Negligence Claims

Interpreting Insurance Policies: What does a Term really Mean?

Published on: March 19, 2011 | By Berniard Law Firm

Insurance policy terms may appear to be easily understandable and concise. However, the interpretation a lay person may give to an insurance policy agreement’s meaning versus a court’s interpretation of the same policy, may substantially differ. It is true that under Louisiana law, words in a contract are presumed to have the plain and ordinary meaning they are generally given. However, an insurer may bear the burden of proof and demonstrate that a certain provision in an insurance policy exempts coverage for such an event in question.

A recent decision by Louisiana’s Second Circuit Court of Appeal, explored the meaning of an insurance policy in order to determine whether or not the insurer was responsible for the plaintiff’s additional damages. The court looked at the totality of the circumstances to aid their decision. The facts are as follows:

In DeSoto Parish, a series of connected collisions occurred which permanently injured one man, and killed another. The chain of events started with Mr. Mike Miles McCauley, who was employed by the defendant, Steve Kent Trucking Inc., he traveling in his 18-wheeler on Highway 5 through DeSoto Parish. Mr. McCauley dropped his cell phone on the floorboard of the truck and decided to retrieve it, at this point he crossed the center line of the highway, then overcorrected and lost control of the vehicle. The 18-wheeler turned over on its side and onto a vehicle, driven by the plaintiff, Henry Washington, who was traveling in the opposite direction on Highway 5. As a result of the size and ass of the 18-wheeler, Mr. Washington’s vehicle was pushed into a small body of water, the 18-wheeler was still sliding at this point and collided with a car driven by Allan C. Richard, who was killed instantly. Mr. Washington suffered numerous serious injuries which left him permanently incapacitated.

Mr. Washington at trial, sought to recover for numerous damages as a result of the serious injuries he incurred from the accident. Mr. Washington sought past and future mental and physical pain and suffering; past and future physical disability and physical impairment; past and present and future loss of enjoyment of life; past and present and future medical expenses; and the loss of economic opportunity. The trial court entered a judgment allowing Mr. Washington’s curator to settle claim arising from the accident for $4.5 million. The defendant insurer, Greenwich paid $4 million and Steve Kent Trucking, Inc., paid $500,000. The only claim left at this point, was the plaintiff’s claim against defendant insurer Greenwich for an additional $1 million in coverage remained. Greenwich filed a motion for summary judgment and subsequently won, as a result of the interpretation of a term in the policy agreement. The defendant insurer, Greenwich was released from liability to the plaintiff on the basis of the court’s interpretation of one single phrase within the policy, “one accident.”

The defendant insurer relied on the company’s interpretation of the policy agreement in order to evade additional liability to the plaintiff. The defendant argued that the policy specified a $5 million “per accident” limit and that an accident is defined as “the continuous or related exposure to the same exposure to the same conditions resulting in bodily injury.” Greenwich also contended that the limit was a combined single limit.” Essentially, this means that according to the policy agreement, if there are multiple parties that are involved within event, their ability to collect for any resulting damages will be combined and they may all collect no more than $5 million collectively. The court reasoned that there was one accident in this matter, although there were two collisions. Greenwich’s liability was limited to no more than $5 million per accident, thus, the company had paid the policy limits by settling with Mr. Washington for $4 million and the second fatally injured driver’s survivors for $1 million. Therefore, according to the court’s interpretation, the defendant insurer had fulfilled their contractual obligation under the policy and were dismissed. Obviously, the plaintiff was not satisfied with this result in consequence to the numerous future medical procedures needed as a result of the accident, so he appealed the decision.

The appeal consists of essentially a battle of interpretations. On the one hand, the plaintiff assert that under the language of the policy, “accident” and “loss” are different and alternative bases of coverage. Further, they urged that Mr. Washington and Mr. Richard, the deceased second driver involved, sustained separate losses and the policy limit is $5 million per loss. The focal concern of the court, is whether or not the $5 million policy limit is to be applied to each person who suffers bodily injury or death, not all such persons. On the other hand, the defendants assert that the plain, ordinary meaning that Louisiana asserts shall be given to contract terms, is that “per accident” a maximum of $5 million shall be allocated. Here, even though there were two victims, they were involved within one incident that caused such injury, thus, they fulfilled the policy limit by allocating between the two victims, a total of $5 million.

