Justia Louisiana Supreme Court Opinion Summaries

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

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

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

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

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

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

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