurer for a bad-faith failure-to-settle claim, because the insurer's duties to the insured can be triggered by information other than the mere fact that a third party has made a settlement offer; and (2) an insurer could be found liable under La. R.S. 22:1973(B)(1) for misrepresenting or failing to disclose facts that are not related to the insurance policy’s coverage because the statute prohibits the misrepresentation of “pertinent facts,” without restriction to facts “relating to any coverages.” View "Kelly v. State Farm Fire & Casualty Co." on Justia Law
Baker v. PHC-Minden, L.P.
Across the state, plaintiffs were filing complaints against health care providers from whom they sought treatment following automobile accidents and with whom their health care insurers had contracted reimbursement rates for the services rendered. At issue was the legality of these providers' policy of collecting or attempting to collect the undiscounted rate from the insured if a liability insurer may be liable, implemented through the filing of medical liens against plaintiffs' lawsuits and settlements pursuant to the health care provider lien statute. The Supreme Court granted certiorari to resolve a conflict among the appellate courts of this state on the issue of whether a class action is the superior method for adjudicating actions brought pursuant to the Health Care Consumer Billing and Disclosure Protection Act ("Balance Billing Act"). After review, the Court found plaintiffs in the Third Circuit Court of Appeal proceeded as a class, while plaintiffs in the Second Circuit Court of Appeal were denied class certification. After reviewing the record and the applicable law, the Supreme Court found the class action was superior to any other available method for a fair and efficient adjudication of the common controversy over the disputed billing and lien practices. Accordingly, the Court reversed the judgment of the Second Circuit. Finding all other requirements for class certification properly met, the Court reinstated the judgment of the trial court. View "Baker v. PHC-Minden, L.P." on Justia Law
Green v. Johnson
In 2007, Dave Peterson, while riding a motorcycle that he co-owned with Benjamin Gibson, was involved in an accident with a sport utility vehicle driven by Michael Johnson. Peterson died from the injuries he received in the accident. At the time of his death, Peterson lived with his girlfriend, Ashanti Green, and their two minor children. Green filed a wrongful death action in 2008, as tutrix for the minor children, and naming as defendants: Michael Johnson and his insurer, State Farm Mutual Automobile Insurance; Allstate Insurance Company, as the UM insurer of the plaintiff, who contended that coverage extended to Peterson under her policy provisions; and American Southern Home Insurance Company as the alleged insurer of the motorcycle. By a supplemental petition, Allstate was also named as a defendant in its capacity as Gibson's automobile insurer on grounds that UM coverage was provided to Peterson under that policy. The question this case presented for the Supreme Court's review centered on whether a motorcycle accident victim, ostensibly insured under the provisions of the motorcycle co-owner’s uninsured/underinsured motorist (UM) automobile insurance policy, was entitled to UM coverage under the policy even though there was no coverage for the accident under the policy’s liability provisions. Finding the insurer failed to demonstrate a lack of UM coverage, the Supreme Court concluded the district court erred in granting summary judgment dismissing the UM insurer, and the appellate court erred in affirming the ruling. Therefore, the Court reversed and remanded this case for further proceedings. View "Green v. Johnson" on Justia Law
Anderson v. Ochsner Health System
The Louisiana Supreme Court granted this writ application to determine whether a plaintiff had a private right of action for damages against a health care provider under the Health Care and Consumer Billing and Disclosure Protection Act. Plaintiff Yana Anderson alleged that she was injured in an automobile accident caused by a third party. She received medical treatment at an Ochsner facility. Anderson was insured by UnitedHealthcare. Pursuant to her insurance contract, Anderson paid premiums to UnitedHealthcare in exchange for discounted health care rates. These reduced rates were available pursuant to a member provider agreement, wherein UnitedHealthcare contracted with Ochsner to secure discounted charges for its insureds. Anderson presented proof of insurance to Ochsner in order for her claims to be submitted to UnitedHealthcare for payment on the agreed upon reduced rate. However, Ochsner refused to file a claim with her insurer. Instead, Ochsner sent a letter to Anderson’s attorney, asserting a medical lien for the full amount of undiscounted charges on any tort recovery Anderson received for the underlying automobile accident. Anderson filed a putative class action against Ochsner, seeking, among other things, damages arising from Ochsner’s billing practices. Upon review of the matter, the Supreme Court found the legislature intended to allow a private right of action under the statute. Additionally, the Court found an express right of action was available under La. R.S. 22:1874(B) based on the assertion of a medical lien. View "Anderson v. Ochsner Health System" on Justia Law
Gorman v. City of Opelousas
An insurance company appealed a decision on the issue of coverage under a claims-made-and-reported policy. The appellate court found that, under the Direct Action Statute, an insurer could not use the policy’s claim-reporting requirement to deprive an injured third party of a right that vests at the time of injury. After considering the applicable law, the Supreme Court found that the reporting provision in a claims-made-and-reported policy was a permissible limitation on the insurer’s liability as to third parties and did not violate the Direct Action Statute. Accordingly, the Court reversed that portion of the court of appeal’s decision relating to the claim of the injured third party, and reinstated the trial court’s judgment, finding no coverage. View "Gorman v. City of Opelousas" on Justia Law
Emigh v. West Calcasieu Cameron Hospital
A putative class action was filed against West Calcasieu Cameron Hospital for alleged violations of La. R.S. 22:1874, also known as the "Balance Billing Act." This case was expanded to name several health insurance issuers as defendants. The claim under review by the Louisiana Supreme Court was asserted by plaintiff Laura Delouche against her insurer, Louisiana Health Service & Indemnity Company, d/b/a Blue Cross and Blue Shield of Louisiana (Blue Cross). The Supreme Court granted certiorari to determine whether a cause of action existed, whereby Delouche could pursue a legal remedy against Blue Cross. Finding no cause of action, and no reversible error in the trial court's decision, the Supreme Court affirmed. View "Emigh v. West Calcasieu Cameron Hospital" on Justia Law