Interpretation of an insurance policy is usually resolved by a summary judgment motion, which is what the defendant insurer claimed. When determining whether a policy affords coverage for an incident, the insured bears the burden of proving that the incident falls within the policy’s terms. The court determined that a lack of coverage under the insurance policy was appropriate because there was no reasonable interpretation of the policy, and when applied to the undisputed material facts shown by the evidence supporting the motion, coverage was not additionally afforded to the plaintiff.

The court in this case, made their determination based on the totality of the circumstances. The accident or occurrence was explored in order to determine the extent of the harm, the seriousness of the injuries, and the insurance coverage in light of the facts presented by the various factors involved. The 18-wheeler fatally killed one man as a result of sliding into the man’s vehicle, and caused the other driver to become permanently incapacitated. These injuries occurred from one event, by one negligent act of the driver, and therefore, was not going continue or persist in injuries to the plaintiff. rather, the plaintiff was suffering as a result of the one act by the driver, thus, according the court’s interpretation of the insurance policy, the plaintiff and the deceased driver’s survivors together, obtained $5 million from the injuries they sustained from the tragic accident. Thus, the insurer fulfilled their contractual obligations and were not responsible for any additional amounts urged by the plaintiff.

Interpretation is a powerful tool, as this case illustrates, contractual terms may be difficult and hard to understand.

Court Hears Appeal Regarding Alleged Insurance Company Delays

Published on: March 17, 2011 | By Berniard Law Firm

In a variety of states, including Louisiana, penalties are imposed on insurers who arbitrarily or capriciously fail to pay a claim. If an insurer behaves in a manner that could be construed as being in “bad faith,” they will face a host of possible penalties. Specifically, the insurer has duties to fulfill, such as paying the amount of any claim due any insured within thirty days respectively. However, determining whether or not the insurer is in bad faith is a two way street, the insured/claimant also has to satisfy certain burden(s) of proof. The court will take into consideration the totality of the circumstances, explore each parties behavior and provided proof, and will thus make their decision.

In a recent Louisiana appellate decision, the court denied finding an insurer in bad faith for denying the plaintiff additional damages. The damages sustained stemmed from an incident that occurred in Winn Parish, Louisiana. Specifically, a five year old boy was crossing Highway 167 to board a school bus when he was struck and injured by a vehicle driven by a minor. Apparently, the minor driving failed to heed the stop sign on the bus which was activated, nor slow down. The force of the impact caused the young boy to be thrown an estaimted distance of 65 feet. His injuries were quite serious, including a broken left femur, damage to the spleen, and severe lacerations to the face and neck. The injured boy had to remain in a full body cast for a number of weeks and incurred substantial bullying from classmates as a result of his visibly scarred facial appearance. The jury awarded damages to the plaintiff for the following: past special damages, future special damages, past general damages, future general damages, and loss of earning capacity.

The plaintiffs in this matter filed a motion for judgment notwithstanding the verdict (JNOV), and in the alternative, sought a new trial. After a hearing, the trial court granted the plaintiff’s JNOV and nullified the jury’s verdict. The court awarded $100,000 initially to the plaintiff; however, after the hearing, the damages were increased to a total of $600,000. This was a $500,000 increase in the amount of total damages to the plaintiff. However, the trial court, without explanation also ruled that the insurer was not in bad faith under Louisiana law in its handling of the plaintiff’s claim. Additionally, the judgment gave the insurer credit for all sums paid to date and further taxed all costs to the insurer. The defendant insurer appealed on the basis that the trial court erred in granting the plaintiff’s motion for JNOV, which increased the jury’s award by $500,000. On the other hand, the plaintiff asserted that the trial court correctly granted the motion for JNOV, but abused its discretion in awarding insufficient damages, specifically in the categories of general damages and loss of earning capacity.

