Burst v. Western Fidelity Insurance Co.

561 So. 2d 980, 1990 La. App. LEXIS 1210, 1990 WL 62073
CourtLouisiana Court of Appeal
DecidedMay 15, 1990
DocketNo. 89-CA-0972
StatusPublished
Cited by2 cases

This text of 561 So. 2d 980 (Burst v. Western Fidelity Insurance Co.) is published on Counsel Stack Legal Research, covering Louisiana Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Burst v. Western Fidelity Insurance Co., 561 So. 2d 980, 1990 La. App. LEXIS 1210, 1990 WL 62073 (La. Ct. App. 1990).

Opinions

ARMSTRONG, Judge.

Defendant, Western Fidelity, appeals the trial court’s judgment finding that Western Fidelity was obligated to pay the claim of Roland Burst in the amount of $38,249.14 and finding that Western Fidelity had acted unreasonably in denying Burst’s claim and thus awarded attorney fees in the amount of $15,143.33 in favor of Burst. Burst appeals the quantum of damages and requests that the judgment be affirmed and amended to increase attorney fees, expert fees, legal interest and costs.

Western Fidelity issued an accident/health and life insurance policy to Roland C. Burst, Jr. with effective coverage as of September 8, 1986. In April, 1987, Burst suffered a traumatic injury to his leg causing ulceration of the underlying muscle tissue. This injury occurred during the effective time of coverage under the aforesaid policy and eventually resulted in surgery to the leg performed by Dr. Thomas Crais in October, 1987. Despite the fact that Western Fidelity had previously made payment to Burst for other unrelated claims, Western Fidelity refused payment of medical bills incurred by Burst for the treatment of this tissue ulceration injury and surgery.

On May 16, 1988, Burst filed suit against Western Fidelity alleging non-payment of medical benefits due under the policy. Western Fidelity answered asserting the defense of pre-existing condition and the defense of misrepresentation on the policy application. Additionally Western Fidelity denied that it was arbitrary and capricious for failing to pay this claim.

On November 18, 1988, Burst filed a Notice of Deposition of Western Fidelity. On November 22, 1988, Western Fidelity filed a Motion to Upset the Deposition on the ground that the deposition improperly sought to depose in New Orleans, Dr. William D. Moehlman, a Texas resident. A hearing was held on December 16, 1988 and Western Fidelity’s motion to upset the deposition was denied. Supervisory writs were taken to the Fourth Circuit by Western Fidelity but were denied on February 22, 1989.

On February 1, 1989, Burst filed a Motion for Contempt against Western Fidelity for its failure to produce Dr. Moehlman for the deposition scheduled in New Orleans. This motion was not ruled on by the trial court until March 1st, a week before trial.

During the interim, Western Fidelity filed a Notice of Intent to Depose Dr. Moehlman in Texas and Burst promptly filed a motion to quash the deposition. Burst’s motion was granted and Western Fidelity thereafter took supervisory writs to the Fourth Circuit. The writs were denied on February 22, 1989.

At the March 1st hearing, the trial court granted Burst’s Motion for Contempt and imposed sanctions as follows: the court disallowed any evidence concerning the fact that Burst suffered from a “pre-exist-ing condition,” the court disallowed any evidence concerning misrepresentation made by Burst on his policy application, [982]*982and the court disallowed any reference to the report of Dr. Moehlman. Western Fidelity did not seek writs on this ruling.

Trial was held before a jury on March 7, 1989. A verdict was returned by the jury wherein it found that Western Fidelity was obligated to pay the claims of Burst amounting to $38,249.14 and that Western Fidelity had acted unreasonably in denying these claims so that the court was to automatically impose penalties of 100% of the claim and reasonable attorney’s fees pursuant to La. R.S. 22:657. The court set the attorney’s fees at $15,143.33 based on an hourly computation.

Western Fidelity thereafter appealed suspensively from the judgment signed March 9, 1989 and Burst answered the appeal seeking interest, costs, expert fees, and an increase in the award of attorney fees to be in accordance with the evidence presented at trial, and an award of attorney’s fees/costs for the present appeal.

On appeal Western Fidelity argues that the trial court erred: 1) in failing to quash Burst’s deposition of Western Fidelity; 2) in striking the affirmative defenses of “pre-existing condition” and “material misrepresentation” and in refusing to allow evidence concerning the issue of whether Western Fidelity was arbitrary and capricious in failing to pay medical benefits under Burst’s policy; 3) and when it granted Burst’s motion to quash Western Fidelity’s deposition of Dr. William D. Moehlman. As its fourth assignment of error Western Fidelity argues that the jury’s verdict was contrary to the law and evidence.

In its first assignment of error Western Fidelity relies on La.C.C.P. article 1442 in arguing that because there was no one who could be designated and who could consent to testify to the matters requested in Burst’s notice of deposition that the deposition should have been quashed.

Western Fidelity asserts that Dr. Moehl-man is the only individual “personally and intimately familiar with the opinions espoused in a medical report of Dr. William D. Moehlman, M.D.” Yet Dr. Moehlman is not an employee of Western Fidelity and he is a resident of Texas where he maintains a family practice. Western Fidelity argues that he is clearly outside the subpoena power of a Louisiana court. La.C.C.P. articles 1352 and 1356. We submit to the court’s previous ruling on this issue in writ order # 89-C 0324.

In its second assignment of error Western Fidelity argues that in striking both of its defenses to Burst’s claim for payment as sanctions the trial court essentially dismissed its case. Western Fidelity cites Skidmore v. Salvadras, 496 So.2d 435 (La.App. 1st Cir.1986) to argue that the sanction of dismissal is most severe and may be imposed only in extreme cases. Western Fidelity also cites Fulgham v. An Unknown Police Officer, 480 So.2d 417 (La.App. 4th Cir.1985). Fulgham states that a dismissal of a party’s claim or defense should only be imposed when the party is clearly aware that its noncompliance will result in the dismissal of its defenses. See also: Kile v. Plaisance, 488 So.2d 290 (La.App. 3d Cir.1986).

We do not agree that Western Fidelity’s case was effectively dismissed as a result of the sanctions imposed. Western Fidelity was an active participant in the trial in which Burst was obligated to prove his case. Burst testified as did the surgeon who rendered the treatment that comprised Burst’s claim. Western Fidelity had the opportunity to discredit them or to challenge their testimony.

The cases which Western Fidelity cites are distinguishable for that reason. Fulg-ham involved an actual dismissal. Skid-more is distinguishable not only because the court of appeal found that disallowing a party-plaintiff from testifying was the equivalent of dismissing his claim but also because it was an especially harsh sanction considering that the inability of the defendants to depose the plaintiff was not a recurring problem.

The issue in the Kile opinion was one of prejudice. The court wrote:

Although it does appear that defendant was not given an opportunity to see the original exhibits until shortly before trial, it is not clear that he was not, in fact, [983]*983provided with copies of these exhibits by plaintiffs’ attorney sometime before trial. What is clear, is that defendant did have access to copies of these exhibits well in advance of trial. There is no claim that there was any variance between the copies and the originals defendant had in his possession.

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Related

Malloy v. Vanwinkle
662 So. 2d 96 (Louisiana Court of Appeal, 1995)
Burst v. Western Fidelity Insurance Co.
566 So. 2d 986 (Supreme Court of Louisiana, 1990)

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Bluebook (online)
561 So. 2d 980, 1990 La. App. LEXIS 1210, 1990 WL 62073, Counsel Stack Legal Research, https://law.counselstack.com/opinion/burst-v-western-fidelity-insurance-co-lactapp-1990.