Jessie Cole, Et Ux. v. State Farm Mutual Automobile Ins. Co.

• Court: Louisiana Court of Appeal
• Decided: October 1, 2014
• Docket: CA-0014-0329
• Status: Unknown

Opinion

STATE OF LOUISIANA COURT OF APPEAL, THIRD CIRCUIT

CA 14-329

JESSIE COLE, ET UX.

VERSUS

STATE FARM MUTUAL AUTOMOBILE INS. CO., ET AL.

**********

APPEAL FROM THE TENTH JUDICIAL DISTRICT COURT PARISH OF NATCHITOCHES, NO. C-85441, DIV. A HONORABLE ERIC ROGER HARRINGTON, DISTRICT JUDGE

BILLY HOWARD EZELL JUDGE

Court composed of John D. Saunders, Billy Howard Ezell, and J. David Painter, Judges.

REVERSED AND REMANDED. Steven D. Crews Corkern and Guillet P. O. Box 1036 Natchitoches, LA 71457-1036 (318) 352-2302 COUNSEL FOR DEFENDANTS/APPELLEES: State Farm Mutual Automobile Ins.Co. Edith P. Breedlove

Musa Rahman Johnson, Rahman & Thomas P. O. Box 98001 Baton Rouge, LA 70898-8001 (225) 231-0756 COUNSEL FOR INTERVENOR/APPELLEE: Louisiana Workers’ Compensation Corporation

Billy Lynn West, Jr. P. O. Box 1033 Natchitoches, LA 71458-1033 (318) 352-7300 COUNSEL FOR PLAINTIFFS/APPELLEES: Jessie Cole Gwen Cole

Michael D Lonegrass Stephanie Dovalina Galloway, Johnson, Tompkins, Burr & Smith 4040 One Shell Square New Orleans, LA 70139-1200 (504) 525-6802 COUNSEL FOR DEFENDANT/APPELLANT: Arch Insurance Company EZELL, Judge.

The Louisiana Workers’ Compensation Corporation (LWCC) sought a credit

against its obligation for future compensation payments because an employer’s

uninsured motorist (UM) carrier made payments on behalf of an employee

involved in an automobile accident. The trial court granted summary judgment in

favor of LWCC finding that it was entitled to a future credit. Arch Insurance

Company, as the UM carrier, filed the present appeal arguing that LWCC is not

entitled to a credit for future payments because the terms of its policy explicitly

prohibit a workers’ compensation insurer from receiving any benefit from its

policy proceeds.

FACTS

Jessie Cole was in the course and scope of his employment with Bellwood

Water Systems when he was involved in an automobile accident with Edith

Breedlove. Mr. Cole and his wife filed suit against Ms. Breedlove and her liability

insurer, State Farm Mutual Automobile Insurance Company. State Farm was also

the provider of liability and UM coverage for the Coles. The Coles also sued Arch

as the insurer of Bellwood providing UM coverage. LWCC intervened in the

proceedings seeking reimbursement for all workers’ compensation payments made

to or on behalf of Mr. Cole and to the extent of any additional payments which it

may be presently obligated or might in the future become obligated to pay to or on

behalf of Mr. Cole.

Arch filed a motion for summary judgment against LWCC arguing that

LWCC had no right to reimbursement from Arch’s UM policy for benefits paid to

Mr. Cole. Arch further argued that it is entitled to a dollar-for-dollar credit for any past and future benefits paid under workers’ compensation to Mr. Cole. State

Farm also filed a motion for summary judgment raising similar arguments.

LWCC filed a cross motion for summary judgment arguing that it was

entitled to a credit against future workers’ compensation payments. LWCC did not

oppose the UM insurers’ summary judgment motion on the issue of reimbursement.

Arch and State Farm opposed LWCC’s motion for summary judgment.

A hearing on the motions for summary judgment was held on August 8,

2013. The trial court granted all three motions for summary judgment. Judgment

was signed on September 3, 2013. Arch appealed the judgment of the trial court

arguing that that the trial court erred in granting LWCC’s motion for summary

judgment.1

In its brief, the LWCC has raised issues that may affect the right of Arch to

oppose the LWCC’s motion for summary judgment. We will address those issues

first.