The first issue the court explored was whether or not the JNOV ruling was correct. There is one main question that must be asked to determine whether granting the motion for JNOV was appropriate: do the facts and inferences point so strongly and overwhelmingly in favor of the moving party that reasonable men could not arrive at a contrary verdict? if the answer to that question in the affirmative, then the trial judge was correct in granting the motion. However, if a reasonable person in exercising impartial judgment might reach a different conclusion, then it was error to grant the motion and the jury should be reinstated. Here, the jury’s verdict awarded only special damages and no general damages. The court had to determine whether or not a jury could award one and not the other. The decision held that the jury’s verdict which failed to award general damages was “illogical and inconsistent, representing an abuse of discretion.” Addressing only the future medical expenses and ignoring the past special medical damages illustrated a large problem with the damages awarded the plaintiff. In fact, the court reasoned that the jury was confused in filling out the verdict form without consideration of the previously tendered insurance payments as instructed by the form. Thus, the trial court was correct in granting the JNOV and overruling the jury’s verdict.

Lastly, the plaintiff claimed that the insurer acted arbitrarily, capriciously, and without probable cause in failing to unconditionally tender more than $190,000 in payment of the damages. The plaintiffs alleged that they made numerous demands supported with medical proof, however, the insurer failed to comply. Under Louisiana law, La. R.S. 22:1892, an insurer owes a duty of good faith and fair dealing to its insured. As such, an insurer has an affirmative duty to adjust claims fairly and promptly to make reasonable efforts to settle claims with the insured. The statute provides that if an insurer is found to have acted in bad faith, several penalties are available to the claimant. First, the plaintiff must clearly show that the insurer was in fact arbitrary, capricious, and without probable cause in refusing to pay. Bad faith hinges on whether or not the insurer is aware of specific facts in making their decision not to satisfy a claimant’s damages. The basis of the plaintiff’s argument for additional damages from the insurer, was the fact that the little boy would suffer extensive mental difficulties in the future. The dilemma in such an argument, was the fact that the alleged future mental injury was Attention Deficit Disorder (ADD), which the defendant insurer argued was not a result of the injuries sustained when he was hit by the motor vehicle. The court reasoned that ADD could not be directly attributable to the incident in question and as a result, the insurer was not found to have acted arbitrarily, capriciously, or have acted without probable cause in denying such additional future damages.

Thus, insurers do have an affirmative statutory duty to act in good faith towards claimants. Insurers are prohibited from refusing to pay claims without a reasnable basis. The bad faith statute is designed to protect individuals who have been injured from having their claims declined without any reasonable basis.

Bossier Parish Police Jury Ordered to Repair Faulty Pipes

Published on: March 15, 2011 | By Berniard Law Firm

A recent ruling by the Second Circuit Court of Appeal for the State of Louisiana ordered the Bossier Parish Police Jury to repair the pipes running under the land that the plaintiffs, Steven and Melanie Petchak, own in Bossier Parish. It was also ordered to pay damages to the plaintiffs for damage to their house.

Mr. and Mrs. Petchak bought Lot 363, which was part of a subdivision plat (Subdivision No. 5), in 1994. In the conveyance records for Subdivision No. 5, several drainage easements, or rights of way, were referenced. These included a 25-foot easement running north to south and a 10-foot easement running east to west. The 10-foot easement extended 5 feet into the Petchaks’ lot. In 1978, the Bossier parish Police Jury had enacted a resolution which agreed to maintain the drainage facilities of Subdivision No. 5. Additionally, Ordinance 509 of Bossier Parish stated that the Police Jury were to forever have a right of way in order to maintain the drainage channels, and that no buildings were to be erected on the right of way.

The house that the Petchaks bought was built between 1983 and 1985, and the Petchaks purchased the home in 1994. They soon noticed a sinkhole developing on their property, and found out that the previous owner had noticed a different sinkhole, in a different place. The previous owner had called the Police Jury, who filled in the sinkhole twice, first with dirt and later with concrete. The Petchaks called the Police Jury about the new sinkhole, which was then filled in with dirt.

Ten years later, in 2005, the Petchaks began to notice problems with their home, including broken windows, sticking doors, and damaged flooring, walls, and woodwork, which were concentrated at the part of the house closest to the sinkholes. A new sinkhole appeared, and the Petchaks hired a civil engineer to inspect the house, who recommended that the drainage system be repaired before attempting to repair the home’s foundation.

