Daney v. Haynes

630 So. 2d 949, 1993 WL 544837
CourtLouisiana Court of Appeal
DecidedDecember 30, 1993
Docket93-CA-1103
StatusPublished
Cited by9 cases

This text of 630 So. 2d 949 (Daney v. Haynes) 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
Daney v. Haynes, 630 So. 2d 949, 1993 WL 544837 (La. Ct. App. 1993).

Opinion

630 So.2d 949 (1993)

Sharon DANEY and Gregory Daney
v.
Carolyn HAYNES, et al.

No. 93-CA-1103.

Court of Appeal of Louisiana, Fourth Circuit.

December 30, 1993.

*950 Marie Riccio Wisner, New Orleans, for plaintiff/appellee.

William Ryan Acomb, Porteous, Hainkel, Johnson & Sarpy, New Orleans, for defendant/appellant.

Before PLOTKIN, WALTZER and LANDRIEU, JJ.

PLOTKIN, Judge.

Defendant State Farm Mutual Automobile Insurance Co. appeals a trial court finding that its failure to timely pay uninsured/underinsured *951 (UM) insurance to plaintiffs Sharon and Gregory Daney was arbitrary, capricious, and without probable cause, entitling the Daneys to penalties and attorney's fees under the provisions of LSA-R.S. 22:658. We amend the judgment to award additional attorney's fees for work performed on appeal and to add legal interest to the judgment from the date of judicial demand, and affirm.

Facts

Ms. Daney injured her back in an automobile accident which occurred at the uncontrolled intersection of Elysian Fields Avenue and Canton Street in the City of New Orleans on August 3, 1989. The accident occurred when the vehicle which Ms. Daney was driving struck a vehicle driven by defendant Carolyn Haynes. The police report on the accident indicates that Ms. Haynes ran a stop sign. Defendant State Farm insured Ms. Haynes under an automobile liability policy with the limits of $25,000 per person and $50,000 per accident. Additionally, State Farm insured Ms. Daney under a UM policy with limits of $25,000 per person and $50,000 per accident.

The State Farm UM claims investigation was handled by Claims Specialist Gabriella Doaks. Ms. Doaks acknowledged at trial that she first received a demand letter from the attorney representing the Daneys on August 24, 1989. Then, on August 31, 1989, she received the police report, which showed that Ms. Haynes had been cited for a traffic violation in connection with the accident; Ms. Doaks stated that she concluded from that report that Ms. Haynes was at fault in causing the accident. On September 18, 1989, Ms. Doaks received a facsimile transmission (FAX) from Ms. Daney's employer, Michael Mayhall, which indicated that Ms. Daney had missed 41 hours of work because of her injuries sustained in the car accident, for a net loss of wages totalling $318.11.

On September 27, 1989, Ms. Doaks sent a letter to Ms. Daney's treating physician, Dr. Gerald Davis, requesting Ms. Daney's medical records. On October 5, 1989, Ms. Doaks paid a medical bill dated October 2, 1989, which indicated that Ms. Daney had been diagnosed with a "lumbar HNP"; Ms. Doaks admitted at trial that she knew that "HNP" meant "herniated nucleus pulpous," a condition commonly known as a "ruptured disc."

On October 19, 1989, Ms. Doaks received the medical records she had requested, which detailed Ms. Daney's condition from the date of the accident until September 15, 1989. The records indicated that Ms. Daney had first consulted Dr. Davis on August 5, 1989 for pain in her back which developed during the three days immediately following the accident. Dr. Davis' history also indicated that Ms. Daney had not previously had any problems with low back or neck pain. Additionally, the medical records indicated that Ms. Daney had submitted to an MRI examination on September 13, 1989. Further, the records included a handwritten notation dated September 15, 1989, by someone named "Susan," indicating that she had contacted Ms. Daney and told her that she had a ruptured disc.

Ms. Doaks stated at trial that she submitted the Daney claim for approval of payment of UM policy limits on October 20, 1989, but the request was rejected by her supervisors who had "problems with causation" because there was not enough medical documentation in the file. Ms. Doaks said she had nothing directly relating the injury to the accident at that time, despite the doctor's recitation of Ms. Daney's history.

On October 23, 1989, Ms. Doaks scheduled an independent medical examination with Dr. James T. Williams, who examined Ms. Daney on October 31, 1989. Ms. Doaks received Dr. Williams' report on November 7, 1989; that report indicated that Ms. Daney had "objective evidence of mechanical dysfunction in her lower back"; Dr. Williams also said that he would like to see the MRI. Thereafter, Ms. Daney asked Dr. Davis to forward the MRI to Dr. Williams. Ms. Doaks admitted that she did not submit the Daneys' claim for approval to make an unconditional tender of the UM policy limits at that time.

Ms. Doaks conceded that she subsequently received four additional demand letters for payment under the UM policy—one dated November 2, 1989; one dated November 16, 1989; one dated December 2, 1989, and one dated January 16, 1990. The plaintiffs filed the instant suit on December 27, 1989. However, *952 Ms. Doaks took no action on the file between the time she made her request to Dr. Davis to send the MRI to Dr. Williams in early November 1989 until sometime in late January 1990, when she received some updated medical reports, which indicated that Ms. Daney was preparing to undergo surgery. At that time, she submitted the Daneys' claim for authorization to pay the UM policy limits.

Ms. Doaks admitted at trial that she never made any requests for updated medical reports on Ms. Daney's condition after her initial request, despite the fact that the reports she received only indicated Ms. Daney's condition up until September 15, 1989. Additionally, Ms. Doaks admitted that she never attempted to get the MRI to forward to Dr. Williams herself. Ms. Doaks conceded that she had complete authority to request those things.

Ms. Doaks stated that her supervisor authorized payment of the $25,000 UM policy limits on January 25, 1990. Thereafter, Ms. Doaks unsuccessfully attempted to negotiate a "structured settlement" of the claim. Finally, on March 2, 1990, State Farm issued a check to the Daneys in the amount of $25,000, the limits under the UM policy.

Arbitrary, capricious, or without probable cause

When this accident occurred in 1989, LSA-R.S. 22:658 provided, in pertinent part, as follows:

A. All insurers issuing any type of contract other than those specified in R.S. 22:656 [life insurance] and 22:657 [health and accident insurance] shall pay the amount of any claim due any insured ... within sixty days after receipt of satisfactory proofs of loss from the insured....
B. (1) Failure to make such payment within sixty days after receipt of such proofs and demand therefor, when such failure is found to be arbitrary, capricious, or without probable cause, shall subject the insurer to a penalty, in addition to the amount of the loss, of ten percent damages on the total amount of the loss, payable to the insured ... together with all reasonable attorney fees for the prosecution and collection of such loss....

After hearing the evidence outlined above, the trial judge found that State Farm was liable for penalties and attorney fees for failure to tender payment within 60 days of November 1989, at which time he found that "there was a reasonable basis ... to conclude... that there was a ruptured disc suffered by Sharon Daney." State Farm challenges that finding, claiming that the trial court applied the wrong standard to determine the amount of damages, and that the trial court did not permit State Farm a reasonable time to determine whether it had sufficient facts to establish the extent of damages.

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Cite This Page — Counsel Stack

Bluebook (online)
630 So. 2d 949, 1993 WL 544837, Counsel Stack Legal Research, https://law.counselstack.com/opinion/daney-v-haynes-lactapp-1993.