STANDING

The LWCC argues that Arch has no standing to oppose its motion for

summary judgment because the LWCC’s claim for future credit based on the

LWCC’s future obligation to Mr. Cole has nothing to do with Arch. The LWCC

argues that Arch’s policy is not the source of the rights and duties arising out of the

LWCC’s workers’ compensation relationship with Mr. Cole.

Pursuant to La.Code Civ.P. art. 681, an action can only be brought by a

person having a real and actual interest in the matter. In opposing the LWCC’s

motion for summary judgment, Arch is seeking enforcement of its own policy

provisions, specifically that its policy exclusions prohibit the LWCC from

1 State Farm did not appeal the ruling.

2 receiving any benefit whatsoever from payments made to Mr. Cole out of Arch’s

policy. Clearly, Arch has a real and actual interest in enforcing its own policy

provisions. We find no merit to this argument.

AFFIRMATIVE DEFENSE

The LWCC also claims that Arch never affirmatively pleaded the defense

that its policy excluded the right of the LWCC to seek any credit toward future

obligations owed under the Workers’ Compensation Act. The LWCC claims that

Arch has no recourse by appeal for failing to plead an affirmative defense pursuant

to La.Code Civ.P. art. 1005.

The LWCC is correct that exclusions to insurance contracts must be

specifically pleaded as affirmative defenses. Sher v. Lafayette Ins. Co., 07-2441,

07-2443 (La. 4/8/08), 988 So.2d 186. “[A]n affirmative defense raises a new

matter, which assuming the allegations in the petition are true, constitutes a

defense to the action. The new matter must be one, however, that is not raised in

the plaintiff’s petition.” Id. at 204.

In its petition of intervention in paragraph 4, the LWCC claimed both a right

of reimbursement and also a credit for any future payments it might become

obligated to pay. Therefore, the issue of whether the LWCC was entitled to a

credit was raised by the LWCC in its own petition. In response, Arch’s answer to

the LWCC’s petition set forth all affirmative defenses as originally set forth in its

answer to the original petition. In the original petition, Arch specifically pleaded

all provisions of its policy including the terms, conditions, limitations, and

exclusions. As in Sher, we find that the exclusions in Arch’s policy were properly

before the trial court.

3 SUMMARY JUDGMENT

Arch argues that the trial court erred in granting summary judgment and

allowing the LWCC a credit for any payments made by Arch to Mr. Cole, because

the terms of its policy explicitly prohibit a workers’ compensation insurer from

receiving any benefit, directly or indirectly, from Arch’s policy. On the other

hand, the LWCC argues that a claim for reimbursement is statutorily distinct from

a claim for credit or offset, and it is legally entitled under the principles of

solidarity to take a credit against any excess UM recovery by Mr. Cole that the

LWCC will become obligated to pay in the future.

Louisiana Code of Civil Procedure Article 966, which governs summary

judgment proceedings, was significantly amended in both the 2012 and 2013

legislative sessions. These amendments affect the burden of proof elements of the

Article. At the time of this hearing, August 8, 2013, the 2013 version of Article

966 was in effect. After the amendment by 2013 La. Acts No. 391, § 1, Article

966(F)(1)(emphasis supplied) now provides that “[a] summary judgment may be

rendered or affirmed only as to those issues set forth in the motion under

consideration by the court at that time.” Furthermore, Article 966(B)(2) now

provides that evidence considered by the trial court must be “admitted for purposes

of the motion for summary judgment.” Article 966(F)(2) now provides that

“[e]vidence cited in and attached to the motion for summary judgment or

memorandum filed by an adverse party is deemed admitted for purposes of the

motion for summary judgment unless excluded in response to an objection.”

Furthermore, “[o]nly evidence admitted for purposes of the motion for summary

judgment may be considered by the court in its ruling on the motion.” La.Code

Civ.P. art. 966(F)(2).