In January 2006, the parish engineer offered to fix the drainage system, but only if the Petchaks would agree to sign a release for any past and future damages associated with the problem, which the Petchaks refused to do.

After more investigation, it was discovered that the pipe was not constructed in accordance with good engineering practices. Despite the pipe changing direction, the parish had not installed junction boxes, which would have stabilized the joint and prevented the separation of the concrete. Because the pipe did not contain any junction boxes, experts believed that either water was escaping or dirt was infiltrating in, causing destabilization of the soil around the drain. The drain was likely bedded in a granular fill, which is a quick-to-erode material, instead of the usual clay. All of this together caused a massive loss of support soil from under the foundation of the house and resulted in damage to the house.

The Second Circuit Court of Appeal decided that the recordation of the easement and Ordinance 509 created duties on the part of the Police Jury to maintain the drainage system as well as a burden on the owner of the land to let the Police Jury onto the land when required. Although the suit would not have been allowed if it were a tort suit under sovereign immunity, it was allowed to go forward because it was based on the special relationship between the Petchaks and the Bossier Parish Police Jury created by the easement. The court also pointed out that prospective owners usually do not conduct underground surveys of the condition of the utilities in easements. Additionally, the Petchaks knew that the right of way existed, could see the manhole cover which was evidence of the right of way, and trusted that the easement would not make the condition of their property worse. The court also found that the Police Jury constructively knew of problems with the drainage system by 1992, when the first sinkhole was reported, so it could not at this time claim lack of knowledge.

DePuy Parent Company Johnson & Johnson Admit Flaws in Cleaning Process

Published on: March 7, 2011 | By Berniard Law Firm

Reuters News Service reports that Johnson & Johnson has blamed “lax cleaning procedures” for its massive recalls of over the counter medicines and artificial joint replacements. “Insufficient equipment cleaning procedures and instances where people failed to adequately document cleaning procedures” are among some of the identified cleaning issues. The company has cited to “label irregularit(ies)” as well.

Johnson & Johnson has recalled nearly 200 million bottles of over the counter medicine products in the past year. Benadryl, Tylenol, and Rolaids are among the brands affected. Some batches of Softchews Rolaids were found to have wood and metal bits in the tablets. What’s more, odors have been reported in some of the other products. In light of Johnson & Johnson’s lack cleaning procedures, one may wonder what sort of research went into the DePuy ASR hip implants. DePuy, a division of Johnson & Johnson, announced in August 2010 a nationwide recall of the ASR hip replacement systems. The artificial hips contain design flaws stemming from too-shallow cups that don’t properly house the ball associated with the joint replacements. Complications of this design flaw include metallosis caused by microscopic metal shavings and substantial loss of mobility, to name a few symptoms. Moreover, pseudotumors have been reported in some recipients of DePuy’s ASR joint replacement products.

In light of Johnson & Johnson’s quality control flaws, and resulting defects, the federal government is beginning to pay attention. The Justice Department is considering potential charges against the corporation. The F.D.A. has initiated an investigation. Congressman Darrell Issa has expressed concern, too. At least one shareholder has filed suit against Johnson & Johnson’s board of directors in response to the manufacturing errors the company have committed recently.

Johnson & Johnson, Parent to DePuy, Under Scrutiny for Manufacturing Practices

Published on: March 1, 2011 | By Berniard Law Firm

In August 2010, DePuy recalled thousands of its ASR hip implant units after medical watchdogs discovered the product was structually unsafe and caused many recipients metallosis, substantial loss of mobility in joints, and other symptoms. Thousands of lawsuits immediately followed, with most still pending.

Hip implants aren’t the only product produced by DePuy, and its parent division, Johnson & Johnson, that have contained flaws. According to a January 2011 New York Times story, 288 million Johnson & Johnson products, including 136 million bottles of liquid Tylenol, Motrin, Zyrtec and Benadryl, have been pulled from store shelves. Foreign bits of metal and moldy odors are among some of the chief reasons behind removal of these items. And in December 2010, 13 million packages of Rolaids, another Johnson & Johnson product, were pulled from shelves after they were contaminated with metal and wood particles.

