Insurance companies do not always make recovery of benefits easy when a worker is injured on the job. The insurance recovery process can be overwhelming, and may be complicated by the often necessary instigation of litigation. Many different provisions governing recovery are involved in insurance contracts. Insurance negotiations can be complicated by differing interpretations of these policy provisions, often standing as the core principles upon which the sides dispute in a case. The interpretation of the language of the contract by the court plays a pivotal role in deciding who is liable for the costs associated with on the job injury. In fact, benefits can be delayed in disputes over the meaning of a single term contained in an insurance contract.
In Bayou Steel Co. v. National Union Fire Ins. Co., two insurance companies, New York Marine and General Insurance Company (NYMAGIC) and National Union Fire Insurance Company of Pittsburgh, Pennsylvania (NUFIC-PA), disagreed over which company was liable for an on the job injury. Both companies provided insurance coverage to the Bayou Steel Corporation when Ryan Campbell, an employee of Bayou Steel’s stevedoring contractor, was injured unloading cargo. A dispute arose as to whether Campbell’s employer was a contractor or a subcontractor of Bayou Steel under NYMAGIC’s “policy that excludes coverage of Bayou’s liability for bodily injury incurred by ‘[e]mployees of … [Bayou’s] sub-contractors’ but does not exclude coverage of such injuries incurred by employees of Bayou’s contractors.” If the court found that Campbell was a subcontractor, NUFIC-PA would be held liable for his injuries, but if they found he was a contractor, NYMAGIC would be liable. The lower court held that Campbell’s employer was a subcontractor of Bayou Steel, and NYMAGIC was not liable for his injury under their insurance agreement. An appeal by NUFIC-PA followed.
On appeal, the U.S. District Court for the Eastern District of Louisiana in New Orleans reversed the lower court’s decision. Based on principles of contract interpretation, the court held that Campbell’s employer was a contractor and not a subcontractor, thus NYMAGIC was liable for the payment of benefits to the injured. When a term in a contract is not specifically defined it is to be given its “generally prevailing meaning.” A terms generally prevailing meaning is determined by the court in examining a myriad of different sources including statues and prior court opinions, as well as various dictionaries. The lower court determined that a subcontractor was “simply some person hired to do part of another person’s work.” The appellate court held that Campbell’s employer could not be defined as a subcontractor because it was the party paying for the work and not the party actually performing the work. The decision of the lower court was reversed, and liability was ultimately determined, based entirely on this judicial interpretation of a single word.
Knowledge of the interpretation of insurance contract provisions can be pivotally important when negotiating an insurance settlement or in litigation for recovery of damages. If you or a loved one has a claim that could involve negotiating with an insurance company, then you need an experienced law firm to help you navigate those negotiations and to represent you in court should it be necessary. The Berniard Law Firm has experience negotiating with insurance providers.
Call us at 504-521-6000 or visit laclaim.com and let us help you.