4 The amendments did not change the burden of proof applicable to a motion

for summary judgment as set forth in Article 966(C)(2):

The burden of proof remains with the movant. However, if the movant will not bear the burden of proof at trial on the matter that is before the court on the motion for summary judgment, the movant’s burden on the motion does not require him to negate all essential elements of the adverse party’s claim, action, or defense, but rather to point out to the court that there is an absence of factual support for one or more elements essential to the adverse party’s claim, action, or defense. Thereafter, if the adverse party fails to produce factual support sufficient to establish that he will be able to satisfy his evidentiary burden of proof at trial, there is no genuine issue of material fact.

“Interpretation of an insurance policy ordinarily involves a legal question

that can be properly resolved by a motion for summary judgment.” Cutsinger v.

Redfern, 08-2607, p. 4 (La. 5/22/09), 12 So.3d 945, 949.

The LWCC argues that, as a solidary obligor, its right to statutory credit

under La.R.S. 23:1102(B) and/or La.R.S. 23:1103(A)(1) exists regardless of any

workers’ compensation exclusion in the Arch UM policy.

In Bellard v. American Cent. Ins. Co., 07-1335 (La. 4/18/08), 980 So.2d 654,

the supreme court addressed the issue of a UM insurer’s entitlement to a credit for

workers’ compensation benefits paid. The supreme court held that by the effect of

the law and the terms of their insuring agreements, both the UM insurer and the

workers’ compensation insurer are solidary obligors because they have coextensive

obligations to reimburse the plaintiff for lost wages and medical expenses incurred

as a result of the injury caused by the tort feasor. The supreme court went on to

recognize there was no right of reimbursement or subrogation in favor of the

employer or workers’ compensation insurer because the terms of the UM insurer’s

policy excluded coverage for the “‘direct or indirect benefit of any insurer or self-

5 insurer under any workers’ compensation, disability benefits or similar law.’” Id.

at 670.

Arch argues that not only is the LWCC not entitled to reimbursement for the

workers’ compensation benefits it has already paid, but it is also not entitled to a

credit for payment of any future benefits because the terms of its policy excludes

such coverage by providing: “This insurance does not apply to . . . . [t]he direct or

indirect benefit of any insurer or self-insurer under any workers’ compensation,

disability benefits or similar law.” Furthermore, coverage for workers’

compensation is specifically excluded as follows: “This insurance does not apply

to any of the following . . . . 3. WORKERS’ COMPENSATION Any obligation

for which the ‘insured’ or the ‘insured’s’ insurer may be held liable under any

workers’ compensation, disability benefits or unemployment compensation law or

any similar law.”

The LWCC relies upon the second circuit case of Tolbrid v. Wyble, 38,969

(La.App. 2 Cir. 12/15/04), 892 So.2d 103, writs denied, 05-444, 05-449 (La.

4/29/05), 901 So.2d 1066, 1067, cert. denied, 546 U.S. 876, 126 S.Ct. 387 (2005).

In Tolbrid, the second circuit recognized that a workers’ compensation insurer

could not recoup benefits paid to a claimant under a UM policy that specifically

excluded reimbursement to the insurer.

In rendering its decision, the second circuit reviewed the law as it had

developed by that time regarding the relationship between a UM insurer and a

workers’ compensation insurer when a third person has injured an employee.

Citing Johnson v. Fireman’s Fund Ins. Co., 425 So.2d 224 (La.1982), and

Travelers Ins. Co. v. Joseph, 95-200 (La. 6/30/95), 656 So.2d 1000, the second

circuit recognized that the supreme court ruled that a UM insurer is a “third

6 person” who is legally liable to pay an employee damages resulting from a work-

related accident so that a compensation insurer may seek reimbursement from the

UM insurer. However, no public policy prevents a UM insurer from expressly

contracting to exclude a compensation insurer’s right to reimbursement in its UM

policy.

The second circuit in Tolbrid then went on to hold that the workers’

compensation insurer was entitled to a future credit for payments made by the UM

insurer. We observe that the specific language in the UM policy is not included in

the opinion, and there is no discussion as to whether the policy specifically

excluded a compensation insurer’s right to a credit in the UM policy.