Johnson & Johnson’s manufacturing errors have led government regulators to more closely scrutinize the company and its subdivisions. The F.D.A., for instance, has expressed that it is baffled as to why company executives have not been able to identify, prevent, or explain the recent emergence of problems that plague the medical manufacturer’s products. Even the State of Oregon has filed a lawsuit against Johnson & Johnson, claiming the company has misrepresented the quality and efficacy of its products. A shareholder’s lawsuit was filed against the company’s board of directors in December 2010 in response to the billions of dollars lost in damages payments to victims of Johnson & Johnson’s defective products.

Understanding Terms: Claims Based Insurance v. Occurrence Based Insurance

Published on: February 21, 2011 | By Berniard Law Firm

Insurance policy coverage can be very confusing regardless of how simple televisions commercials may claim it can be. Sometimes insurance companies limit their liability by setting a time period within which the policy applies. In other circumstances, insurance policies limit their liability by creating categories of actions that can be instituted against it. For example, if an insurance policy states that it protects a health care provider for one year after the policy begins, this may mean that 366 days later a patient is out of luck if the doctor performs malpractice. Some insurance companies create distinctions on the types of actions that fall under the policy. For example, coverage can extend either based on occurrence or claims.

The distinction here is important, especially as it relates to the time period to bring a claim. If an insurance policy begins on January 1 and ends on December 31, the malpractice occurs on November 10, and the plaintiff files suit in March of the next year, the definitional difference is important. If the policy is occurrence based, the plaintiff will likely have no problem. In an occurrence based policy, coverage extends to any malpractice which occurred within the policy period. In our set of facts, since the malpractice occurred on November 10, it is covered because it is within the policy period. In a claims based policy, coverage extends to any claim that is filed within the insurance coverage period. In this case, although the malpractice took place within the time period of the insurance policy, the claim was not filed until after the coverage period had extinguished. Thus, in out facts, if the policy was claims based, the insurance company would not be liable for the malpractice.

In a recent case, Dewayne Wright v. Willis-Knighton Medical, the plaintiff, Ms. Wright suffered cramps, a coma, insulin shock, and stroke as a result of medical malpractice. The mother of the plaintiff filed suit on behalf of Ms. Wright. She filed initial suit against the facility, Willis-Knighton Medical. At a later date she amended her brief and added the ER doctors to the suit as well. Later, the plaintiff discovered that the insurance policy did not include the health care facility and only included the medical practitioners who decided to join under the coverage. The doctors that she added under the amended brief were originally protected by the coverage.

The problem for the plaintiff begins, though, when the insurance company that she sued later based its policy with the doctors on a claims based basis. Only the claims that were filed within the insurance coverage period were covered. Unfortunately for Mr. Wright, the period ended the day before the brief was amended. Mr. Wright argued that because the doctors were employed by Willis-Knighton, they were solidary defendants. However, because the policy did not cover the medical facility there is no legal basis to extend the coverage of the policy more than the contract states. Thus, because the coverage period had expired by the time the claim was brought against the insurance company and doctor, the claim failed to meet the requirement within the policy’s scope and thus must fail in court to make the insurance provider liable for the alleged malpractice.

This case shows that if you feel that your rights have been violated or that you have been injured because of medical malpractice that you should seek legal counsel as soon as possible. By waiting before speaking to an attorney you increase the chance that time may run out on your ability to protect your rights.

Accident Involving Criminal Leads to Questions Relating to Insurance Company Policies

Published on: February 19, 2011 | By Berniard Law Firm

The purpose behind having insurance is to help injured parties get relief. In a world without insurance, every accident has the potential to be the financial ruin of the party judged to be at fault. Insurance policies have the effect of creating a large pool of money that can be used to provided financial backing in the post accident period. However, insurance policies will not have the effect of covering every accident that occurs in every circumstances. For example, can we expect to allow an individual who uses his vehicle as a weapon to gain the benefits of his car insurance policy? Answering questions like this are at the cornerstone of lawsuits seeking compensation when tragedy strikes in unfortunately complex ways.

