Hyatt v. Mutual of Omaha Ins. Co.

149 So. 3d 406, 14 La.App. 3 Cir. 282, 2014 La. App. LEXIS 2381, 2014 WL 4851818
CourtLouisiana Court of Appeal
DecidedOctober 1, 2014
DocketNo. CA 14-282
StatusPublished
Cited by5 cases

This text of 149 So. 3d 406 (Hyatt v. Mutual of Omaha Ins. 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
Hyatt v. Mutual of Omaha Ins. Co., 149 So. 3d 406, 14 La.App. 3 Cir. 282, 2014 La. App. LEXIS 2381, 2014 WL 4851818 (La. Ct. App. 2014).

Opinion

EZELL, Judge.

11 This appeal involves the reformation of a disability benefits insurance policy issued by Mutual of Omaha Insurance Company [409]*409(Mutual) to Daniel Hyatt. The trial court found the policy language was ambiguous and reformed the policy to allow Mr. Hyatt to receive full recovery of benefits. The trial court also awarded penalties and attorney fees. The trial court refused to allow a reduction in benefits based upon Mr. Hyatt’s receipt of social security benefits. However, the trial court granted Mutual’s motion for remittitur based on the settlement by its agent Larry Perron with Mr. Hyatt, finding the two parties to be solidary obligors. Mutual filed the present appeal seeking reversal of the judgment, and Mr. Hyatt answered the appeal seeking reversal of the grant of the remittitur and additional attorney fees for work performed at the appellate level.

FACTS

Daniel Hyatt drove an eighteen-wheeler for a living. In January 2000, he applied for an income replacement policy with Mutual with the help of its agent, Larry Per-ron. In the application, Mr. Hyatt was required to list “Gross annual earned income from your occupation (after business expenses).” He listed his current salary as $60,000.00 and his previous year’s salary as $90,000.00. Mr. Hyatt was issued a policy costing $90.18 a -month and providing benefits of $2,000.00 a month for two years if Mr. Hyatt became disabled from working.

In August 2002, Mr. Hyatt began having difficulty walking and keeping his balance. In March 2008, he was diagnosed with spinal muscular atrophy. Spinal muscular atrophy causes muscle weakness and wasting. In September 2006, Mr. Hyatt made a claim with Mutual for disability benefits. Mutual sent a letter to Mr. Hyatt informing him of the information it needed to begin processing his claim, | gMutual also sent forms that needed to be completed. Mutual never received the requested information from Mr. Hyatt, so it mailed additional letters requesting the information. Mr. Hyatt never proceeded with his claim for disability benefits at that time.

Subsequently, Mr. Hyatt again sought disability benefits from Mutual in March 2008, claiming that he was no longer able to work as of February 1, 2008. In processing his claim, Mutual requested his 2006 and 2007 tax returns. Mr. Hyatt responded by sending the 2005 and 2006 tax returns because his 2007 tax returns had not been prepared. He also enclosed his denial of disability benefits letter from the social security administration from when he applied for benefits in 2006.

Based on the information in the tax returns, Mutual informed Mr. Hyatt on June 9, 2008, that his benefits would be reduced to $200.00 a month. Taking into account that Mr. Hyatt was a sole proprietor, Mutual utilized his net income with the addition of any depreciation expense in calculating his entitlement to disability benefits. This resulted in a negative or minimum income. Using this amount of income, Mr. Hyatt was not entitled to disability benefits. However, pursuant to a relation-to-earnings provision in the policy, $200.00 was the minimum that could be paid to Mr. Hyatt. He was issued a disability draft in the amount of $400.00, representing two months’ disability benefits: Based on the same provision, Mutuál also refunded 90% of the premiums Mr. Hyatt paid to Mutual in the previous twenty-four months in the amount of $1,947.88. This is because he did not qualify for the benefits he paid for.

After receiving the 2007 tax returns, Mutual adjusted Mr. Hyatt’s benefits to $436.00 a month versus $200.00 a month. This meant an additional payment of |s$472.00 was due but also meant that the refund of the premium should have only been $1,670.76 instead of $1,947.88 for a difference of $277.12. Therefore, Mutual [410]*410sent an additional check in the amount of $194.88 representing the difference between the benefits of $472.00 due minus the overpayment of the premium due of $277.12.

Mutual also requested that Mr. Hyatt provide monthly continuation of disability forms in order to continue his disability past July 1, 2008. Following multiple requests for the forms, Mr. Hyatt’s file was closed in November 2008. Mr. Hyatt never received any additional benefit checks.

On July 17, 2008, Mr. Hyatt filed suit against Mutual and Larry Perron who sold him the disability insurance policy claiming entitlement to $2,000.00 a month in benefits. He also sought damages, penalties, and attorney fees. Mr. Hyatt later amended his petition asking for reformation of the policy to conform to the original intent that it provided disability insurance coverage in the amount of $2,000.00 per month because Mr. Perron represented that the application required him to list his gross annual income.

On February 23, 2009, Mr. Hyatt filed another claim for social security benefits, claiming to be disabled as of September 1, 2007. After an investigation, the Social Security Administration determined that he was disabled.

A bench trial was held in May 2013. After two days of trial, Mr. Hyatt settled with Mr. Perron for $25,000.00. The trial proceeded, and the trial court ruled from the bench on May 16, 2013. The trial court found the policy to be ambiguous regarding the definition of “earnings” and ordered that the policy be reformed to reflect the intention of the parties that Mr. Hyatt was entitled to $2,000.00 a month in disability benefits. The trial court also determined that Mr. |4Hyatt was entitled to the full two-year period of benefits. Pursuant to La.R.S. 22:1821, the trial court awarded penalties in the amount of $48,000.00 and $27,204.00 in attorney fees. In considering Mutual’s motion for remitti-tur filed after the trial, the trial court reduced the award to Mr. Hyatt by $25,000.00 based on his settlement with Mr. Perron, finding Mr. Perron to be a solidary obligor with Mutual.

Final judgment was signed on October 13, 2013. Mutual filed the present appeal, and Mr. Hyatt answered the appeal.

Amount of Benefits

The main argument by both sides in this case involves the definition of “earnings” when calculating the amount of benefits, or extent of coverage, Mr. Hyatt is entitled to. Mutual argues that the policy requires that his net earnings, earnings after business expenses, should be utilized. Mr. Hyatt argues that his gross earnings should be utilized. In making its ruling, the trial court found the policy issued by Mutual was ambiguous regarding the meaning of “earnings.” The trial court further found that Mr. Perron knew that Mr. Hyatt intended to purchase a policy which would provide benefits in an amount which would cover his eighteen-wheeler truck note if he became disabled. The trial court then reformed the insurance policy to provide that Mr. Hyatt’s gross earnings would be considered in determining the amount of benefits he was entitled to.

An insurance policy is a contract between the insured and insurer and is the law between the parties which governs their relationship. La.Civ.Code art. 1983; Peterson v. Schimek, 98-1712 (La.3/2/99), 729 So.2d 1024. In interpreting insurance policies, courts should use general rules of contract interpretation while determining the common intent of the parties as reflected by the words of the | ^insurance policy. Id.; La.Civ.Code art. 2045; Highlands Underwriters Ins. Co. v. Foley,

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149 So. 3d 406, 14 La.App. 3 Cir. 282, 2014 La. App. LEXIS 2381, 2014 WL 4851818, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hyatt-v-mutual-of-omaha-ins-co-lactapp-2014.