In Watson v. Funderburk, 98-618 (La.App. 3 Cir. 10/28/98), 720 So.2d 808,

writ denied, 98-2961 (La. 1/29/99), 736 So.2d 834, this court cited with approval

the reasoning in Cleaning Specialists, Inc. v. Johnson, 96-2677, 97-1 (La.App. 4

Cir. 5/21/97), 695 So.2d 562, writ denied, 97-1687 (La. 10/3/97), 701 So.2d 210,

and held that the exclusionary clause in a UM policy that prohibits any “direct or

indirect benefit” precluded a workers’ compensation insurer from seeking a credit

against future compensation benefits. The fourth circuit in Cleaning Specialists

held that “[a] credit against future obligations would certainly be an indirect

benefit, if not a direct one.” Id. at 565. This court also recognized that “solidarity

could be affected by contract.” Watson, 720 So.2d at 810 (citing Fertitta v.

Allstate Ins. Co., 462 So.2d 159 (La.1985).

Once again this court in Landry v. Martin Mills, Inc., 98-1395 (La.App. 3

Cir. 3/3/99), 737 So.2d 58, writ denied, 99-957 (La. 6/4/99), 744 So.2d 625, held

that this same language in a UM policy prevented a self-insured employer from

claiming a credit against a claimant’s future workers’ compensation benefits when

7 the claimant received payment from the UM insurer. The fourth circuit also once

again held this language prevented a compensation insurer from seeking a credit

against future workers’ compensation benefits. Viada v. A & A Mach. Works, Inc.,

05-210 (La.App. 4 Cir. 6/15/05), 914 So.2d 1113, writs denied, 05-1838, 05-1902

(La. 3/10/06), 925 So.2d 506.

It is important to note that a different panel of the second circuit in Tommie’s

Novelty v. Velasco, 37,924, 37,925 p. 7 (La.App. 2 Cir. 2/26/04), 868 So.2d 962,

966, did specifically address exclusionary language stating that UM coverage did

not apply to “[t]he direct or indirect benefit” of any workers’ compensation insurer.

That panel, including one judge who authored Tolbrid, 892 So.2d 103, held that

this exclusion applied to compensation already paid as well as to any future

compensation payable by the compensation insurer.

The first circuit has also held that this specific exclusionary language

precluded a workers’ compensation insurer’s right to claim a future credit as well

as a reimbursement. Bergeron v. Williams, 99-886, 99-887 (La.App. 1 Cir.

5/12/00), 764 So.2d 1084, writ denied, 00-1697 (La. 9/15/00), 768 So.2d 1281.

The first circuit concluded that the right to a future credit is a benefit to a

compensation insurer. Citing Travelers Insurance Company, 656 So.2d 1000, the

first circuit noted that “the supreme court emphasized the strong public policy

supporting full recovery for innocent automobile accident victims by making UM

coverage available when they are injured by impecunious tortfeasors, as well as the

importance of Louisiana Civil Code principles establishing freedom to contract on

all matters not forbidden by law.” Bergeron, 764 So.2d at 1089.

Finally, the supreme court once again in Cutsinger v. Redfern, 08-2607 (La.

5/22/09), 12 So.3d 945, reinforced its previous holdings that there are no statutory

8 provisions or policy considerations that preclude a UM insurer from contracting to

exclude liability for compensation reimbursement or subrogation even though it

means that the plaintiff would receive a double recovery. Relying on the language

in the UM policy, the supreme court held that the UM insurer could reduce the UM

benefits by the amount of workers’ compensation benefits paid to the insured.

We find in the present case that the policy language contained in the UM

policy specifying that the UM coverage does not extend to the “direct or indirect”

benefit of the workers’ compensation insurer precludes the LWCC from claiming a

credit for future workers’ compensation benefits payable.

For the above reasons, the September 3, 2013 judgment of the trial court

granting summary judgment in favor of the Louisiana Workers’ Compensation

Corporation is reversed, and we remand this matter for further proceedings. Costs

of this appeal are assessed against the Louisiana Workers’ Compensation

Corporation.

REVERSED AND REMANDED.