Strong public policy in Louisiana indicates that any accident that occurs in the course of committing a crime should not be protected by insurance. In fact, for obvious business reasons, most insurance policies limit the insurance company’s liability with a crime exception. The Ruston City Court, Parish of Lincoln, State of Louisiana, had this concept in mind when it made a recent decision.

The defendant, Shedrick Green, was driving down a road while he was feuding with another individual in another car. At one point, the party in the other vehicle pulled into a parking lot, at which time Mr. Green pulled out a gun and began shooting. After shooting at the other vehicle, he got back into his car and continued driving. At the next stop sign, he drove into the intersection without stopping at the stop sign and his vehicle collided with the vehicle that the plaintiff, Latasha Potts, was driving. At the trial court level, Ms. Potts sued both Mr. Green and his insurance company. The trial court ruled that driving through the intersection was part of a continuation of a criminal activity. The insurance policy on the vehicle driven by Mr. Green stated that the policy did not extend to criminal actions. Thus, the trial court ruled that the insurance company was not liable because of the criminal nature of the vehicle’s use.

However, upon appeal, the appellate court looked at the circumstances differently. Mr. Green was arrested for assault and battery. According to the facts set out by the trial court, the assault and battery were completed when Mr. Green shot at the other vehicle and drove away. Any action taken after that was not in the course of a criminal activity. If Mr. Green had been charged with fleeing the scene of a crime, there could be a chance that the accident with Ms. Potts was a criminal activity. Parties who are involved in an accident expect to be protected against normal acts of negligence on the part of a driver. In this case, Mr. Green drove down the road and negligently failed to realize that he needed to stop at the stop sign. Thus, the accident with Ms. Pott was as a result of Mr. Green’s negligence, not his prior criminal actions. Criminal law should not be used as a tool to limit civil liablity. Thus, the appellate court overturned the trial court decision.

Insurance policies have the potential to deal with many different areas of law. The facts of this case show an interlocking of civil, contract, and criminal law all in one case. Thus, it is essential or any person who has been involved in a car accident to seek legal advice. Simply settling with an insurance company may not be the most effective way to retain your rights. By consulting with an attorney, finding where the law is flexible or is not as simple as first glance can mean a significant amount, like in this case.

Younger Patients Opt for Joint Replacement Surgery, Increased Numbers Affected by Defective Implants Manufactured by DePuy

Published on: February 17, 2011 | By Berniard Law Firm

In January 2011 the Washington Post reported on the recent trend of younger patients opting for joint replacement surgery. In 2008, of the 277,000 hip replacements performed in the United States, 27 percent were conducted on patients ages 45 to 64. That represents an increase of 78 percent for that age group.

One orthopaedic surgeon believes the trend stems from younger peoples’ proactive approach to pain and aging. “Younger people are less willing to accept physical disability than older generations,” Dr. Mary O’Connor, president of the American Association of Knee and Hip Surgeons, said. “[Younger people] don’t want to hear that they should use a cane or they can’t walk or play golf…”

But with increased joint replacement surgeries comes increased risk. Because most replacement joints are expected to last 15 to 20 years, many younger patients will outlive their artificial knees and hips. And when the usefulness of those joints diminishes, a second surgery, known as a revision, is necessary to replace the failing artificial joint with a new one. Revision surgery carries with it increased complications. “If you need a [revision surgery], that surgery is a little more difficult,” Dr. Mary O’Connor explained. Usually when [the implant] fails, it fails because one of the parts loosens…every time you have to revise it, there’s a higher risk of complications.”

Criticisms of Metal-on-Metal Hip Replacements May Push Physicians Away from Usage

Published on: February 15, 2011 | By Berniard Law Firm

Medical literature has showcased several problems with metal-on-metal hip implants, such as the DePuy ASR line that was recalled in August 2010. Among the various problems, soft tissue reactions and high risks associated with metal-on-metal implant materials emerge to the top. For example, some hip implant recipients are especially sensitive to cobalt and chromium, two metal alloys commonly found in metal-on-metal hip implants. Doctors have observed “soft tissue breakdown and pseudo-tumors” in patients who exhibit these types of sensitivities, as well as other symptoms. Further discussion of these symptoms can be found here.

