McDill v. Utica Mut. Ins. Co.

475 So. 2d 1085, 1985 La. LEXIS 9224
CourtSupreme Court of Louisiana
DecidedSeptember 10, 1985
Docket85-C-0610
StatusPublished
Cited by192 cases

This text of 475 So. 2d 1085 (McDill v. Utica Mut. Ins. Co.) is published on Counsel Stack Legal Research, covering Supreme Court of Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McDill v. Utica Mut. Ins. Co., 475 So. 2d 1085, 1985 La. LEXIS 9224 (La. 1985).

Opinion

475 So.2d 1085 (1985)

Stanley D. McDILL,
v.
UTICA MUTUAL INSURANCE COMPANY.

No. 85-C-0610.

Supreme Court of Louisiana.

September 10, 1985.

*1087 Paul H. Due, Charles William Roberts, Due, Dodson, deGravelles, Robinson & Caskey, Baton Rouge, Calvin C. Fayard, Jr., Fayard, Morrison & Kuhn, Denham Springs, Joseph H. Simpson, Simpson & Schwartz, Amite, for plaintiff-applicant.

Robert E. Kerrigan, Jr., Melanee A. Gaudin, Deutsch, Kerrigan & Stiles, New Orleans, for defendant-respondent.

BLANCHE, Justice.

On March 30, 1981, plaintiff, Stanley D. McDill, age 26, was involved in a motor vehicle accident with Dale M. Latino at the intersection of Louisiana Highways 935 and 431 in Ascension Parish. McDill was operating a trailer-truck owned by his employer, J.W. Cade, and insured by Utica Mutual Insurance Company. The policy provided $100,000 uninsured/underinsured motorist coverage. The 1974 Grand Prix automobile driven by Latino was covered by a liability insurance policy issued by Southern Farm Bureau Casualty Insurance Company with only an applicable $10,000 policy limit. The accident occurred at about 2:45 a.m. and was caused by 17 year old Latino who ran a stop sign governing his direction of travel. McDill was hauling 23 yards of sand when Latino's car struck the trailer-truck just behind the cab. The moment the truck was hit, it caught fire. In an effort to avoid the collision, McDill pulled his rig to the right, lost control and had his truck flip over in the ditch. He managed to crawl through the windshield of the cab. Following the accident, McDill was taken by ambulance to the East Ascension General Hospital Emergency Room where a triangular laceration of his scalp was stitched and x-rays were taken of his neck and upper back.

Approximately 12 hours after the accident, McDill was seen by his family doctor, Dr. Joseph L. Mass. He complained of soreness in his neck and ribs. Dr. Mass found in addition to the laceration on his scalp, a large abrasion over his right upper back, a large bruise on his right thigh and marked congenital scoliosis of the upper spine. Dr. Mass concluded that McDill took a significant amount of trauma to the head at that time. He prescribed antibiotics and a soft cervical collar. Dr. Mass saw McDill again on April 2 and 9, 1981, noting only tenderness of his right lower ribs, soreness of his neck and problems with his scalp laceration.

On April 20, 1981, Dr. Mass referred McDill to Dr. John Fraser, a orthopedist in Baton Rouge, to evaluate his scoliosis and clear him to return to work. After examining McDill on May 2, 1981, Dr. Fraser reported that McDill had "neck and back" complaints and had probably suffered a neck strain secondary to the accident. The doctor concluded, however, that he was ready to return to work.

McDill stated that his back had always bothered him after the accident but since he had so much time off, he had to go back to work to pay the utility and grocery bills for his wife and three children. McDill got the same type job, hauling sand and gravel for Raymond McMorris. McDill had a good reputation with Mr. McMorris as a good and steady worker. Because McMorris *1088 knew McDill's back was giving him problems, all he was required to do was drive and occasionally grease the truck. McDill was not to change tires or do any heavy lifting. McDill developed severe headaches which, together with his back pains, forced him to return to Dr. Mass on June 13, 1981. McDill stated that he had never had any significant headache problems prior to the accident which, unlike the present situation, could not be relieved by taking aspirin. Dr. Mass' impression was that he had post-traumatic headache. He was also complaining of pain between his shoulder blades. Dr. Mass continued him on his same medication and ran an EEG.

Dr. Mass did not see Mr. McDill again until November 23, 1981. McDill complained of having severe back pain for five days. This was eight months after the accident. According to Dr. Mass, McDill was in marked distress. He described his pain as radiating down both legs. Some maneuvers indicated that he might have a herniated disc. X-rays of McDill's lower back were taken for the first time. They were evaluated as normal by Dr. Mass. However, he believed that this did not really mean anything because x-rays would not show a herniated or ruptured disc. He then referred McDill to Dr. Andrew Kurcharchuk, an orthopedic surgeon.

On December 2, 1981, Dr. Kurcharchuk saw Mr. McDill for the first time. He was complaining of excruciating low back pain. After examining his patient, Dr. Kurcharchuk concluded he had all of the classic signs of a herniated disc at the L-5/S-1 level. The doctor had McDill admitted to Our Lady of the Lake Hospital in Baton Rouge on December 14, 1981, for a myelogram and definitive treatment. Dr. Kurcharchuk referred McDill to a neurosurgeon, Dr. George Lohmann, who did the myelogram and removed a ruptured disc on December 16, 1981.

McDill initially instituted suit against Latino and Southern Farm Bureau in the 23rd Judicial District Court. This suit was subsequently settled for the $10,000 policy limit on June 11, 1982. McDill reserved all rights against Utica.

On March 12, 1982, McDill filed suit against Utica for the $100,000 underinsured motorist coverage. McDill also asked to recover penalties and attorney's fees in the event that Utica arbitrarily or without just cause failed to pay or tender to plaintiff either the full amount of the available policy limits, or alternatively, the amount which it would undisputedly owe considering the nature of plaintiff's injuries and damages, the absence of any issue of liability herein and the limited amount of available liability insurance coverage.

It also had been determined that McDill's employer at the time of the accident was without worker's compensation coverage and in the process of filing for bankruptcy.

Utica answered alleging that McDill was contributorily negligent and that it could not be held liable for penalties and attorney's fees under La.R.S. 22:658[1] because it never received "satisfactory proofs of loss". Utica requested a jury trial on all *1089 issues except the question of penalties. The parties later stipulated that this issue would be decided by the trial judge.

The parties agreed that the first notice Utica was given of the claim was the filing of suit on March 12, 1982, alleging that McDill had medical expenses of $25,000, lost wages of $300,000 and personal injury damages (including permanent residual disability, pain and suffering and mental anguish and distress) of $600,000.

After trial on the merits, the jury found McDill free of contributory negligence and awarded $250,000 in damages.

The trial judge found Utica's refusal to pay to be arbitrary and capricious and assessed a 12% penalty on the total amount and $40,000 in attorney's fees.[2]

The five judge panel of the appellate court, 465 So.2d 19, voted four to one to reverse, holding that "McDill did not satisfy the statutory and jurisprudential requirements of submitting `satisfactory proofs of loss' to Utica of his legal entitlement to damages and the extent of those damages." This finding resulted from an examination of the correspondence between plaintiff and defendant. What concerned the appellate court was the absence of anything tending to establish the extent of plaintiff's damages, an objective legal cause for the surgery or the cost of the surgery.

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Cite This Page — Counsel Stack

Bluebook (online)
475 So. 2d 1085, 1985 La. LEXIS 9224, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcdill-v-utica-mut-ins-co-la-1985.