McDill v. Utica Mutual Insurance

465 So. 2d 19, 1984 La. App. LEXIS 10308
CourtLouisiana Court of Appeal
DecidedDecember 28, 1984
DocketNo. 83 CA 0970
StatusPublished
Cited by3 cases

This text of 465 So. 2d 19 (McDill v. Utica Mutual Insurance) 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
McDill v. Utica Mutual Insurance, 465 So. 2d 19, 1984 La. App. LEXIS 10308 (La. Ct. App. 1984).

Opinions

SHORTESS, Judge.

This appeal is from a judgment of the trial court which found Utica Mutual Insurance (Utica) liable for its $100,000.00 limit of uninsured/underinsured motorist coverage, and also arbitrary and capricious in failing to pay the uninsured motorist claim. The trial court judgment assessed a 12% penalty and $40,000.00 in attorney fees under La.R.S. 22:658.1

On March 30, 1981, Stanley D. McDill (McDill) and Joseph A. Latino (Latino) were involved in an automobile accident at the intersection of Louisiana Highway 431 and Louisiana Highway 935 in Ascension Parish. McDill was operating a trailer-truck owned by his employer, J.W. Cade, and insured by Utica with $100,000.00 uninsured/underinsured motorist coverage. The automobile driven by Latino was covered by a liability insurance policy issued by Southern Farm Bureau Casualty Insurance Company with a $10,000.00 policy limit. The accident occurred at about 2:45 a.m. and was caused by Latino running a stop sign governing his direction of travel. Following the accident McDill was taken by ambulance to the East Ascension General Hospital Emergency Room where a laceration of his scalp was stitched and x-rays were taken.

Approximately 12 hours after the accident McDill was seen by Dr. Joseph L. Mass. Upon examination 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 spine. 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 and problems with the scalp laceration. At McDill’s April 13, 1981, visit Dr. Mass noted that he had no complaints and was not wearing his collar. On April [21]*2120, 1981, Dr. Mass referred McDill to Dr. John Fraser, an orthopedist, to evaluate his scoliosis and also to discuss clearing 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, but he was ready to return to work.

Dr. Mass next saw McDill on June 13, 1981, at which time McDill complained of a continuous severe headache across the front of his head and pain between his shoulder blades. Dr. Mass continued him on his same medication and ran an EEG.

On November 23, 1981, Dr. Mass saw McDill for the last time. McDill complained of having severe back pain for the past five days. Dr. Mass took some x-rays of the lower back, which were normal, and put McDill through some maneuvers which indicated the possibility of a herniated disc. He then referred McDill to Dr. Andrew Kucharchuk, an orthopedic surgeon.

On December 2, 1981, Dr. Kurharchuk saw McDill for the first time as a referral from Dr. Mass. McDill at that time complained of excruciating low back pain. After a physical examination, Dr. Kucharchuk concluded McDill had a disc problem. Dr. Kucharchuk had McDill admitted to Our Lady of the Lake Hospital on December 14, 1981, for a myelogram and definitive treatment. Dr. Kucharchuk 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 Twenty-third Judicial District Court. This suit was subsequently settled for Southern Farm Bureau’s $10,000.00 policy limit on June 11, 1982. McDill reserved all rights against Utica.

On March 12, 1982, McDill filed suit against Utica for the $100,000.00 underin-sured motorist coverage. . McDill also sought penalties and attorney fees alleging Utica was arbitrary and capricious in failing to pay the policy limits.

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

After trial on the merits, the jury found McDill free of contributory negligence and awarded $250,000.00 in damages.

The trial judge found Utica’s refusal to pay to be arbitrary and capricious and assessed a penalty of 12% on the total amount of the loss and $40,000.00 in attorney fees. It is from this judgment by the trial judge that Utica appeals, arguing that its refusal to pay cannot be found arbitrary and capricious under La.R.S. 22:658 because it never received satisfactory proof of loss as required by that statute.

La.R.S. 22:658 applies to an “uninsured” or “underinsured” motorist claim. Hart v. Allstate Insurance Company, 437 So.2d 823 (La.1983). A claimant for penalties and attorney fees under La.R.S. 22:658 has the burden of proving that the insurer failed to pay the claim within 60 days after receiving “satisfactory proofs of loss” of the claim, and that the insurer was arbitrary, capricious or without probable cause in failing to pay. A “satisfactory proof of loss” within the meaning of La.R.S. 22:658 is that which is sufficient to fully apprise the insurer of the insured’s claim. Hart, 437 So.2d at 828. To establish satisfactory proof of loss under an uninsured motorist claim, the insured must establish that the insurer received sufficient facts to fully apprise the insurer that the owner or operator of the other vehicle involved in the accident was uninsured or underinsured, that he was at fault, that such fault gave rise to damages and the extent of those damages. Hart, 437 So.2d at 828. The parties stipulated 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 $25,000.00, lost [22]*22wages of $300,000.00, and personal injury damages of $600,000.00. Our question here becomes, then, whether during the course of the proceedings Utica received from McDill sufficient information to constitute “satisfactory proofs of loss” under the uninsured motorist policy. If Utica did, but did not make payment within 60 days, and is found to have been arbitrary and capricious, then an award of penalties and reasonable attorney fees is proper.

On March 26, 1982, counsel for Utica wrote a letter to counsel for McDill and requested, inter alia, copies of all medical bills and medical reports, lost wage verification, and a copy of the police report.

On April 6, 1982, counsel for McDill sent a letter to counsel for Utica. It claimed to contain “all of the medical which I have in the file to date,” and stated that co-counsel “has further verified that McDill did undergo disc surgery.” This letter also purported to transfer a copy of the police report. However, there is no evidence in the record to show what, if anything, was attached. We note that even if the claims made in this letter had been proven at trial, same would not necessarily satisfy McDill’s burden; the statute demands “satisfactory proof,” not “everything in the file.” Likewise, an insurer cannot be required to rely upon its insured’s unsupported assertion that co-counsel has “verified” the insured’s surgery.

On August 4, 1982, Utica took the discovery deposition of McDill. McDill testified that he was presently employed as a truck driver and had been so employed since March 4, 1982, when released by Dr.

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Related

McDill v. Utica Mut. Ins. Co.
475 So. 2d 1085 (Supreme Court of Louisiana, 1985)
McDill v. Utica Mutual Insurance Co.
467 So. 2d 1123 (Supreme Court of Louisiana, 1985)

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465 So. 2d 19, 1984 La. App. LEXIS 10308, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcdill-v-utica-mutual-insurance-lactapp-1984.