Additionally, physicians are beginning to balk at the use of metal-on-metal implants due to the newly uncovered information on the devices just now bubbling to the surface. As a result of recent lawsuits against DePuy in relation to the company’s flawed manufacturing processes, physicians are just now realizing some of the inherent risks associated with the metal-based units. Some medical observers predict the popularity of metal-on-metal implants could decrease as a result. Not only are physicians worried about personal liability for implanting a faulty metal-on-metal product, they are increasingly concerned with the proper maintenance of their patients’ wellbeing and health as well. Certainly, the use of metal-based devices in patients can run counter to such goals.

As metal-on-metal implants have been subjected to much scrutiny, physicians are turning to alternative joint implant materials, such as ceramics or plastic. One plastic model, known as the ADM X3 Mobile Bearing Acetabular System, has a ninety-four percent reduction in wear compared to metal-on-metal implants. Although the potential risks associated with plastic hip devices are not entirely known, they do not seem to carry the same risks of metallosis or soft-tissue poisoning that occurred in the DePuy metal-on-metal implants.

Insurance Policy Exceptions in Automobile Accidents

Published on: February 8, 2011 | By Berniard Law Firm

Automobile insurance policies are a means of protecting car drivers and accident victims. It creates a pool of money so that any party at fault can make the victim of his or her negligence whole. When a business holds itself out as a car dealer, policy terms are a little different based on each party and insurer. An insurance policy agreement between the insurer and the insured is a contract between the parties. Under Louisiana law, words in a contract are presumed to have the plain and ordinary meaning they are generally given. The basic intent of the parties is construed through the words of the contract, and no court can disturb the intent of the parties. If an insurer is attempting to show that a certain provision in an insurance policy exempts coverage, the insurer has the burden to prove any exception.

In a recent case, a court discussed how insurance policy language will be interpreted. The facts giving rise to the cause of action in McKay v. W & J Farms, are as follows:

The plaintiff, Connie McKay, was driving South on Highway 153 in Richland Parish. As she travelled through an intersection, her vehicle was struck on the side by a tractor driven by Kyle Mills. Ms. McKay claims that an insurance policy held by the seller of the tractor extended to Mr. Mills when he was driving the tractor. The way in which Mr. Mills came to be driving that vehicle at the very moment are interesting and are crucial in relation to the cause of action. Mr. Mills works on a farm with his brother and another individual, Mr. Livingston. The three individuals decided that it was important that they purchase another tractor to increase productivity on the farm. Mr. Livingston and Mr. Mill’s father went to a Peterbuilt tractor dealership in order to check prices of tractors. Mr. Livingston brought a tractor to the farm to test it out. Mr. Mills was advised to drive the tractor from the farm to the elevator. During this fateful drive, he struck Ms. McKay at the intersection with Highway 153.

Ms. McKay argued that the Peterbuilt dealer’s insurance coverage extends to Mr. Mills as he was driving the tractor. The insurance company’s policy with the Peterbuilt dealer states in relevant part:

The following are insured for covered autos…anyone else while using with your permission a covered auto you own, hire, or borrow, except…Your customers, if your business is shown in the Declarations as an auto dealership.

In the Peterbuilt dealers business declaration, the business was declared a car dealership. Ms. McKay argued that there is a distinction between auto dealership, as is stated in the insurance policy, and car dealership, as is stated in the declaration. There is obviously no real distinction between these terms. From a logical perspective, a person reading these two terms would find that they are identical. The next question is whether Mr. Mills was a customer of the Peterbuilt dealer. The facts in the case showed that Mr. Mills’ brother was going to be the actual purchaser of the tractor. However, under Louisiana law, a person test driving a vehicle in order to help a purchaser make a decision of whether to purchase that vehicle is considered an extension of the purchaser. This means that the test driver is a customer in the eyes of the law. Therefore, when Mr. Mills was driving the tractor he was a customer and under the terms of the dealer’s contract with the insurance provider, Mr. Mills was not covered under the policy.

Insurance policies are difficult and complex contractual agreements. In order to understand policies, a general understanding of the law is essential. If you have been involved in an accident, you are likely going to have to deal with an insurance company.